钙化与非钙化乳腺导管原位癌的影像表现及病理特点

Imaging and Histopathological Characteristics of Calcified and Non-calcified Ductal Carcinoma in Situ of Mammary Glands

目的比较钙化与非钙化乳腺导管原位癌(ductal carcinoma in situ,DCIS)的乳腺X线摄影、超声、MRI表现及病理特点。方法收集本院2009年4月—2013年12月212例共计217处DCIS。依据乳腺X线摄影有无钙化将患者分为钙化与非钙化DCIS两组,由乳腺X线摄影、超声、MRI各两位医师共同阅片,详细记录肿瘤形态、大小、密度/回声/信号、边缘、边界、钙化形态及周围组织结构等。病理组织学结果通过本院病理科报告获得。结果乳腺X线摄影检出非钙化DCIS假阴性为49.3%,乳腺X线摄影检出钙化DCIS为100%,其中68.5%钙化灶为单纯钙化。所有非钙化DCIS在超声上呈肿块状为100%,超声显示钙化DCIS为61.6%。MRI检出非钙化与钙化分别为65.0%、51.7%,非钙化与钙化者MRI特点无统计学差异(P>0.05)。病理组织学显示高级别、坏死、孕酮受体阳性、HER-2在钙化DCIS比非钙化DCIS更为常见(分别为P=0.017、P<0.001,P=0.027,P<0.001)。乳腺X线摄影、超声、MRI表现测量钙化与非钙化DCIS直径大小与病理测定直径大小的ICC值分别为:0.625,0.705;0.801,0.552;0.760,0.767。结论钙化与非钙化DCIS在乳腺X线摄影、超声、MRI呈不同表现,乳腺X线摄影对钙化DCIS敏感性较高,超声对非钙化敏感性较高,MRI对检出钙化与非钙化DCIS均有较高敏感性。

Objective To compare histopathological characteristics of calcified and non-calcified ductal carcinoma in situ（ DCIS） of mammary glands by mammography,ultrasound and magnetic resonance imaging（ MRI）. Methods The study involved 212 DCIS patients（ 217 sites） admitted during April 2009 and December 2013. The patients were divided into calcified and non-calcified DCIS groups according to the calcifications by mammography. The imagings were observed by two physicians using each method to carefully record tumorous shape,size,density / echo / signal features,borderline,boundary,calcified shape,surrounding tissue formation and so on. The histopathological features of the lesions were obtained from medical records. Results Mammography showed 49. 3% of non-calcified DCIS patients with a false-negative finding,and 100% of calcified patients with DCIS,in which 68. 5% of calcified lesions were calcification alone. Ultrasound showed that all non-calcified DCIS were massive with 100% incidence rate,while the incidence rate of calcified DCIS was 61. 6%. The MRI showed that incidence rates of non-calcified and calcified DCIS were 65. 0% and51. 7% respectively,but there were no significant differences in MRI features between the two groups（ P〉0. 05）. Histopathology showed that high nuclear grade,necrosis,positive progesterone receptor and HER-2 were more common in the calcified DCIS patients compared with those in the non-calcified DCIS patients（ P = 0. 017,P〈0. 001,P = 0. 027,P〈0. 001 respective）. The ICC values of the non-calcified and calcified DCIS patients between predicted tumour size and pathologic size were 0. 625 and 0. 705 by mammography,0. 801 and 0. 552 by ultrasound,and 0. 760 and 0. 767 by MRI. Conclusion The calcified and non-calcified DCIS patients have different features in mammographic,ultrasonic and MRI features. The mammography has high sensibility for calcified DCIS,while ultrasound has high sensibility for non-calcified DCIS,and MRI has high sensibility for calcified and non-calcified DCIS.