乳腺单纯性浸润性微乳头状癌超声表现及其与病理的关系

目的探讨乳腺单纯性浸润性微乳头状癌（PIMPC）超声表现及其与病理的关系。 方法选取2010年1月至2015年8月福建医科大学附属协和医院收治并经手术病理证实18例乳腺PIMPC患者共18个病灶与40例乳腺浸润性导管癌（IDC）患者共40个病灶。对比观察乳腺PIMPC与IDC的超声表现，并与病理结果进行对照。采用χ²检验及Fisher确切概率法比较乳腺PIMPC与IDC超声声像图特征差异；采用χ²检验比较乳腺PIMPC与IDC淋巴结转移率；以术后病理结果作为金标准，计算超声检查提示乳腺PIMPC淋巴结转移的敏感度、特异度、准确性、阳性预测值、阴性预测值。 结果18个乳腺PIMPC病灶（100%，18/18）表现为低回声；18个病灶（100%，18/18）形态不规则；16个病灶（88.9%，16/18）边界不清；16个病灶（88.9%，16/18）边缘毛刺；15个病灶（83.3%，15/18）内部见钙化灶，微钙化灶数量一般大于3个，且多集中分布在病灶近中央的位置，而病灶边缘分布较少；16个病灶（88.9%，16/18）后方回声正常或增强；14个病灶（77.7%，14/18）边缘无蟹足状改变；13个病灶（72.2%，13/18）周围无高回声晕；10个病灶（55.6%，10/18）血流信号0~Ⅰ级。乳腺PIMPC病灶边缘蟹足状改变、周围高回声晕、纵横比≥0.7、后方回声衰减、血流信号Ⅱ~Ⅲ级的检出率均低于乳腺IDC，且差异均有统计学意义，二者病灶最大径、形态、边界、边缘毛刺、微钙化灶等超声声像图特征差异均无统计学意义。病理检查示PIMPC癌细胞微乳头状排列呈集块型分布；PIMPC血流信号0~Ⅰ级为主，镜下见肿块少量新生血管主要在细胞簇周围的透明带；而IDC血流信号以Ⅱ~Ⅲ级为主，镜下可见较多再生血管分布在胶原纤维；PIMPC缺乏周围高回声晕，其镜下见肿块边缘无纤维组织簇包饶，IDC周围常见高回声晕其镜下肿块边缘见较多的纤维组织。术后病理结果证实乳腺PIMPC淋巴结转移率达72.2%（13/18），高于乳腺IDC的45.0%（18/40）（χ²=3.697，P=0.05）。术后病理结果证实13个病灶淋巴结转移，其中超声检查提示淋巴结异常6个（46.2%，6/13），表现为皮髓质结构异常4个（30.8%，4/13）、淋巴门偏心4个（30.8%，4/13），血流信号0~Ⅰ级5个（38.5%，5/13）。以术后病理结果作为金标准，超声检查提示乳腺PIMPC淋巴结转移的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为46.2%、60.0%、50.0%、75.0%、30.0%。 结论乳腺PIMPC超声表现以形态不规则、边界不清、边缘毛刺及内部微钙化灶为主要特征，其超声表现与其特殊的病理特点有密切关系。超声检查对于提示PIMPC患者腋窝淋巴结转移具有一定价值。

Ultrasonic findings of pure invasive micropapillary carcinoma of the breast and its relationship with pathology

ObjectiveTo investigate ultrasonic findings of pure invasive micropapillary carcinoma (PIMPC) of breast. MethodsA total of 18 patients with surgically confirmed PIMPC and 40 patients with surgically confirmed invasive ductal carcinoma (IDC) treated between January 2010 and August 2015 in Affiliated Union Hospital of Fujian Medical University, who had undergone preoperative ultrasound examination, were included in the study. To compared with the postoperative pathological examination, the value of ultrasonography in the diagnosis of axillary lymph node metastasis was discussed. Ultrasound findings of PIMPC and pathological results were compared. ResultsUltrasound analysis of PIMPC masses identified predominantly hypoechoic lesions and irregular shape 100% (18/18), obscure lesion boundaries 88.9% (16/18), spiculated or angular margins 83.3% (15/18), combined microcalcifications 83.3% (15/18), with posterior acoustic enhancement or normal 88.9% (16/18), dcrab claws changes 77.7% (14/18), witout hyperechoic halo72.2% (13/18) and with 0-?Ⅰ grade flow signals 55.6% (10/18). Compared to the IDC, the PIMPC had lower proportions in long speculation, hyperechoic halo, aspect ratio≥0.7, posterior echo attenuation, Ⅱ-Ⅲ grade blood flow signals (P<0.05), while their lesions in the maximal tumor size, shape, boundary, edge bur, microcalcification has no significance (P>0.05). The rate of lymph node metastasis of PIMPC was 72.2% (13/18), which was significantly higher than that of IDC 45.0% (18/40) (t=3.697, P=0.05). 13 cases were pathologically confirmed lymph nodes metastasis in 18 cases, and among them, the ultrasound indicated abnormal 46.2% (6/13), and showed abnormal cortex and medulla structure 30.8% (4/13), eccentric lymph door 30.8% (4/13), poor blood flow signals 38.5% (5/13). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PIMPC lymph node metastasis by preoperative ultrasound were respectively 46.2%, 60.0%, 75.0%, 30.0%, 50.0%. Ultrasound performance of PIMPC has a certain relationship with its special pathological characteristics. Sonography findings were compared with pathological results: Microscopically, PIMPC cell arranged as pseudo-papillary or tubuloalveolar structures floating in empty spaces; PIMPC with 0-Ⅰ grade flow signals were seen that the small amount of new blood vessels of the tumor were mainly found in the pellucid zone around the cell clusters under the microscope, while IDC with Ⅱ-Ⅲ grade blood flow signals were found that more regenerated blood vessels were distributed in the collagen fibers. PIMPC witout hyperechoic halo were noticed that under the microscope, there were no fibrous tissue clusters in the edge of the tumor, meanwhile, IDC with hyperechoic halo were discovered that fibrous tissue was seen at the edge of the mass of the lens. ConclusionsUltrasound performance of PIMPC has a close relationship with its special pathological characteristics. To be familiar with ultrasound characteristic of PIMPC is significant for improving its ultrasound detection rate.