钼靶摄片诊断乳腺导管内癌价值的初步探讨

Initial experiences of mammographic diagnosis in breast ductal carcinoma in situ

目的探讨乳腺钼靶摄片对乳腺导管内癌(ductal carcinoma in situ,DCIS)的诊断价值。方法按照病人主诉分组,回顾性分析20例患者、21个经病理证实为DCIS病灶的钼靶影像特征,与病理结果对照研究。结果以触诊乳腺肿物为主诉的9例患者10个病灶中,表现为结节并微小钙化者6例,乳头血性溢液者1例,片状增高密度影2例,另1例患者影像表现阴性,上述后3例病灶行细针穿刺细胞学检查确诊;以腺体增厚为主诉的5例患者中,钼靶表现为腺体结构紊乱,密度不均,其中2例伴微小钙化及乳头溢液,单纯性微小钙化3例;以单纯性乳头溢液为主诉者2例,均伴微小钙化,导管造影示导管局部显影中断或间断显影;以乳腺癌术后复查发现另一侧乳腺单纯性微小钙化灶者2例;1位患者因乳腺脂肪瘤而漏诊。结论钼靶影像学能为DCIS的诊断提供重要依据,尤其对临床检查阴性的患者,乳腺钼靶摄片辅以导管造影及细针穿刺细胞学检查是诊断早期乳腺癌不可或缺的手段。

Objective To evaluate the value of mammographic diagnosis of ductal carcinoma in situ. Methods The patients were divided into groups according to the chief complaints. Retrospective review was performed in 21 DCIS lesions of 20 patients which were confirmed by histopathologic findings. The characteristics of mammography were analyzed correlating with histologic findings. Results Among the 10 lesions of 9 patients＇ group whose chief complaint was soft tissue masses by palpation, six lesions were featured with nodule and micro-calcification on mammography, one lesion was featured with bloody nipple discharge, two lesions were featured with increased density, and the other lesion＇ s mammographic feature was negative. The last three lesions above were diagnosed by fine needle aspiration aytology （FNAC）： Among the group of 5 patients＇ lesions whose chief complaint was local thickness of mammary gland, the mammographic features were structure distortion and local increased density uneven, two of which were accompanied with both micro-calcification and nipple discharge, three of which were featured with micro-calcification only; among the group of two patients whose chief complaint was nipple discharge, the lesions were featured with micro-calcification, and the galactograms showed intra-luminal filling defect or duct cut-off signs, besides these, two patients were diagnosed on mammography featured with micro-calcification when rechecked after mastectomy in the other breast＇ s cancer. One patient was missed diagnosed with large breast lipoma. Conclusion Mammography can provide valuable information for the diagnosis of DCIS, and the galactogram and FANC is necessary, especially for the patients with negative symptom in clinic. The diagnostic accuracy can be improved by mammography diagnosis combination with galactograms and FANC