数字乳腺断层摄影鉴别诊断浆细胞性乳腺炎与乳腺癌

Digital breast tomosynthesis for differential diagnosis of plasma cell mastitis and breast cancer

目的评价数字乳腺断层摄影(DBT)鉴别诊断浆细胞性乳腺炎(PCM)和乳腺癌的价值。方法回顾性分析47例PCM(PCM组,50个病灶)及159例乳腺癌(乳腺癌组,163个病灶)DBT表现,以病理结果为金标准,评价DBT诊断准确率。结果PCM组28例(28/47,59.57%)病灶侧乳晕后导管扩张,主要表现为乳晕后多支管状透亮影(25/28,89.29%),其中22例(22/28,78.57%)双侧乳晕后均见扩张导管,仅3例(3/47,6.38%)双侧同时存在病灶。乳腺癌组6例(6/159,3.77%)见病灶侧乳晕后导管扩张,其中5例(5/6,83.33%)为乳晕后单侧、单支管状致密影或透亮影,1例(1/6,16.67%)为双侧、多支管状透亮影。2组间扩张导管数量、累及单或双侧及形态差异均有统计学意义(P均<0.01),导管扩张程度差异无统计学意义(P>0.05)。PCM病灶主要表现为非对称致密影(31/50,62.00%)和肿块(19/50,38.00%),肿块多不规则(15/19,78.95%),无毛刺状边缘及微钙化。乳腺癌病灶以肿块为主(127/163,77.91%),多不规则(120/127,94.49%),边缘多模糊/微分叶(67/127,52.76%)或可见毛刺(53/127,41.73%),其中78个(78/127,61.42%)伴微钙化。组间肿块形状、边缘及钙化差异均有统计学意义(P均<0.05),肿块密度差异无统计学意义(P>0.05);乳头凹陷和钙化、皮肤增厚与腋窝淋巴结肿大差异亦均无统计学意义(P均>0.05)。DBT诊断PCM及乳腺癌的准确率分别为90.00%(45/50)和83.44%(136/163)。结论DBT对鉴别诊断PCM与乳腺癌具有较高价值。

Objective To observe the value of digital breast tomosynthesis(DBT)for differential diagnosis of plasma cell mastitis(PCM)and breast cancer.Methods DBT manifestations of 47 PCM patients(PCM group)and 159 breast cancer patients(breast cancer group)were observed.Taken pathological results as golden standards,the diagnostic accuracy of DBT was calculated.Results Dilated ducts in a subareolar location on the affected side was detected 28(28/47,59.57%)cases of PCM group,among them 22(22/28,78.57%)with bilateral dilated ducts,but only 3 cases(3/47,6.38%)with bilateral lesions.In breast cancer group,dilated ducts in the subareolar location of the affected side were observed in 6 cases(6/159,3.77%),presented as unilateral and single tubular dense shadows or translucent shadows in the subareolar location in 5 cases(5/6,83.33%),bilateral and multiple tubular translucent shadows in 1 case(1/6,16.67%).There were significant differences of the number,unilateral or bilateral,also manifestations of dilated ducts between groups(all P<0.01),but not of the degrees of dilation(P>0.05).PCM lesions present as asymmetric densities(31/50,62.00%)or masses(19/50,38.00%),most of the masses were irregular(15/19,78.95%)without burr like edge and microcalcification.Breast cancers mainly manifested as mass(127/163,77.91%),which were often irregular(120/127,94.49%),and the margins were commonly fuzzy/differential lobes(67/127,52.76%)or burr(53/127,41.73%),while microcalcifications were found in more than half of the lesions(78/127,61.42%).There were significant differences of the shape,margin and calcification between groups(all P<0.05),but not of the density of masses(P>0.05).No significant differences of the nipple retraction,calcification,thickened skin nor swollen axillary lymph nodes was found between groups(all P>0.05).The accuracy of DBT for diagnosing PCM and breast cancer was 90.00%(45/50)and 83.44%(136/163),respectively.Conclusion DBT had good application value for differential diagnosis of PCM and breast cancer.