乳腺导管原位癌的钼靶X线表现与病理对照研究

The comparison of mammographic and pathologic features in ductal carcinoma in situ

目的 分析乳腺导管原位癌 (DCIS)的钼靶X线表现 ,并分析其与病理亚型间的相关性 ,为临床选择治疗方法提供参考。方法 经手术、病理证实的乳腺导管原位癌 2 1例和原位癌伴微浸润8例 ,观察钼靶X线表现 ,并与病理分型、分级对照。结果 (1)单纯簇状微钙化表现 2 0例 ,钙化伴块影 3例 ,单纯软组织块影表现 4例 ,乳头内陷伴乳头后大导管增粗和钼靶表现阴性各 1例。 (2 ) 2 3例钙化表现者 ,分布呈V形 7例、圆形 8例、不规则形 5例、某一象限内多个分散分布的小簇状钙化 3例。(3)从乳头向深部的长条状肿块 1例、圆形肿块 3例。(4)线样分支状钙化易出现在粉刺型 (7/ 9)高核级 (6 / 9)DCIS中 ;颗粒点状钙化易出现在非粉刺型 (11/ 12 )低核级 (11/ 12 )DCIS中。 2组差异有非常显著性意义 ,P =0 0 0 2和P =0 0 0 9(χ2 检验 ,Fisher′s精确算法 )。结论 DCIS的钼靶X线表现有一定特征 ,与基于分子生物改变为基础的病理分型、分级密切相关 ,在一定程度上可为临床治疗方法的选择提供参考。

Objective To analyze the mammographic features of ductal carcinoma in situ (DCIS) of the breast and the correlation between the mammographic and pathologic findings, and try to provide clinical criteria for selecting patients for appropriate local treatment. Methods A retrospective study was performed to analyze the mammographic features and to correlate the mammographic and pathologic findings in 29 consecutive cases of DCIS including 8 cases of DCIS associated with small invasive foci. Results (1)There were various features in mammograms of DCIS, including cluster microcalcifications (20 cases), ill defined mass with calcifications (3 cases), mass (4 cases), nipple retraction associated with big ductal dilatation (1 case), and normal mammogram (1 case). (2)The shape of the calcification cluster distributed as V shaped in 7 cases, round in 8 cases, irregular in 5 cases, and scattered as many small areas in one quadrant in 3 cases.(3)1 lesion appeared as strip from the deep aspect of the breast to the nipple, and 3 masses were round. (4)The comedo subtype (7/9) and the high grade nuclei of DCIS (6/9), correlating with poor prognosis, were more likely to be accompanied by linear and branching calcification. Noncomedo DCIS (11/12) and low grade nuclei (11/12) were more likely to be associated with granular and punctate calcification when microcalcification were seen on mammogram. There was statistically significant difference between the two groups with P =0.002 and P =0.009 respectively (Chi square test, Fisher′s exact method). Conclusion The mammographic findings of DCIS were characteristic. They were closely associated with the pathologic features that were correlated with the biomolecular findings. To some extent, the choice of treatment could be based on these mammographic findings.