乳腺包裹性乳头状癌不同亚型的超声及病理对比分析  

Ultrasonic and pathological comparative analysis of different subtypes of breast encapsulated papillary carcinoma

作　　者：邓晶 宗晴晴 徐祎[2] 周文斌[3] 吴苏玲 李沁 王慧 Deng Jing;Zong Qingqing;Xu Yi;Zhou Wenbin;Wu Suling;Li Qin;Wang Hui(Department of Ultrasound Medicine,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Pathology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Breast Surgery,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院超声医学科,南京210029 [2]南京医科大学第一附属医院病理科,南京210029 [3]南京医科大学第一附属医院乳腺外科,南京210029

出　　处：《中华医学杂志》2021年第1期57-61,共5页National Medical Journal of China

基　　金：国家自然科学基金(81771953)。

摘　　要：目的:探讨乳腺包裹性乳头状癌(EPC)患者的临床病理特点和超声特征及不同亚型对比分析。方法:回顾性收集2014年9月至2020年8月南京医科大学第一附属医院57例病理诊断为乳腺EPC的患者资料,按病理分为3个亚型,对其在临床、病理及超声表现上进行对比分析。结果:入组患者中,男2例,女55例,年龄41~88(63±11)岁。EPC病灶直径7.0~7.5(2.9±1.9)cm。其中16例单纯型EPC,9例EPC伴导管原位癌(DCIS),32例EPC伴浸润。分子分型以腔面型为主(55/57,96.6%),Luminal A型38例,Luminal B型17例。EPC声像图多表现为大小>2 cm(68.4%)、形态规则(64.9%)、边缘光整(54.4%)、无毛刺成角(82.5%)、不伴钙化(93%)结节。不同亚型存在差别,单纯型较伴浸润型病灶更靠近乳头、形态规则、边缘光整( P<0.05);伴浸润的EPC较伴DCIS的 EPC血流更丰富、更远离乳头( P<0.05);单纯型与伴DCIS差别不大( P>0.05)。 结论:单纯型EPC超声多见形态规则、边缘光整、内部结构囊实性等良性征象。若病灶距乳头距离>3 cm、形态不规则、边缘模糊,提示伴浸润可能性大。影像多模态的联合有助于EPC的精准诊疗。Objective To investigate the clinicopathological and ultrasonic characteristics of patients with breast encapsulated papillary carcinoma(EPC)and the comparative analysis of different subtypes.Methods A total of 57 patients with pathological diagnosis of breast EPC in the First Affiliated Hospital of Nanjing Medical University from September 2014 to August 2020 were retrospectively collected.Based on pathological diagnosis,patients were divided into 3 subtypes,and their clinical,pathological and ultrasonic manifestations were compared and analyzed.Results Among the enrolled patients,there were 2 males and 55 females,aged 41-88(63±11)years.The lesion diameter of EPC was 7.0-7.5(2.9±1.9)cm.There were 16 cases of simple EPC,9 cases of EPC with ductal carcinoma in situ(DCIS),and 32 cases of EPC with infiltration.The molecular classification was mainly luminal(55/57,96.6%),of which 38 cases were Luminal A type and 17 cases were Luminal B type.The majority ultrasound images of EPC showed nodules with size greater than 2 cm(68.4%),regular morphology(64.9%),edge finishing(54.4%),no burr forming angles(82.5%),and no calcification(93%).There were differences between different subtypes.The simple EPC was closer to the nipple than the EPC with infiltration,with regular shape and smooth edge(P<0.05).Compared with the EPC with DCIS,the EPC with infiltration had richer blood flow and was farther away from the nipple(P<0.05).There was no significant difference between the simple EPC and the EPC with DCIS(P>0.05).Conclusion The simple EPC often showed benign signs on ultrasound,such as regular morphology,smooth edge,and cystic-solid internal structure.If the distance between the lesion and the nipple was greater than 3 cm,the shape was irregular,and the edge was blurred,the possibility of EPC with infiltration was high.Multi-modality image fusion was helpful for accurate diagnosis and treatment of EPC.

关 键 词：乳腺肿瘤 包裹性乳头状癌 超声 亚型 

分 类 号：R737.9[医药卫生—肿瘤]