钼靶X线对检出早期乳腺癌中广泛的导管内成分的作用  

Mammographic features at predicting the presence of an extensive intraductal component in early stage breast carcinoma: mammographic-pathologic correlation

作　　者：顾雅佳[1] 周康荣[2] 张廷璆[3] 王玖华[1] 陈彤箴[3] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,上海200032 [2]复旦大学附属中山医院放射诊断科 [3]复旦大学附属肿瘤医院病理科,上海200032

出　　处：《中华放射学杂志》2003年第4期317-321,共5页Chinese Journal of Radiology

摘　　要：目的　评价钼靶X线对检出广泛的导管内成分 (EIC)的作用 ,为临床治疗提供参考。方法　经钼靶X线检查 ,手术、病理证实的Ⅰ、Ⅱ期乳腺癌 340例 348个病灶 ,包括浸润性导管癌2 97个、导管原位癌伴微浸润 8个、黏液腺癌 2 1个和髓样癌 2 2个。观察钼靶X线表现 ,与病理有无EIC对照。结果　 (1)浸润性乳腺癌EIC阳性较EIC阴性在钼靶X线片上显示钙化病灶的比例高(6 6 4 %、2 0 4 % ,χ2 =75 2 9,P <0 0 0 1)。尤其当表现为单纯钙化时 ,这种差别就更明显 (2 1 1%、2 0 % ,χ2 =5 2 5 6 ,P <0 0 0 1)。 (2 ) 5 4 6 % (10 7个 )的单纯肿块和 19 4 % (38个 )的临床扪及肿块而钼靶X线阴性的较易出现在浸润性乳腺癌EIC阴性中 ,与分别为 2 5 0 % (38个 )和 5 9% (9个 )出现在EIC阳性病例的比较差异有非常显著意义 (两者 χ2 值分别为 30 84和 13 2 9,P值均 <0 0 0 1)。(3)结构扭曲伴或不伴钙化对判断EIC差异无显著意义 (χ2 =1 84 ,P >0 0 5 )。 (4)阳性预测值统计显示 ,单纯钙化和钙化灶最大径≥ 3cm预示着浸润性乳腺癌有 88 9%和 95 8%的可能为EIC阳性 ,肿块伴钙化为 6 7 8%。相反 ,钼靶X线片上显示为钙化颗粒 <10枚或钼靶X线片为阴性 ,而临床扪及肿块时对EIC阴性的阳性预测值分别为 96 6 %和 80 9%Objective To evaluate the value of mammographic findings at predicting the presence of an extensive intraductal component (EIC), a major factor in determining breast conserving surgery Methods A prospective study of 348 consecutive mammograms in patients with stage Ⅰ or Ⅱ breast carcinoma, including infiltrating ductal carcinoma ( n =297), ductal carcinoma in situ (DCIS) associated with small invasive foci ( n =8), mucinous carcinoma ( n =21), and medullary carcinoma ( n =22), was performed to determine the predictive value of mammographic features in evaluating the presence or absence of an EIC Results (1) EIC+ cancers were significantly more likely to show the lesion with microcalcifications in comparing with EIC- cases (66 4% vs 20 4%, χ 2=75 29, P <0 001) In particular, the presence of microcalcifications alone was more common for EIC+ cancers than for EIC- cancers (21 1% vs 2 0%, χ 2=52 56, P <0 001) (2) 54 6% of patients in whom mammograms showed only a mass and 19 4% of patient with a palpable mass clinically but normal mammograms were seen in EIC- cases, compared with 25 0% and 5 9% respectively of EIC+ cases(both P <0 001) (3) Distortion with or without microcalcifications had no significant difference in predicting the presence or absence of an EIC ( P >0 05) (4) Positive predictive value calculations showed that the presence of microcalcifications alone and the extent of microcalcification distribution greater than 3 cm conveyed a 88 9% and 95 8% likelihood that a cancer will be EIC+, respectively, and a mass with microcalcifications was 67 8% On the contrary, the positive predictive value of the number of microclcification less than 10 or normal mammograms but a palpable mass clinically for an EIC- cancer was 96 6% and 80 9%, respectively, and a mammographic mass was 73 8% Conclusion The mammographic findings may be useful preoperatively for the differentiation between patients with and without an EIC To some extent, the breast co

关 键 词：早期乳腺癌 导管内成分 钼靶X线诊断 钙化 结构扭曲 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]