乳腺癌的X线表现及病理基础

Mammographic features of breast carcinoma: mammographic-pathologic correlation

目的 分析常见乳腺癌的X线表现及其病理基础。方法 经乳腺X线检查 ,手术、病理证实的乳腺癌灶 397个 ,包括浸润性导管癌 2 97个、导管原位癌及导管原位癌伴微浸润 38个、黏液腺癌 2 1个、髓样癌 2 2个和浸润性小叶癌 19个。观察乳腺癌的X线表现 ,与病理分型、分级对照。结果 ( 1)癌灶的X线表现为有钙化者 170个 ( 42 8%) ,有肿块者 2 5 8个 ( 6 5 0 %) ,有结构扭曲者 33个( 8 3%)。 ( 2 )有钙化者易出现在导管原位癌和浸润性导管癌中 ( χ2 =30 90 ,P <0 0 0 1) ,尤其单纯钙化多出现在导管原位癌中 ( 6 5 8%,2 5 / 38)。 ( 3)呈肿块表现的多见于髓样癌 ( 90 9%,2 0 / 2 2 )和黏液腺癌 ( 81 0 %,17/ 2 1) ,与其他乳腺癌相比差异有非常显著意义 ( χ2 =30 87,P <0 0 0 1)。肿块伴钙化 99个 ,在各病理类型乳腺癌中均可见 ,但当钙化颗粒 >10枚 ( χ2 =11 47,P <0 0 0 1)或钙化灶直径≥ 3cm(Fisher法精确 χ2 检验 ,P =0 0 2 3 7)则多见于导管原位癌和浸润性导管癌。单纯肿块改变 15 9个病灶 ,各类乳腺癌的边缘改变不完全相同 ( χ2 =34 82 ,P <0 0 5 )。 ( 4)结构扭曲伴钙化仅见于浸润性导管癌 ,单纯结构扭曲见于浸润性导管癌和浸润性小叶癌 ,其他类型未见。 ( 5 )对浸润性导管癌 ,Ⅰ、Ⅱ级?

Objective To analyze the mammographic features of breast carcinoma and the correlation between the mammographic and pathologic findings. Methods A prospective study of 397 consecutive mammograms in patients with breast carcinoma, including infiltrating ductal carcinoma (IDC, n=297), ductal carcinoma in situ (DCIS) and DCIS associated with small invasive foci (n=38), mucinous carcinoma (n=21), medullary carcinoma (n=22) and invasive lobular carcinoma (n=19), was performed to determine the correlations between the mammographic and pathologic findings. Results (1)Microcalcifications appeared in 170 cases (42.8%), a mass in 258 cases (65.0%), and distortion in 33 cases (8.3%), respectively. (2) Microcalcifications were more commonly associated with DCIS and IDC (χ2=30.90, P<0.001), and microcalcifications alone were most commonly seen in DCIS (65.8%). (3) Masses were more commonly associated with medullary (90.9%) and mucinous carcinoma (81.0%). The statistically significant difference was seen in comparison with the other types of breast carcinoma (χ2=30.87, P<0.001). Masses with microcalcifications (99 cases)appeared in all kinds of breast carcinoma. The number of microcalcification more than 10 or the extent of microcalcification distribution greater than 3 cm was significantly more likely to appear in both DCIS and IDC than in the other types of breast carcinoma (P<0.001 and P=0.023 7, respectively). Mass alone appeared in 153 cases, the margins of all types of breast carcinoma were not the same (χ2=27.40, P<0.001). (4) Distortion with microcalcifications was only seen mammographically in IDC, and distortion without microcalcifications was seen in both IDC and invasive lobular carcinoma. (5) Grade I and grade Ⅱ IDC were more likely to be associated with distortion (χ2=6.22, P<0.05), and grade Ⅲ IDC was more likely to be associated with a mass when findings were seen on mammogram(χ2=7.19, P<0.01). Conclusion The common features of breast carcinoma in mammography were microcalcifications, microcalcifications with a mass, a mass, and distortion. IDC was the commonest in breast carcinoma, and could be considered when mammographic malignant features above mentioned were found except the appearance of microcalcifications alone, which was firstly suggestive of DCIS. A mass also appeared in medullary and mucinous carcinoma, and distortion appeared in invasive lobular carcinoma.