乳头状瘤背景下乳腺导管原位癌多模态影像学特征分析

Multimodality imaging analysis of breast ductal carcinoma in situ within papillomas

目的探讨乳头状瘤背景下乳腺导管原位癌(DCIS-WP)和普通导管原位癌(DCIS-IG)的X线、超声和MRI影像学表现,并选择合适的乳腺癌影像筛查方法。方法回顾性分析2015年1月至2018年10月天津医科大学肿瘤医院经病理证实为DCIS-WP和DCIS-IG女性患者的临床和影像资料。共入组DCIS-WP患者40例,DCIS-IG患者94例。依据乳腺影像报告和数据系统(BI-RADS)标准对X线、超声和MRI上的病变进行系统性分析,评估3种影像方法的漏诊率和诊断准确度,并评价病变术前穿刺、术中冰冻病理与术后最终石蜡病理诊断一致性。定性资料的比较采用χ^2检验或Fisher确切概率法检验。结果DCIS-WP组和DCIS-IG组的X线漏诊率分别为42.50%(17/40)和5.32%(5/94),诊断准确度分别为22.50%(9/40)和77.66%(73/94),2组相比差异均有统计学意义(χ^2=28.268、35.952,P均<0.001)。DCIS-WP组和DCIS-IG组在超声上病变内部具有多发低回声结节分别有8例和2例,差异有统计学意义(χ^2=20.819,P<0.001);漏诊率分别为0和24.47%(23/94),差异有统计学意义(P<0.05)。MRI上DCIS-WP组和DCIS-IG组出现导管扩张征象的分别有24例和15例,具有多发乳头状瘤背景的分别有21例和16例,病变内部环形分布稀疏分别有15例和12例、环形形态大小不一分别有19例和13例,2组相比差异均有统计学意义(χ^2=26.378、17.671、8.524、14.530,P均<0.05)。DCIS-WP组和DCIS-IG组术前穿刺、术中冰冻病理与术后最终石蜡病理诊断一致的分别有12例和82例,2组差异有统计学意义(χ^2=44.165,P<0.001)。结论DCIS-WP的X线和超声表现特点与DCIS-IG不同,在X线上通常不表现为钙化性病变而易漏诊,超声对其检出具有优势;MRI对DCIS-WP和DCIS-IG均具有较好的诊断效能且有助于两者的鉴别。

Objective To investigate the mammography,ultrasound and MRI features of breast ductal carcinoma in situ within papillomas(DCIS-WP)and ductal carcinoma in situ in general(DCIS-IG),and to select the appropriate screening methods for breast cancer.Methods A retrospective analysis of 134 patients with DCIS-WP and DCIS-IG confirmed by pathology from January 2015 to October 2018 was conducted,including 40 patients with DCIS-WP and 94 patients with DCIS-IG.Mammography,ultrasound and MRI images were analyzed based on BI-RADS criteria,to evaluate the missed diagnosis rate and accuracy rate of three imaging methods,and the consistency of preoperative puncture,intraoperative frozen section and postoperative paraffin section was also observed.Qualitative data were compared using theχ^2 test or Fisher′s exact test.Results The X-ray missed diagnosis rate of DCIS-WP group and DCIS-IG group was 42.50%(17/40)and 5.32%(5/94),respectively,while the diagnostic accuracy rate was 22.50%(9/40)and 77.66%(73/94)respectively.The difference between the two groups was statistically significant(χ^2=28.268,35.952,P<0.001).In DCIS-WP group and DCIS-IG group,there were 8 and 2 cases with multiple hypoechoic nodules in the lesions,the difference was statistically significant(χ^2=20.819,P<0.001);the missed diagnosis rate was 0 and 24.47%(23/94),the difference was statistically significant(P<0.05).On MRI,there were 24 cases and 15 cases of DCIS-WP group and DCIS-IG group with the signs of catheter dilation,21 cases and 16 cases with multiple papillomas background,15 cases and 12 cases with sparse internal ring manifestations,19 cases and 13 cases with different sizes,respectively.The difference between the two groups was statistically significant(χ^2=26.378,17.671,8.524,14.530,P<0.05).In DCIS-WP group and DCIS-IG group,12 cases and 82 cases had the same diagnosis of preoperative puncture,intraoperative frozen pathology and postoperative paraffin pathology respectively,and the difference between the two groups was statistically significant(χ^2=44.165,P<0.001).Conclusions The features of DCIS-WP are different from those of DCIS-IG on mammography and ultrasound.DCIS-WP is likely to be missed on mammography as there is less calcification,while it is easier to be detected by ultrasound.MRI has good diagnostic efficacy for both types of DCIS and is helpful in differentiating them.