美国医学超声学会乳腺超声检查实践指南

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美国医学超声学会乳腺超声检查实践指南TheAmericanInstituteofUltrasoundinMedicine(AIUM)isamultidisciplinaryassociationdedicatedtoadvancingthesafeandeffectiveuseofultrasoundinmedicinethroughprofessionalandpubliceducation,research,developmentofguidelines,andaccreditation.Topromotethismission,theAIUMispleasedtopublish,incollaborationwiththeAmericanSocietyofBreastSurgeons(ASBS),thisupdatedAIUMPracticeGuidelineforthePerformanceofaBreastUltrasoundExamination.Weareindebtedtothemanyvolunteerswhocontributedtheirtime,knowledge,andenergytobringingthisdocu-menttocompletion.美国医学超声学会是一个通过对指南的专业的大众宣传、研究和发展及资格认证，致力于推进超声在医学领域的安全、有效地应用的跨学科的组织。为了推进这个目标，我们很高兴与美国乳腺外科医生学会合作，使美国医学超声学会乳腺超声检查实践指南得以更新。感谢许多为这个文件的完成献出时间、知识和精力的志愿者们。TheAIUMrepresentstheentirerangeofclinicalandbasicscienceinterestsinmedicaldiagnosticultrasound,and,withhundredsofvolunteers,theAIUMhaspromotedthesafeandeffectiveuseofultrasoundinclinicalmedicineformorethan50years.Thisdocumentandotherslikeitwillcontinuetoadvancethismission.美国医学超声学会展示临床和基础医学感兴趣的超声诊断的全部范围，同时在数以百计的志愿者的努力下，美国医学超声学会已经使超声在临床得以安全、有效应用50多年。这份指南及其它指南将会继续推进这个目标。PracticeguidelinesoftheAIUMareintendedtoprovidethemedicalultra-soundcommunitywithguidelinesfortheperformanceandrecordingofhigh-qualityultrasoundexaminations.TheguidelinesreflectwhattheAIUMconsiderstheminimumcriteriaforacompleteexaminationineachareabutarenotintendedtoestablishalegalstandardofcare.AIUM-accreditedpracticesareexpectedtogenerallyfollowtheguidelineswithrecognitionthatdeviationsfromtheseguidelineswillbeneededinsomecases,dependingonpatientneedsandavailableequipment.Practicesareencouragedtogobeyondtheguidelinestoprovideadditionalserviceandinformationasneededbytheirreferringphysiciansandpatients.美国医学超声学会的实践指南旨在为医学超声团体提供完成和记录高质量超声检查的指导方针。指导方针反应美国医学超声学会考虑到的在每个区域检查中需要的最低条件，而不是试图设立一个法定的注意标准。美国医学超声学会认可的做法是，在通常情况下遵循指南，并承认在某些情况下需要违背指南，这取决于病人的需要和设备条件。鼓励进行超过指南的实践，提供相关医生和病人需要的额外的服务和信息。I.Introduction简介Thisguidelinehasbeendevelopedtoprovideassistancetopractitionersperformingsonographicexaminationsofthebreast.Whensonographyisusedasguidanceforinterventionalproceduresorbiopsy,guidelinesthataddressthosespecificsituationsshouldbeconsulted. 这个指南已经改进了，为乳腺超声检查的操作者提供帮助。随着超声检查被用于介入操作和活组织检查的引导，服务于这些特殊情况的指南就应该被商讨。II.Indications适应症Appropriateindicationsforbreastsonographyinclude:1.Identificationandcharacterizationofpalpableabnormalitiesandfurtherevaluationofclinicalandimagingfindings.2.Guidanceforinterventionalprocedures.3.Evaluationofproblemsassociatedwithbreastimplants.4.Treatmentplanningfortherapy.Breastsonographyistheinitialimagingtechniqueforevaluatingpalpablemassesinwomenyoungerthan30yearsandinlactatingandpregnantwomen.Althoughtheefficacyofsonographyasascreeningstudyforoccultmassesisanareaforresearch,atthistimesonographyisnotconsideredaprimaryscreeningmodalityinotherpopulations.乳腺超声检查的适应症包括：1、  确认及描述明显的异常，进一步评估临床和图像所见。2、  介入操作的引导。3、  乳房植入物相关问题的评估。4、  治疗计划的制定。乳腺超声检查是评估小于30岁的女性、哺乳期女性及孕妇的可见包块的首选影像技术。虽然超声检查作为隐性包块的筛查术的功效是研究的一个领域，但是目前超声检查在其它人群并不被认为是主要筛查形式。III.QualificationsandResponsibilitiesofPersonnel相关人员的任职要求及职责SeetheAIUMOfficialStatementTrainingGuidelinesforPhysiciansWhoEvaluateandInterpretDiagnosticUltrasoundExaminationsandtheAIUMStandardsandGuidelinesfortheAccreditationofUltrasoundPractices.详见美国医学超声学会内科医生培训指南官方声明，其中评估及解释了诊断超声检查及美国医学超声学会对超声实践的认证标准和指导方针。IV.WrittenRequestfortheExamination检查申请的书写Thewrittenorelectronicrequestforasonogramshouldprovidesufficientinformationtoallowforappropriateperformanceandinterpretationoftheexamination.Therequestfortheexaminationmustbeoriginatedbyaphysicianorotherappropriatelylicensedhealthcareproviderorundertheirdirection.Theaccompanyingclinicalinformationshouldbeprovidedbyaphysicianorotherappropriatehealthcareproviderfamiliarwiththepatient’sclinicalsituationandshouldbeconsistentwiththerelevantlegalandlocalhealthcarefacilityrequirements.手写的或电子的超声检查申请应当提供充分的信息以规定检查的合适表现和解释。检查申请必须出自于内科医生或被恰当地许可的医疗工作者，或者在他们的指导下（完成）。相关临床信息应该由内科医生或其他恰当的熟悉患者临床情况的医疗工作者，同时应当符合相关法律及当地的医疗设备条件。 V.SpecificationsoftheExamination技术规范A.LesionCharacterizationandTechnicalFactors病变描述和技术因素1.Thebreastsonogramshouldbecorrelatedwithmammographicandotherappropriatebreastimagingstudiesaswellaswithaphysicalexaminationdirectedtotheareainquestion.Ifsonographyhasbeenperformedpreviously,thecurrentexaminationshouldbecomparedwithpriorsonograms,asappropriate.Alesionoranyareaofthebreastbeingstudiedshouldbeviewedin2perpendicularprojections;1viewisinsufficient.乳腺声像图应当与乳腺摄影、其他乳腺成像结果及可以指示问题区域的体格检查相结合。如果（患者）以前进行过超声检查，那么这次检查应该适当地和以前的检查进行对比。病变或其它检查区域应当分别在两个垂直切面进行观察，一个切面是不够的。2.Atleast1setofimagesofalesionshouldbeobtainedwithoutcalipers.Themaximaldimensionsofamassshouldberecordedinatleast2dimensions.一个病变至少应该采集一张没有测径器的图像。肿块的最大尺寸应当测量两次。3.Theimagesshouldbelabeledastotherightorleftbreast,thelesion’slocation,andtheorientationofthetransducerwithrespecttothebreast(eg,transverseorlongitudinalandradialorantiradial).Thelocationofthelesionshouldberecorded;thequadrantshouldbespecified,orthelocationcanbeindicatedbyusingclocknotationanddistancefromthenippleorshownonadiagramofthebreast.Severalsonographicfeaturesmaybehelpfulincharacterizingbreastmasses.Thesefeaturesshouldbenoted:size,shape,echogenicity,marginfeatures,orientation,andattenuation(eg,shadowingorenhancement).FeaturesmayalsobedescribedusingtheAmericanCollegeofRadiologyBreastImagingReportingandDataSystem(BI-RADS)lexicon.图像应表明左乳或右乳、病变的位置和探头相对于乳房的方位（例如：横切或纵切及径向切面或者非径向切面）。病变的位置应当被描述：应该指明（病变）所在象限，或者可以用时钟表示法指示病变位置，说明至乳头的距离或者在乳房示意图上标明。许多超声特征可能会有助于对乳腺肿块的认识。这些特征应该被记录：大小、形状、回声反射性、边界、方位和衰减（例如：减弱或增强）。可应用美国放射学会的乳腺影响报告和数据系统的专业词汇对特征进行描述。4.Masscharacterizationwithsonographyishighlydependentontechnicalfactors.Properdepth,gain,andfocalzonesettingsshouldbeoptimizedtoobtainhigh-qualityimages.Thepatientshouldbepositionedtominimizethethicknessoftheportionofthebreastbeingevaluated.Forevaluationofsuperficiallesions,astandoffdeviceoruseofathicklayerofgelmaybehelpful.超声成像对肿块的认识很大程度上取决于技术因素。应将深度、增益和增益设置到最佳以得到高质量的图像。病人的体位应使被观察部分的厚度最小。观察表浅的病变时，支架设备或一层厚的凝胶可能会有帮助。B.GuidanceofInterventionalProcedures介入操作的引导1.Interventionalproceduresthatcanbeperformedwithsonographicguidanceincludebutarenotlimitedtocystaspirations,presurgicalneedlehookwirelocalization,therapeuticprocedures,andfine-needle,core,orvacuum-assistedbiopsy.介入可以在超声引导下进行的包括但不限于以下方面：囊肿穿刺，术前针钩线定位、治疗过程，细针、带芯或真空负压细针穿刺活检。2.Afullsonographicexaminationoftheareaofinterestshouldbecompletedbeforetheprocedure. 应该在（介入）操作之前对感兴趣区进行一次全面的超声检查。3.Thereisnosinglecorrectmethodforaccomplishinginterventionalprocedureswithsonographicguidance.Bothafreehandtechniqueandtheuseofatransducerwithaneedleguidearesuitableforbreastinterventions.Thetypeofequipmentonhandandtheexperienceofthephysicianperformingtheprocedurewilldeterminethetechnique.在超声引导下完成介入操作没有唯一正确的方法。手法和带引导针的探头的应用适于乳腺介入术。仪器的类型和进行（介入）操作的医生的经验将会决定技术水平。4.High-frequencytransducerswithacenterfrequencyof7.0MHzorhigherusedforimagingthebreastaresuitableforguidinginterventionalprocedures.Withthesetransducers,continuousvisualizationofthedevicepathispossible.Dependingonthetransducerconfiguration,thegeometryoftheacousticbeam,andtherouteofdeviceentry,eitherasmallportionofthedevicemaybevisibleasanechogenicfocus,or,ifthedeviceentryisalignedwiththeacousticbeamandnearlyperpendiculartoit,theentiredevicemaybevisible.中心频率7.0MHz或更高频率的高频探头对乳腺的成像适用于介入操作的引导。在探头作用下，设备路径的连续可见变为可能。装置的一个小部分可能发生回波聚焦而可见，或者当装置的进入（方向）与声束平行或几乎垂直时，整个装置都可见，这取决于探头的结构、声波的几何学特性和装置的进入（方向）。5.  Sonographicguidancecanbeusedtoaidininfiltrationofanestheticsaroundthemass.超声引导可被用于引导肿块周围的浸润麻醉。VI.Documentation文件材料Imagesofallimportantfindings,includinginthecaseofinterventionalprocedurestherelationshipofthedevicetothelesion,shouldberecordedonaretrievableandreviewableimagestorageformat.所有重要发现的图像，包括在介入操作时装置和病变的关系，应被记录为可修复及可读的图片格式。A.Officialdocumentationfortheultrasoundimagesshouldincludebutisnotlimitedtothefollowing:正式的超声影像文件材料应包括但不限于以下（方面）：1.Patient’snameandotheridentifyinginformation.病人的姓名和其它识别信息。2.Facility’sidentifyinginformation.仪器识别信息。3.Dateofsonographicexamination.超声检查时间。4.Imageorientationwhenappropriate.适当的图像说明。B.Thephysician’sreportofthesonographicfindingsshouldbeplacedinthepatient’smedicalrecord.医生的超声所见报告应当放入病人的病历。C.Retentionofthebreastsonogramsshouldbeconsistentwiththepoliciesforretentionofmammogramsincompliancewithfederalandstateregulations,localhealthcarefacilityprocedures,andclinicalneeds.对乳腺超声影像的留存应与乳腺X线照片的留存政策一致，遵照联邦政府或州的规章、地方性医疗设备规程和临床需要。D.ReportingshouldbeinaccordancewiththeAIUMPracticeGuidelineforDocumentation ofanUltrasoundExamination.报告应当符合美国医学超声学会关于超声检查文件材料的指南。VII.EquipmentSpecifications设备规格Breastsonographyshouldbeperformedwithahighfrequencylineararraytransduceroperatingatacenterfrequencyofatleast7MHz.Equipmentpermittingelectronicadjustmentoffocalzoneisrecommended.Ingeneral,thehighestfrequencycapableofadequatepenetrationtothedepthofinterestshouldbeused.Forevaluationofsuperficiallesions,astandoffdeviceoruseofadditionalgelmaybehelpful.乳腺超声检查需要在中心频率至少7MHz的高频线阵探头下进行。推荐使用允许电动调节聚焦区域的设备。总的来说，应该应用足够到达感兴趣区深度的最高频率。对于浅表病变的观察，支架设备或附加凝胶的应用可能会有帮助。VIII.QualityControlandImprovement,质量控制和改善Safety,InfectionControl,andPatientEducationConcernsPoliciesandproceduresrelatedtoquality,patienteducation,infectioncontrol,andsafetyshouldbedevelopedandimplementedinaccordancewiththeAIUMStandardsandGuidelinesfortheAccreditationofUltrasoundPractices.EquipmentperformancemonitoringshouldbeinaccordancewiththeAIUMStandardsandGuidelinesfortheAccreditationofUltrasoundPractices.安全性、感染控制和病人教育相关策略和过程与（检查）质量相关，应当制定和实施与美国医学超声学会的标准和关于超声实践认证指南符合的病人教育、感染控制和安全性（规定）。Acknowledgments鸣谢ThisguidelinewasdevelopedbytheAmericanInstituteofUltrasoundinMedicine(AIUM)incollaborationwiththeAmericanSocietyofBreastSurgeons(ASBS).这个指南是美国医学超声学会与美国乳腺外科医生学会合作完成的。