乳腺浸润性导管癌动态增强MRI边缘强化的组织病理学影响因素  

Histopathologic features of rim enhancement MRI for breast infiltrating ductal carcinoma

作　　者：万卫平[1,2] 陶晓峰[3] 高欣[1,2] 赵殿辉[1,2] 刘士远[3] 萧湘生[3] 郑建明[4] 

机构地区：[1]第二军医大学长征医院闸北分院 [2]上海市闸北区中心医院放射科,上海200070 [3]第二军医大学长征医院影像科,上海200003 [4]第二军医大学长海医院病理科,上海200433

出　　处：《第二军医大学学报》2010年第6期625-629,共5页Academic Journal of Second Military Medical University

基　　金：上海市闸北区中心医院“789”人才学科攀登计划基金~~

摘　　要：目的探讨乳腺浸润性导管癌(infiltrating ductal carcinoma,IDC)动态增强MRI边缘强化的组织病理学因素。方法对65例女性乳腺肿块患者行平扫及动态增强MRI检查,从中筛选出30个经术后病理证实的乳腺浸润性导管癌肿块作为研究对象。观察肿瘤病灶动态增强MRI表现,观察肿瘤瘤巢大小、基质宽窄、微血管密度及纤维化程度等组织病理学特征,分析动态增强MRI表现与上述肿瘤组织病理学特征的相关性。结果乳腺浸润性导管癌边缘强化明显,时间-信号强度曲线以流出型为主(17/30,56.7%),第一分钟内平均强化率(ΔSI1%)>75%。30例浸润性导管癌包括小癌巢13例(43%),中癌巢12例(40%),大癌巢5例(17%);肿瘤纤细、窄、宽基质分别为5例(17%)、16例(53%)、9例(30%)。早期边缘强化与小癌巢明显相关(P<0.05),也与其高比值的周边部/中央部微血管密度及低比值的周边部/中央部纤维化显著相关性(P<0.01);延迟边缘强化与窄基质明显相关(P<0.05)。结论浸润性导管癌边缘强化和造影剂流出现象不仅与肿瘤血管生成有关,还与肿瘤自身癌巢大小、基质宽窄及纤维化程度等组织病理学特征密切相关。Objective To investigate the histopathologic features of rim enhancement MRI of breast infiltrating ductal carcinoma （IDC）.Methods Routine and dynamic contrast enhanced MRI was used to examine 65 patients with breast lumps.Thirty of the 65 patients who were pathologically confirmed to have breast IDC were included in the present study.The manifestations of dynamic contrast enhanced MRI and the histopathologic parameters of the masses （the size of cancer nest,stroma type,microvessel density and degree of fibrosis） were observed.And the relationship of MR findings with the above-mentioned histopathologic features was analyzed.Results Peripheral rim enhancement was obvious in IDC and a type-Ⅲ（wash-out） time/signal intensity course was the dominant type （17/30,56.7%）.The average enhancement rate during the first post-contrast minute（SI1%）was higher than 75% in IDC.The 30 IDCs fell into small （13,43%）,medium（12,40%）,and large（5,17%） groups according to the size of cancer nest;and into delicate（5,17%）,narrow（16,53%）,and broad（9,30%） groups according to the cancer stroma type.Early rim enhancement was associated with a small cancer nest （P0.05）,a high ratio of peripheral-to-central microvessel density,and a low ratio of peripheral-to-central fibrosis （P0.01）.Delayed rim enhancement was significantly associated with narrow stroma （P0.05）.Conclusion Rim enhancement and washout sign on contrast-enhanced MR imaging of the breast IDC are associated not only with angiogenesis,but also with various histological features of the cancinoma,including the size of cancer nests,width of stroma,and degree of fibrosis.

关 键 词：乳腺肿瘤 乳腺导管癌 磁共振成像 组织病理学 

分 类 号：R737.9[医药卫生—肿瘤]