乳腺导管原位癌的钼靶X线表现与病理分级、ER/PR表达的对照研究

Control Study of Molybdenum Target X-ray Features and Pathologic Grading and ER/PR Expression of Breast Ductal Carcinoma in Situ

目的探讨乳腺导管原位癌(ductal carcinoma in situ,DCIS)的钼靶X线特点,并分析其与病理分级、雌激素与孕激素受体(ER/PR)表达的相关性。资料与方法搜集经手术、病理证实的43例单纯性乳腺DCIS,观察其钼靶X线表现,并与病理分级对照。结果 (1)钼靶表现:43例中单纯钙化10例,结构紊乱伴细小钙化5例,肿块伴钙化9例,单纯结构紊乱7例,单纯肿块8例,非对称性致密4例;钼靶X线评估在乳腺影像-报告和数据系统(BI-RADS)分类中2、3类者共12例,其中结构紊乱及非对称性致密者11例。(2)43例中出现钙化者24例,表现为中间性钙化者13例,高度恶性钙化者11例,中间性钙化出现在非高级别组中6例,高度恶性钙化出现在高级别组中11例,两者间差异具有统计学意义(P=0.016)。(3)钼靶表现与病理分级、ER/PR表达的关系:11例非高级别组中,10例ER/PR阳性,6例钼靶表现为结构紊乱伴或不伴有细小钙化,2例表现为非对称性致密;32例高级别组中,14例ER/PR阳性,6例钼靶表现为结构紊乱,2例表现为非对称性致密,ER/PR表达与病理学分级间差异有统计学意义(P=0.018),钼靶表现与病理分级之间差异有统计学意义(P=0.018)。结论 DCIS的钼靶X线表现具有一定特征性,但对结构紊乱伴或不伴有细小钙化及非对称性致密易低估。钼靶X线表现与基于分子生物改变为基础的病理分级密切相关,对患者的预后、临床治疗方法的选择具有参考价值。

Objective To study the molybdenum target x-ray features of breast ductal carcinoma in situ （DCIS）,and the correlationship between the mammographic features and pathologic findings. Materials and Methods A retrospective study of 43 cases with DCIS of breast was performed to explore X-ray features and the correlation of the mammographic features to the pathological findings. Results （1）Molybdenum target x-ray features：pure calcifications in 10 cases,mass with calcifications in 9 cases,architectural distortion with fine calcifications in 5 cases,pure architectural distortion in 7 cases,pure mass in 8 cases,and asymmetry in 4 cases. 12 cases were evaluated in BI-RADS 2 and 3,and 11 of 12 cases appeared in cases of architectural distortion and asymmetry. （2）24 cases with calcifications：There were 13 cases with intermediate concern,suspicious calcifications,and 11 cases with higher probability of malignancy. 6 cases with intermediate concern,suspicious calcifications were included in the non-high-nuclear-grade lesions and 11 cases with higher probability of malignancy were included in the high-nuclear-grade lesions. There was statistical significance between the different pattern of calcification and the different nuclear grade （P=0.016）. （3）Correlation of the mammographic features to pathologic findings and ER/PR expression：10 cases with positive ER/PR appeared in the non-high-nuclear-grade lesions,in which 6 cases showed architectural distortion with or without fine calcifications,2 cases showed asymmetry on mammography. 13 cases with positive ER/PR appeared in the high-nuclear-grade lesions,in which 5 cases showed architectural distortion,2 cases showed asymmetry on mammography. There was statistical significance between the ER/PR expression and pathologic grading （P=0.018） and statistical significance between the mammographic appearance and the pathologic grading（P=0.018）. Conclusion The mammographic appearances of DCIS were characteristic,and the common features of DCIS were the signs of tumor masses,micro-calcifications and asymmetry of breast structures,but the BI-RADS were easily underestimated in the cases of architectural distortion and asymmetry. There were close correlation between the mammographic features and the pathology,so the pre operational mammographic appearances can provide values for the prognosis and the selection of treatment.