乳腺癌的X线表现及病理基础  

Mammographic features of breast carcinoma: mammographic-pathologic correlation

作　　者：顾雅佳[1] 周康荣[2] 陈彤箴[3] 王玖华[1] 张廷璆[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放射病理科,上海200032

出　　处：《中华放射学杂志》2003年第5期439-444,共6页Chinese Journal of Radiology

摘　　要：目的　分析常见乳腺癌的X线表现及其病理基础。方法　经乳腺X线检查 ,手术、病理证实的乳腺癌灶 397个 ,包括浸润性导管癌 2 97个、导管原位癌及导管原位癌伴微浸润 38个、黏液腺癌 2 1个、髓样癌 2 2个和浸润性小叶癌 19个。观察乳腺癌的X线表现 ,与病理分型、分级对照。结果　 ( 1)癌灶的X线表现为有钙化者 170个 ( 42 8%) ,有肿块者 2 5 8个 ( 6 5 0 %) ,有结构扭曲者 33个( 8 3%)。 ( 2 )有钙化者易出现在导管原位癌和浸润性导管癌中 ( χ2 =30 90 ,P <0 0 0 1) ,尤其单纯钙化多出现在导管原位癌中 ( 6 5 8%,2 5 / 38)。 ( 3)呈肿块表现的多见于髓样癌 ( 90 9%,2 0 / 2 2 )和黏液腺癌 ( 81 0 %,17/ 2 1) ,与其他乳腺癌相比差异有非常显著意义 ( χ2 =30 87,P <0 0 0 1)。肿块伴钙化 99个 ,在各病理类型乳腺癌中均可见 ,但当钙化颗粒 >10枚 ( χ2 =11 47,P <0 0 0 1)或钙化灶直径≥ 3cm(Fisher法精确 χ2 检验 ,P =0 0 2 3 7)则多见于导管原位癌和浸润性导管癌。单纯肿块改变 15 9个病灶 ,各类乳腺癌的边缘改变不完全相同 ( χ2 =34 82 ,P <0 0 5 )。 ( 4)结构扭曲伴钙化仅见于浸润性导管癌 ,单纯结构扭曲见于浸润性导管癌和浸润性小叶癌 ,其他类型未见。 ( 5 )对浸润性导管癌 ,Ⅰ、Ⅱ级?Objective To analyze the mammographic features of breast carcinoma and the correlation between the mammographic and pathologic findings. Methods A prospective study of 397 consecutive mammograms in patients with breast carcinoma, including infiltrating ductal carcinoma (IDC, n=297), ductal carcinoma in situ (DCIS) and DCIS associated with small invasive foci (n=38), mucinous carcinoma (n=21), medullary carcinoma (n=22) and invasive lobular carcinoma (n=19), was performed to determine the correlations between the mammographic and pathologic findings. Results (1)Microcalcifications appeared in 170 cases (42.8%), a mass in 258 cases (65.0%), and distortion in 33 cases (8.3%), respectively. (2) Microcalcifications were more commonly associated with DCIS and IDC (χ2=30.90, P<0.001), and microcalcifications alone were most commonly seen in DCIS (65.8%). (3) Masses were more commonly associated with medullary (90.9%) and mucinous carcinoma (81.0%). The statistically significant difference was seen in comparison with the other types of breast carcinoma (χ2=30.87, P<0.001). Masses with microcalcifications (99 cases)appeared in all kinds of breast carcinoma. The number of microcalcification more than 10 or the extent of microcalcification distribution greater than 3 cm was significantly more likely to appear in both DCIS and IDC than in the other types of breast carcinoma (P<0.001 and P=0.023 7, respectively). Mass alone appeared in 153 cases, the margins of all types of breast carcinoma were not the same (χ2=27.40, P<0.001). (4) Distortion with microcalcifications was only seen mammographically in IDC, and distortion without microcalcifications was seen in both IDC and invasive lobular carcinoma. (5) Grade I and grade Ⅱ IDC were more likely to be associated with distortion (χ2=6.22, P<0.05), and grade Ⅲ IDC was more likely to be associated with a mass when findings were seen on mammogram(χ2=7.19, P<0.01). Conclusion The common features of breast carcinoma in mammography were microcalcifications, microcal

关 键 词：乳腺癌 X线检查 病理类型 钙化 肿块 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]