数字化乳腺摄影中的微钙化对临床触诊阴性乳腺癌的诊断意义

Diagnostic value of microcalcifications by full-field digital mammography in impalpable breast cancer

目的探讨数字化乳腺摄影中微钙化对临床触诊阴性乳腺癌的诊断价值。方法回顾性分析212例临床触诊阴性而数字化乳腺摄影发现微钙化患者的临床及影像学资料,所有病例均经手术或病理证实,其中乳腺癌131例,乳腺良性病变81例。着重对微钙化的形态分型(根据Le Gal乳腺微钙化分型,Ⅰ型:环形钙化;Ⅱ型:形态规整的小点状钙化;Ⅲ型:泥沙状钙化;Ⅳ型:形态不规则的点状钙化;Ⅴ型:蠕虫样钙化)、特征进行分析,以比较其在良、恶性病变中的差异。数字化乳腺摄影的诊断采用美国放射学会推荐的乳腺影像报告和数据系统。结果乳腺微钙化在良性病变中多为环状、规则细点状,散在分布,密度较高;微钙化在恶性病变中多为泥沙状、不规则颗粒状、蠕虫状、簇状分布,密度较低。乳腺微钙化的形态、大小、数量、密度、均匀性、密集度及其分布在良、恶性病变中存在统计学差异(P<0.05)。结论微钙化对乳腺癌(尤其是临床触诊阴性的乳腺癌)的诊断具有重要意义。

Objective To explore the diagnostic value of microcalcifications by full-field digital mammography in impalpable breast cancer. Methods Clinical data and radiological characteristics were analyzed retrospectively in 212 cases of breast lesions, inclu- ding 131 cases of breast cancer and 81 cases of benign lesions with microcalcifications by full-field digital mammography that were confirmed by operation and pathology. Specially, the morphology classification（ according to Le Gal classification of breast microcal- cifications ： type Ⅰ： annular shape ; type Ⅱ ： regularly punctiform ; type Ⅲ ; dusty shape ; type Ⅳ ： irregularly punctiform ; type V ： ver- micular form） and feature of microcalcifications were analyzed between the benign and malignant lesions. The radiological diagnosis followed Breast Imaging-Reporting And Data System（BI-RADS） suggested by American College of Radiology. Results In full-field digital mammography, most microcalcifications appeared annular, regularly punctiform, hyperdense and scatteringly distributed in benign breast lesions ,while microcalcifications were usually dusty, irregularly punctiform,vermicular,hypodense and clusteringly distributed in malignant breast lesions. There were significant differences in microcalcifications between benign and malignant breast lesions according to shape, size, number, density, homogeneity, concentration and distribution （P 〈 0.05）. Conclusion Micro- calcification is of important value in diagnosing the impalpable breast cancer in full-field digital mammography.