乳腺髓样癌的超声表现及临床意义

The ultrasonic manifestations and clinical significance of medullary carcinoma of the breast

目的:探讨乳腺髓样癌的超声和病理之间关联性,以便确定超声在区别典型髓样癌(TMC)和非典型髓样癌(AMC)的临床意义。方法:我们回顾性分析了20例确诊为乳腺髓样癌(MC)的组织切片和超声图像。依照严格的组织学分类标准,我们将肿瘤分为TMC和AMC。比较了二者在超声图像和组织学类型之间的关联。结果:20例MC中的8例(40%)确定为TMC,12例(60%)确定为AMC。在超声图像中,8例TMC中有6例(75%)显示了整齐平滑的边缘,而12例AMC却没有此特征。12例AMC中的10例(83%)其超声图像显示为锯齿样边缘,2例(17%)的病灶边缘光滑伴局部不规则。从而发现在TMC和AMC中,其肿瘤边缘变化规律性上具有统计学上的显著意义(P<0.001)使用四格表确切概率法检验。结论:如果超声图像显示了肿瘤锯齿样边缘或病灶边缘光滑伴局部不规则,对诊断AMC有一定的帮助,应对整个肿瘤进行认真的病理学分型,以便正确评估预后,采取正确治疗方案。

Objective： We investigated whether there was a relationslfip between the sonographic and histologic appearances of medullary carcinomas（MC） of the breast to determine whether sonography is helpful in the differentiation of typical and atypical medullary carcinomas（TMC and AMC）. Methods：We retrospectively reviewed the histologic slides and sonograms of 20 patients who had been diag- nosed with medullary carciunoma of the breast. We then classified the carcinoma as typical or atypical based on strict histologic criteria. We also evaluated the relationship between sonographic findings and the histologic reclassification. Results： Eight（40%） of the 20 medullary carcinomas were classified as typical, and 12（60% ） were classified as atypical. On sonography, a smooth outline was visualized in 6 （75%） of the 8 typical medullary carcinomas but in none of the 12 atypical carcinomas. A sawtooth like margin was sonographically visualized in 10 （83%） of the 12 atypical carcinomas, and a focal irregularity in the margin was visualized in 2 （ 17% ） of the 12 atypical carcinomas. Four of the typical medullary carcinomas had posterior enhancement, and 9 of the atypical medullary carcinomas showed retrotumoral shadowing. The difference in tumor-margin regularity between typical and atypical medullary carcinomas was found to be statistically significant （ P 〈 0. 001 ） using the 2-tailed Fisher＇s exact test. Conclusion： To prevent overdiagnosis of medullary carcinoma, a thorough pathologic review of the entire tumor is recommended if sonography showed a sawtooth like margin or a margin with focal irregularity.