非肿块型乳腺癌影像学诊断及临床病理分析

Imaging diagnosis and pathological analysis of non-mass-like breast cancer

目的探讨非肿块型乳腺癌影像学诊断及临床病理特征,提高非肿块型乳腺癌的诊断符合率。方法选择2012年5月至2017年5月在内蒙古自治区人民医院经病理诊断确诊的113例非肿块型乳腺病变患者,均为女性,年龄27~72岁,平均年龄44.83岁。行超声检查和X射线钼靶检查。对其影像学资料进行分析,同时分析其病理特征。结果113例病例中,经病理诊断证实51例为恶性肿瘤,62例为良性病变;其中恶性肿瘤导管原位癌17例,浸润性小叶癌8例,浸润性导管癌26例。超声检查表现为单纯簇状微钙化4例,均为恶性;片状低回声45例,其中恶性19例;片状低回声伴钙化28例,其中恶性13例;结构紊乱31例,其中恶性10例;5例恶性病例超声检查未见明显异常。X射线钼靶检查主要有4种征象,其中微钙化占比最高,占恶性肿瘤的66.7%;腺体结构扭曲占41.2%;而腺体局灶性不对称性致密及腺体弥漫性或局部密度增高分别占恶性肿瘤29.4%、19.6%,且以合并其他一种或两种征象为主。非肿块型乳腺癌超声检查、X射线钼靶检查、两者串联诊断及并联诊断的灵敏度分别为62.75%、74.51%、47.06%、90.20%,特异度分别为88.71%、92.94%、100.00%、80.65%,曲线下面积(AUC)值分别为0.757、0.832、0.735、0.854;非肿块型乳腺癌中,导管原位癌占比33.3%,浸润性小叶癌占比15.7%,浸润性导管癌占比51.0%。结论对于非肿块型乳腺癌的诊断,超声检查、X射线钼靶检查并联诊断符合率较高;导管原位癌在非肿块型乳腺癌中占比高于其在整体乳腺癌中占比。重视非肿块型乳腺癌的诊断对于提高乳腺癌的早期诊断具有积极作用。

Objective To investigate the imaging diagnosis and pathological characteristics of non-mass-like breast cancer,and improve the diagnostic rate of non-mass-like breast cancer.Methods From May 2012 to May in 2017,a total of 113 female patients with non-mass-like breast lesions diagnosed by pathology were enrolled,which aged 27-72 years old with mean age of 44.83 years old.All of them were performed ultrasound and X-ray mammography,and the imaging data were analyzed.The pathological characteristics were also analyzed.Results Among the 113 cases confirmed by pathology,51 were malignant tumors and 62 were benign lesions;in which,17 with malignant ductal carcinoma in situ,8 with invasive lobular carcinoma,and 26 with invasive ductal carcinoma.The ultrasound examination showed that 4 cases with simple clustered microcalcification were all malignant;45 cases with simple sheet-like hypoechoic,including 19 of malignancy;28 cases with hypoechoic with calcification,including 13 of malignancy;31 cases with structural disorder,including 10 of malignancy;and there were no obvious abnormalities in 5 malignant cases.There were 4 main signs in X-ray mammography,in which microcalcification(66.7%)accounted for the highest in malignant tumors;and distortion of glandular structure accounted for 41.2%;the focal asymmetry and density of glands as well as diffuse or local density increase in malignant tumors were 29.4%and 19.6%,respectively,which mainly combined with one or two other signs.The diagnostic sensitivity of non-mass-like breast cancer by ultrasound,X-ray mammography,serial diagnosis and parallel diagnosis were 62.75%,74.51%,47.06%and 90.20%,respectively,and the specificities were 88.71%,92.94%,100.00%and 80.65%,respectively.Area under curve(AUC)values were 0.757,0.832,0.735,0.854.In non-mass-like breast cancers,the ratio of ductal carcinoma in situ was 33.3%,lobular carcinoma was 15.7%and invasive ductal carcinoma was 51.0%.Conclusion It is demonstrated that the coincidence rate of ultrasound and X-ray parallel diagnosis in non-mass-like breast cancer is the highest;and the proportion of ductal carcinoma in situ in non-mass-like breast cancer is higher than that of overall breast cancer.Diagnosis of non-mass-like breast cancer showed positive effect on improving the early diagnosis of breast cancer.