乳腺癌超声分型与病理分型关系的研究

Study on relationship between sonographic types and pathology of breast cancer

目的探讨乳腺癌超声分型与病理组织学分型的关系及其临床意义。方法对207例术后病理证实为乳腺癌患者的术前彩色多普勒超声声像图进行分型并与病理分型对照,分析各型超声特点及其与病理诊断符合率。结果207例乳腺癌患者中超声发现局灶性病变203例,根据声像图表现分为5型:Ⅰ型(团块型)158例,病理为浸润性癌155例(98.1%),早期浸润性癌3例,超声与病理诊断符合率为98.1%(155/158);Ⅱ型(结节型)23例,病理为浸润性癌18例,早期浸润性癌4例和原位癌1例,超声与病理诊断符合20例(8.7%);Ⅲ型(导管型)12例,病理为浸润性导管癌8例,原位癌4例,超声与病理诊断符合6例(50%);Ⅰ型与Ⅱ型、Ⅱ型与Ⅲ型超声与病理诊断符合率比较差异有统计学意义(P<0.05);Ⅳ型(囊样型)4例,病理诊断为原位癌1例,浸润性导管癌3例,超声与病理诊断符合3例;Ⅴ型(弥漫型)6例,病理诊断早期浸润性癌1例,浸润性导管癌5例,超声与病理诊断符合4例。余4例超声未见局灶性病变未予分型。207例乳腺癌超声与术后病理符合率为90.8%(188/207)。超声对乳腺癌病灶内微小钙化灶显示率为39.1%(81/207),其中以导管型居多(6/12)。结论乳腺癌的超声分型与病理分型密切相关;导管型声像图为乳腺癌的不典型声像之一。微小钙化灶是超声诊断导管型乳腺癌的重要征象。

Objective To probe the relationship between typing according to color Doppler ultrasound and histopathology of breast cancer and to assess the clinic significance. Methods Preoperative ultrasonography in 207 cases with breast cancer were categorized. The relationship between the sonographic types and the pathology, and the diagnostic accuracy of ultrasonography correlated to the pathology were analyzed. Results According to their different ultrasonographic appearances, of the 207 cases, 203 with focuses of breast cancer were divided into five types: Type I-Lump Type in 158 cases, of which 155 cases were with infiltrative carcinoma(IC) and 3 cases with early infiltrative carcinoma(EIC) in pathology, and the concordance rate was 98.1%(155/158); Type Ⅱ-Nodal Type in 23 cases, 18 cases with IC and 4 cases with EIC and one with carcinoma in situ(CIS), and the concordance was 87.0% (20/23); Type Ⅲ-Ductal Type in 12 cases, 8 cases with infiltrative ductal carcinoma(IDC) and 4 cases with CIS , and the concordance rate was 50% (6/12). There was statistically difference in the diagnostic accuracy of ultrasound both between TypeⅠ and Ⅱ and between Type Ⅱand Ⅲ (87.0%, all P<0.05). Type IV-Cystiform Type in 4 cases, one with CIS and 3 cases with IDC, and the coordance was 3 cases. Type V-Diffuse Type in 6 cases, one with EIC and 5 cases with IDC , and the concordance was 4/6. Nondescript was in 4 cases. Of the 207 cases, 188 were diagnosed as malignant tumors on ultrasound and the total concordance rate with pathology was 90.8%(188/207). The detection rate of microcalcification within lesions on ultrasound was 39.1%(81/207) and it was the highest in Ductal Type (6/12).Conclusions There was a close relation between sonographic types and pathology of breast cancer. The ultrasonographic pattern of Ductal Type is one of atypical signs of breast cancer in ultrasound. Microcalcification is an important feature for the ultrasound diagnosis of Ductal Type.