乳腺病灶内钙化的超声诊断价值(附136例分析)

Ultrasound differential diagnosis of breast lesion calcification

目的探讨乳腺病灶内钙化的声像特征在病灶良恶性鉴别诊断及预测乳腺浸润性导管癌(IDC)恶性程度中的应用价值。方法应用高频超声检查152个乳腺病灶,观察良恶性乳腺病灶中钙化大小及分布情况。28例IDC标本进行雌激素受体(ER)、孕激素受体(PR)、C-erbB-2癌基因蛋白免疫组织化学染色分析。结果乳腺良恶性病灶均可出现钙化(P>0.05),但良恶性病灶组间比较,钙化的大小及分布特征的差异有统计学意义(P<0.05);不同钙化声像的IDC之间免疫组化指标阳性表达率的差异无统计学意义(P>0.05);以簇状分布的微钙化作为乳腺恶性病灶的评判指标,其诊断的准确率、特异度和阳性预测值分别为77%、92%和90%。结论乳腺病灶内簇状分布的微钙化可作为超声诊断乳腺恶性病灶的可靠指标,但是能否反映IDC的恶性程度及其侵袭力有待于进一步研究。

Objective To explore the ultrasonographic features of breast lesion calcification for distinguishing benigh from malignant breast lesions and for predicting the malignant degree of breast infiltrating ductal carcinoma （IDC）. Methods A total of 152 breast lesions were detected with high-frequency ultrasound. The size and distribution of calcification in the breast lesions were observed carefully. ER, PR and C-erbB-2 of IDC were determined in 28 cases with IDC. Results Calcifications were detected in both malignant and benign breast lesions groups （P〉0.05） and showed statistically significant difference in the size and the distribution between the groups （P〈0.05）. The positive expression rate of ER, PR, C-erbB-2 had no statistically significant difference between the groups, but presented different features of calcification in IDC. Regarding the clustered miscrocalcification as the ultrasonic diagnostic criterion of malignant breast lesions, the accuracy, specificity and positive predictive value were 77 %, 92 %and 90 %, respectively. Conclusions The results indicate that the clustered microcalcification may be regarded as the reliable criterion of ultrasonic diagnosis in the malignant breast lesions. However further study is to be done for proving whether they are correlated to the malignancy degree and invasiveness of IDC.