乳腺导管内癌超声声像图特征和临床病理的相关性研究

An analysis of the correlation between sonography and pathology of ductal carcinoma in situ of the breast

目的:回顾性分析乳腺导管内癌常见超声表现,探讨导管内癌超声图像特征和临床病理的相关性。方法:回顾性分析59例乳腺导管内癌(其中21例伴微浸润)超声检查结果,总结导管内癌常见超声声像图特征。根据病灶超声声像图特征,将全部病例分为超声肿块型和超声非肿块型2大类,研究这两类图像特征与患者钼靶、病理分级及ER、PR、CerbB-2、P53、bcl-2表达的相关性。结果:59例导管内癌(DCIS)超声声像图表现多样,31例(52.5%)为肿块型,28例为非肿块型包括:11例(18.6%)导管扩张型,5例(8.5%)微小结节型,4例(6.8%)片状低弱回声型,2例(3.4%)仅见钙化而无其他图像改变,6例(10.2%)超声未见异常。超声肿块型DCIS通常钼靶也多表现为肿块影(67.7%),超声非肿块型DCIS钼靶上以钙化为主要表现(64.3%),组间分布有统计学差异(P<0.01)。超声肿块型组中,高级别DCIS较少,占38.7%,ER、PR阳性率较高,为83.9%和77.4%;超声非肿块型组中,高级别DCIS较多,占67.9%(P=0.02),ER、PR阳性率较低,为53.6%(P=0.01)和46.4%(P=0.01),组间分布均有统计学差异。结论:超声非肿块组DCIS高级别比例和激素受体阴性表达明显高于超声肿块组。DCIS非肿块的超声声像图特征提示肿瘤高级别和激素受体阴性可能性大,间接预示肿瘤分化差、侵袭性强。超声非肿块型可能是DCIS预后不良的指标。

Objective ：To describe the sonographic appearances of ductal carcinoma in situ （DCIS）, and to analyze the correlation between the sonographic appearances and pathologic features. Methods： Records of 59 women with diagnosis of DCIS（ including 21 cases of microinvasive DCIS ） were reviewed retrospectively. According to the sonographic characteristics,59 lesions were classified into two groups：lesions of sonographic mass and of sonographic nonmass. The correlation between the sonographic appearances and mammographic findings, histological features （ such as pathological grade, expression of ER, PR, cerbB - 2, p53, bcl - 2） were analyzed. Results： The sonographic characteristics were masses in 31cases（52.5% ） ,nonmass in 28cases which included dilated ducts in 11 cases（ 18. 6% ）, mini nodules in 5 cases （8.5 % ）, generalized decreased acoustic transmission with ill - defined large regions in 4 （6.8%）. Calcifications were detected as the only finding in 2 cases （3.4%）. No specific features were observed in 6 cases（ 10.2% ）. Mammographic masses were the most common radiologic features of DCIS with sonographic mass （67.7%） while mammographic calcifications were more commonly seen in DCIS with sonographic nonmass （64. 3% ）, and the difference was significant （ P 〈 0.01 ）. In sonographic mass group, 38.7% lesions were high grade DCIS. 83.9% were ER positive and 77.4% were PR positive. In sonographic nonmass group,67.9% lesions were high grade DCIS（P = 0.02） ,53.6% were ER positive （P = 0.01 ） and 46.4% were PR positive. Conclusion： In this study,high grade and negative hormone receptors status were more common in DCIS of sonographic nonmass. DCIS of sonographic nonmass were more likely to be high grade and negative hormone receptors which indicated peorly differentiated tumor cell and aggressive biological behaviour. Sonographic nonmass may be an indicator of poor prognosis in DCIS.