乳腺实性乳头状癌的MRI表现及与导管内乳头状瘤的鉴别诊断

MRI Manifestations of Solid Papillary Breast Carcinoma and Differential Diagnosis of Breast Intraductal Papillomatosis

目的探讨乳腺实性乳头状癌(SPC)的MRI表现,并与良性导管内乳头状瘤(BIDP)进行鉴别诊断。资料与方法回顾性分析经穿刺或手术病理证实的24例SPC患者和24例BIDP患者的临床资料,比较两组患者的MRI征象、表观扩散系数(ADC)值及早期强化率的差异。结果 SPC患者平均(65.8±13.0)岁,显著大于BIDP患者的(45.4±7.4)岁,差异有统计学意义(P=0.000)。15例(62.5%)SPC患者为非肿块样强化,且多发,其中线样/段样强化13例、9例伴有集丛状强化。9例(37.5%)SPC患者表现为结节/肿块强化。两组病例病灶数、强化形态及结节/肿块强化边界、内部强化差异均有统计学意义(P<0.05);而病变部位、非肿块强化分布形态、导管是否扩张、ADC值、早期强化率及时间-信号曲线类型等差异均无统计学意义(P>0.05)。结论乳腺SPC的MRI表现具有一定的特征性,常表现为伴有集丛状强化的线样/段样强化。结合患者的年龄和MRI特征有助于与BIDP鉴别。

Purpose To explore the MRI manifestations of breast solid papillary carcinoma (SPC) and differential diagnosis of breast intraductal papillomatosis (BIDP). Materials and Methods Clinical data of 24 SPC patients confirmed by biopsy or surgical pathology and 24 BIDP were retrospectively analyzed. Difference of MRI signs, apparent diffusion coefficient (ADC) value and early-stage enhancement rate was observed and compared. Results Average age of SPC patients was (65.8±13.0) years old, which was obviously greater than that of BIPD patients. The difference was of statistical significance ( P =0.000). 15 (62.5%) SPC patients were non-mass enhancement and multiple. Among there were 13 linear and segmental enhancement and 9 with clustered enhancement. 9 (37.5%) SPC patients was manifested by nodular and mass enhancement. Difference of lesion numbers, enhanced morphology and boundary of nodular and mass enhancement as well as internal enhancement in two groups were of statistical significance ( P <0.05). However, difference of lesion location, distribution morphology of non-mass enhancement, ductal expansion or not, ADC value, early-stage enhancement rate and time-signal intensity curve type was of no statistical significance ( P >0.05). Conclusion MRI manifestations of breast SPC were of certain characteristics and were commonly manifested by combined clustered enhanced linear and segmental enhancement. The combination of patients' age and MRI features could assist with identification of benign breast intraductal papillomatosis.