乳腺导管原位癌及其微浸润的磁共振成像评价  

MR imaging evalution of ductal carcinoma in situ and ductal carcinoma in situ with small invasive foci of breast

作　　者：顾雅佳[1] 汪晓红[1] 肖勤[1] 杨文涛[2] 曾炜[3] 唐峰[1] 毛健[1] 郑晓静[1] 彭卫军[1] 冯晓源[4] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,上海200032 [2]复旦大学附属肿瘤医院病理科,上海200032 [3]复旦大学附属肿瘤医院超声科,上海200032 [4]复旦大学上海华山医院放射科

出　　处：《中华放射学杂志》2007年第3期248-253,共6页Chinese Journal of Radiology

摘　　要：目的与 X 线片、超声检查比较,评价 MRI 对乳腺导管原位癌及其微浸润诊断的正确率和界定病灶范围的准确性。方法经手术病理证实、术前行乳腺 MR 检查的乳腺导管原位癌及导管原位癌伴微浸润连续病例17例,其中13例同时行 X 线检查、16例行超声检查。以病理资料作为金标准,作对照分析。结果 (1)MR 检查14例病灶有强化,11例表现为非块状强化,其中6例呈段样强化,2例呈区域性强化,导管样强化、多灶性局灶性强化、双乳大致对称的弥漫性强化各1例。这11例中有2例伴病变侧增强前的乳头后大导管扩张,其中1例增强后大导管强化,这2例均以乳头滴血为临床症状。2例块样强化表现为信号均匀、形态不规则的肿块。混合有肿块和非块样强化的1例,为信号均匀、边缘光整的卵圆形肿块伴肿块周围线样强化。(2)13例行 X 线检查,2例阴性;单纯钙化表现6例;钙化伴其他征象2例;非钙化病灶3例。8例含钙化的病灶中,恶性钙化5例,交界性钙化3例;钙化簇状分布5例,区域性分布2例,弥漫分布1例。(3)16例行超声检查,4例阴性,1例诊为良性病变,其余11例作出了正确的术前诊断,表现为不规则的低回声区内伴有点状的强回声改变。(4)以病理检查测量的大小作为金标准,对病灶范围界定方面 MRI 符合13例(13/17),高估2例;X 线诊断符合7例(7/13),高估3例,低估1例;超声符合7例(7/16),高估2例,低估3例。差异无统计学意义(P=0.161)。结论乳腺导管原位癌及原位癌伴微浸润 MRI 表现具有特征性,联合X线和 MR 检查能提高其正确诊断。Objective To retrospectively assess diagnostic accuracy of magnetic resonance imaging （MRI） in preoperative assessment of local extent of breast ductal carcinoma in situ （DCIS） and DC1S with small invasive loci, compared with the mammography and ultrasonography （US） imagings. Methods Results of MRI, mammography, and US imaging from 17 consecutive women with known breast DCIS and DCIS with invasive loci were analyzed, and then compared with pathologic examination. Results （1） Fourteen lesions showed enhancement on dynamic breast MRI, of which 11 lesions were no-mass-like enhancement. Six of 11 lesions appeared segmental enhancement, and 2 were regional enhancement. Ductal and multiple focal areas enhancement were 1 case respectively. Symmetric diffuse enhancement in bilateral breast was showed in 1 patient. Ductal dilation was visible in ipsilateral breast on pre-contrast MRI in 2 cases, which manifested bloody nipple discharge in clinical examination, and duct enhanced on postcontrast imaging in one of them. Two lesions appeared mass enhancement with irregular shape and homogeneous signal. Linear enhancement surrounding the oval homogeneous mass with smooth margin found in 1 case. （2） Thirteen of 17 patients underwent bilateral mammography. There were various findings in mammograms, including microcalcifications （6 cases）, normal mammograms （2 cases）, calcifications with other appearance （2 cases） , and non-calcification abnormity （3 cases）. In 8 lesions with calcifications, 5 were noted higher probability of malignancy calcifications and 3 intermediate concern calcifications. Calcifications distributed clustered （5 cases） , regional （2 cases） and diffuse （1 case） shape. （3） Sixteen of 17 patients were performed breast US examination. Eleven lesions, which were correct diagnosed, appeared higher echo spots within irregular lower echo area. One lesion diagnosed benign and 4 were negative on US examination. （4） Regarded the size measured on pathologic examinat

关 键 词：乳腺肿瘤 癌 导管内 非浸润性 磁共振成像 乳房X线摄影术 超声检查 乳房 

分 类 号：R737.9[医药卫生—肿瘤]