青年与中老年乳腺浸润性导管癌MRI增强形态类型的差异及病理基础初探  

Mass and non-mass type invasive ductal breast cancer:different age preference and pathologic basis

作　　者：姜蕾[1] 李继生 王征[3] 华彬[4] 杨重庆[3] 周诚[1] 陈敏[1] 周意明[5] 

机构地区：[1]卫生部北京医院放射科,北京100730 [2]山东省蓬莱市中医医院放射科,山东蓬莱265600 [3]卫生部北京医院病理科,北京100730 [4]卫生部北京医院乳腺外科,北京100730 [5]首都医科大学北京朝阳医院介入放射科,北京100043

出　　处：《医学影像学杂志》2015年第2期254-257,共4页Journal of Medical Imaging

摘　　要：目的探讨乳腺浸润性导管癌MRI增强形态类型与年龄的相关性及其病理基础。方法收集经病理学证实的乳腺浸润性导管癌97例,均进行了MRI动态增强检查。2名放射科医生独立阅片确定肿瘤MRI增强后形态类型(肿块/非肿块样强化)及大小。2名病理科医生确定浸润性导管癌成分的组织学分级及肿瘤内是否含有导管内原位癌(ductal carcinoma in situ,DCIS)。分析MRI增强形态类型与年龄段的相关性,青年与中、老年MRI增强形态类型是否有显著差异,肿块与非肿块型乳腺癌病变大小、浸润性导管癌成份组织学分级及DCIS存在与否的差异性。结果 MRI增强形态类型与年龄显著相关(P=0.000);40岁(含)以下青年中的非肿块型乳腺癌比40岁以上中老年的明显增多(P=0.000)。非肿块型乳腺癌大小大于肿块型(P=0.022)。非肿块型乳腺癌中病理含DCIS者明显多于肿块型乳腺癌(P=0.000),且前者浸润性导管癌成分的组织学分级明显低于后者(P=0.006)。结论非肿块型乳腺癌更易发生于青年,肿块型乳腺癌更易发生于中老年。非肿块型乳腺癌与存在DCIS显著相关,但浸润性导管癌成分组织学分级相对较低,其恶性程度未必差于肿块型乳腺癌。Objective To investigate the age preference of mass and non-mass type invasive ductal breast cancer and to compare their pathologic features.Methods Ninety-seven consecutive cases of pathologic-proven invasive ductal breast cancers were collected.All the patients underwent MRI dynamic enhancement examination before surgery or biopsy.Two radiologists independently assessed the images of each lesion for the morphologic enhancement type（mass enhancement or non-mass-like enhancement）and measured lesion size in consensus.Two pathologists independently evaluated the presence or absence of ductal carcinoma in situ（DCIS）and histological grade of invasive component.The correlation between MRI morphologic enhancement type and age was analyzed by Spearman rank correlation.The morphologic enhancement type between the young（less than 40y/o）and the older counterpart（older than 40y/o）were compared by Fisher exact test.The lesion size,the difference of histological grades of invasive component and status of DCIS between mass and non-mass type were compared.Results The enhancement type was correlated with age（P =0.000）.The young（below 40y/o）had more non-mass type than the older counterpart（beyond 40y/o）（P =0.000）.The lesion size of non-mass type was larger than mass type（P =0.022）.The non-mass type was significantly related to the presence of DCIS and low histological grade of invasive components,compared with mass type,with P =0.000,0.006,respectively.Conclusion Non-mass-type breast cancer prefers to occur in the young,while the older are more vulnerable to mass type.Compared with mass type,non-mass type breast cancer often has larger tumor size,but may not necessarily have worse malignant behavior due to strongly related to presence of DCIS and low histological grade of invasive components.

关 键 词：乳腺 非肿块样强化 肿块 磁共振成像 年龄 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]