乳腺包被性乳头状癌的磁共振成像特征及与囊实性乳腺导管内乳头状瘤的鉴别诊断

Magnetic resonance imaging features of breast encapsulated papillary carcinoma and differential diagnosis of solid and cystic breast intraductal papillomatosis

目的:分析乳腺包被性乳头状癌(encapsulated papillary carcinoma,EPC)的磁共振成像(magnetic resonance imaging,MRI)特征,并探讨与良性囊实性乳腺导管内乳头状瘤(breast intraductal papillomatosis,BIDP)的鉴别。方法:回顾并分析广东省人民医院2014年6月-2019年10月经病理学检查证实并在术前行MRI检查的10例乳腺EPC患者及10例囊实性BIDP患者的临床病理学资料。分析乳腺EPC的MRI形态学特征、时间-信号强度曲线(time-signal intensity curve,TIC)类型及表观扩散系数(apparent diffusion coefficient,ADC)的特点,并探究其与囊实性BIDP的临床及影像学表现差异。结果:10例EPC均为结节/肿块型,其中8例为囊实性肿块,3例出现液平,2例合并导管扩张。乳腺EPC患者的平均年龄[(65.50±11.64)岁]显著大于囊实性BIDP的患者,差异有统计学意义(P=0.018)。两组患者在实性部分抑脂T2WI信号之间的差异有统计学意义(P=0.019),其余MRI特征差异无统计学意义。结论:乳腺EPC在MRI上常表现为囊实性结构,实性部分在T2WI抑脂相常呈高或等信号,结合患者的年龄及MRI表现有助于与囊实性BIDP鉴别。

Objective:To explore magnetic resonance imaging(MRI)features of encapsulated papillary carcinoma(EPC)and differential diagnosis of solid and cystic breast intraductal papillomatosis(BIDP).Methods:The clinical and pathological data of 10 breast EPC patients and 10 solid and cystic BIDP patients confirmed by pathology from Jun.2014 to Oct.2019 in Guangdong Provincial People’s Hospital were retrospectively analyzed.The differences in MRI features,time-signal intensity curve(TIC)types,and apparent diffusion coefficient(ADC)between the two groups were analyzed and compared.Results:Average age of EPC patients was(65.50±11.64)years old,which was significantly greater than that of solid and cystic BIDP patients.The difference was of statistical significance(P=0.018).All 10 EPCs presented as masses,of which 8 cases were cystic solid masses,3 showed fluid levels and breast duct dilatation was found in 2 cases.There was statistically significant difference between the two groups of cases in the signal of fat-saturated T2 WI(P=0.019),and there was no significant difference in the other MRI features.Conclusion:The breast EPC often presented as a solid and cystic mass and the solid part often manifested high or equal signal on fat-saturated T2 WI.Combining the patient’s age and MRI findings could contribute to distinguish breast EPC from solid and cystic BIDP.