囊实性乳腺癌的影像学及临床病理学特征

Analysis of imageology appearance and clinical characteristics of the cystic and solid breast carcinoma

目的 分析囊实性乳腺癌的影像学特征及临床病理学特点。方法 回顾经病理证实的26例囊实性乳腺癌的磁共振成像（MRI）及超声等影像学表现，对照术后病理及临床表现进行相关性分析。结果 临床表现：鳞状细胞癌高龄者居多（平均70.1岁），囊内乳头状癌（平均67.7岁）、黏液癌相对较低（平均55.1岁）；鳞状细胞癌生长迅速，囊内乳头状癌及黏液癌相对比较迟缓；鳞状细胞癌多发生在乳头周围（4／5），囊内乳头状癌及黏液癌与其他乳腺癌相似，多发生在乳腺外上象限。鳞状细胞癌肿瘤直径平均值最大（49.6 mm），囊内乳头状癌（35.2 mm）、黏液癌（25.1 mm）次之；鳞状细胞癌较黏液癌及囊内乳头状癌恶性程度高，且易发生淋巴结转移和皮肤浸润；黏液癌及囊内乳头状癌术前穿刺确定诊断的成功率较低，鳞状细胞癌较高。MRI共同点：肿块多为圆形或分叶状，T1WI呈现等-稍高信号，T2WI上显示高信号，增强后均呈环状强化；MRI不同点：黏液癌和鳞状细胞癌边缘粗糙，囊内乳头状癌边缘光整；鳞状细胞癌的囊壁较厚，且不均匀，囊肿内癌的囊内可见乳头状软组织影，增强后均表现为明显强化，黏液癌囊壁均匀，不伴有乳头状成分。超声：较其他乳腺浸润癌囊实性乳腺癌肿瘤内部回声较低，且伴后方回声增强，大部分黏液癌同时有侧方阴影，鳞状细胞癌血流丰富，黏液癌及囊内乳头状癌血流供应较少。结论 囊实性乳腺癌的组织学类型多样，MRI及超声表现具有一定特征性，结合术前穿刺活检及临床表现，能够推测组织学类型及病变范围，对手术方式的选择及指导治疗有着重要的作用。

Objective To analyze imageology appearance and clinical characteristics of the cystic and solid breast carcinoma. Methods Features of MRI and B-type ultrasonic inspection of 26 patients with the cystic and solid breast carcinoma pathologically confirmed （15 patients with mucinous carcinoma, 6 patients with intracystic papillary carcinoma, 5 patients with squamous cell carcinoma of the breast） were retrospectively reviewed. Results In terms of clinical appearance, the incidence of the squamous cell breast carcinoma with an average age of 70.1 years old was larger than in youth, while mucinous carcinoma with an average age of 67.7 years old and intracystic carcinoma of breast with an average age of 55.1 years old were contrary. The squamous cell breast carcinoma developed more quickly than mucinous carcinoma and intracystic carcinoma of breast. The squamous cell breast carcinoma often occurred around mammilla（4/5）, while the mucinous carcinoma and intracystic papillary carcinoma often occurred upper outer quadrant of breast, which was similar with other breast cancer. The average size of 49.6 mm in the squamous cell breast carcinoma was largest than the average size of 25.1 mm in mucinous carcinoma and the average size of 35.2 mm in intracystic papillary carcinoma. The malignant degree of squamous cell breast carcinoma was higher than mucinous carcinoma and intracystic papillary carcinoma,which intended to occur lymph node metastasis and skin infiltration. The diagnosis probability of mucinous carcinoma was smaller than intracystic papillary carcinoma through preoperative puncture, while squamous cell breast carcinoma was larger. On the MRI imageology appearance, both types of breast cancer had the same shape of rotundity or lobulated. The tumors were low signal on T1WI and partially high signal on T2WI, which were circular enhancement after enhancement.However, the edge of mucinous carcinoma and squamous cell breast carcinoma was rougher than intracystic papillary carcinoma compared with squamous cell breast carcinoma. The bursa wall of mucinous carcinoma was more uniformity, while papillary soft tissue image can be found in intracystic papillary carcinoma, which was enhanced significantly after enhancement. In terms of ultrasonic sound （US）, there were low echo signal and high echo signal on the back of tumor compared with other breast tumor. There were shadow beside mucinous carcinoma. Squamous cell breast carcinoma was rich in blood supply, while mucinous carcinoma and intracystic papillary carcinoma were opposite. Conclusion Histological type of cystic and solid breast carcinoma is complex, but the appearances of MRI and US have some characteristics. Histological type and the range of disease could be guessed through the combination of preoperative puncture and clinical appearance, which plays an important role in operation mode and treatment guidance.