三阴性乳腺癌与非特异性肉芽肿性乳腺炎的影像鉴别诊断

Differential diagnosis of imaging findings between patients with triple-negative breast cancer and patients with idiopathic granulomatous mastitis

目的:通过对比三阴性乳腺癌(Triple-negative breast cancer,TNBC)与非特异性肉芽肿性乳腺炎(Idiopathic gran-ulomatous mastitis,IGM)的钼靶X线、超声及MRI表现,旨在加深对二者影像共性及差异的认识,为临床鉴别诊断提供参考。方法:回顾性分析经病理证实的45例TNBC与18例IGM的影像表现,其中所有TNBC与IGM患者均行钼靶X线检查;行超声检查的TNBC 37例,IGM 18例;行MR检查的TNBC 33例,IGM 14例。钼靶X线表现包括:病灶形态、密度、边缘、钙化、有无皮肤增厚及有无腋窝淋巴结肿大。超声表现包括:病灶形态、边界、大小范围、内部回声、腋下等引流区有无淋巴结肿大等。MRI表现包括:肿块的大小、形态、边缘、在T2WI信号强度、肿块强化情况,同时绘制时间-信号增强曲线(Time-signal intensitycurve,TIC)以及在压脂T2WI图像上肿块周围是否有高信号。结果:①钼靶X线表现:TNBC组肿块影占67%(30/45),其中边缘光滑占60%(18/30);非对称性局限致密影占22%(10/45);钙化占9%(4/45);局限性结构扭曲占2%(1/9)。IGM组非对称性局限性致密影占50%(9/18);肿块影占39%(7/18),其中边缘光滑占29%(2/7);局限性结构扭曲占11%(2/18)。②超声表现:TNBC组低回声肿块影占92%(34/37),其中边缘光滑占62%(21/34);腋窝淋巴结肿大占38%(14/37);皮肤增厚占14%(5/37)。IGM组低回声肿块影占89%(16/18),其中边缘光滑占37%(6/16);腋窝淋巴结肿大占17%(3/18);皮肤增厚占22%(4/18)。另外,IGM组病灶分布于乳腺外周区域占56%(10/18)。③MRI表现:TNBC组肿块型占91%(30/33),肿块呈环形强化占67%(20/30),其中边缘光滑占70%(14/20),在T2WI序列肿块周边存在高信号的占85%(17/20),TIC曲线表现为II型或III型,无I型病例。IGM组肿块型占86%(12/14),非肿块型占14%(2/14)。肿块呈环形强化占75%(9/12),其中边缘光滑占11%(1/9),在T2WI序列肿块周边存在高信号占21%(2/9),TIC表现为I型或II型,无III型病例。另2例非肿块型IGM在T2WI序列均为稍高信号,边界欠清,增强后呈局灶样强化。结论:TNBC与IGM影像表现存在重叠性,尤其是二者在MR上均可表现为环形强化的肿块,在压脂T2WI序列肿块内都可出现超高信号,但通过仔细观察病灶的部位、边缘,在压脂T2WI序列肿块周边信号、强化方式及TIC类型等方面,有助于二者的鉴别。

Objective： To analyze the imaging findings of triple-negative breast cancer（TNBC） and to improve the understanding and diagnostic performance of the disease,by comparing it with idiopathic granulomatous mastitis（IGM）.Methods： The imaging findings in 63 randomly assigned women with surgically and pathologically confirmed TNBC（n=45） and IGM（n=18） were retrospectively analyzed.All cases underwent a mammographic examination.An ultrasonic examination was performed in 37 cases of TNBC and 18 cases of IGM.MR examination was performed in 33 cases of TNBC and 14 cases of IGM.The mammographic imaging findings included lesion shape,density,margin,calcification,axillary adenopathy and thickening of the skin.The ultrasound imaging findings included shape,margin,size,echo,axillary adenopathy and thickening of the skin.The MR imaging findings included tumor shape,size,margin and internal enhancement,signal intensity within the tumor as well as peripheral signal intensity on T2-weighted,then the type of time-signal intensity curve（TIC） was analyzed.Results： The results of comparing TNBC group with IGM group showed as follows： ①Mammography imaging findings： mass type accounts for 67%（30/45） in TNBC group and 39%（7/18） in IGM group.Smooth margin of the lesion accounts for 60%（18/30） in TNBC group,while 29%（2/7） in IGM group.②Ultrasound imaging findings： mass type accounts for 92%（34/37） in TNBC group and 89%（16/18） in IGM group.Smooth margin of the lesion accounts for 62%（21/34） in TNBC group,while 37%（6/16） in IGM group.③MR imaging findings： mass type accounts for 91%（30/33） in TNBC group and 86%（12/14） in IGM group.Rim enhancement accounts for 67%（20/30） in TNBC group and 75%（9/12） in IGM group.For the rim enhancement mass type,smooth margin of the lesion accounts for 70%（14/20） in TNBC group,while 11%（1/9） in IGM group;peripheral hyperintense pattern on T2-weighted accounts for 85%（17/20） in TNBC group and 21%（2/9） in IGM group.Conclusion： We believe that through careful observation of the lesion site,shape,edge of the tumor mass and peripheral signal intensity on T2-weighted,enhancement pattern and the TIC types,might be useful for the identification of TNBC and IGM.