钼靶X线征象与不同类型乳腺癌关系的病理基础研究

目的:探讨不同类型乳腺癌的X线表现与其病理基础之间的关系。方法:经乳腺X线检查,手术、病理证实的乳腺癌36例,共36个病灶,包括浸润性导管癌26个,导管内癌及导管内癌伴微浸润7个,浸润性小叶癌2个,黏液腺癌伴浸润性导管癌1个。观察乳腺癌的X线表现,与病理分型对照。结果:①癌灶的X线表现有肿块者23个(63.9%),有钙化者18个(50%),有结构扭曲者3个(8.3%);②呈肿块表现的以浸润性导管癌为主,占87.9%;有钙化者易出现在导管内癌和浸润性导管癌中,分别占87.5%、42.3%,尤其单纯钙化多出现在导管内癌中(71.4%,5/7);结构扭曲可见于浸润性导管癌和导管内癌中,其它类型未见。结论:肿块、钙化和结构扭曲为乳腺癌的主要X线表现。浸润性导管癌占乳腺癌的大部分,除单纯钙化首先考虑导管内癌,其余征象均首先考虑浸润性导管癌;肿块改变尚要想到髓样癌和黏液腺癌的可能;结构扭曲也可出现在导管内癌中。     

乳腺癌61例X线表现及病理对照分析

目的探讨和分析乳腺癌的钼靶X线影像特点及其病理基础,提高乳腺癌的X线诊断水平。方法回顾性分析研究61例经乳腺钼靶X线摄影检查、手术及病理证实的乳腺癌患者的X线表现。结果①61例患者中,单纯肿块41例,肿块伴钙化13例,单纯钙化8例,结构扭曲5例,结构扭曲伴钙化4例,局灶性致密影5例,磨玻璃样改变1例,阴性1例。②有钙化者多见于浸润性导管癌和导管原位癌,有肿块者多见于浸润性导管癌、粘液腺癌和髓样癌,结构扭曲者和局部致密性影多见于浸润性导管癌。结论①乳腺癌常见的X线表现为单纯肿块、钙化伴肿块、单纯钙化和结构扭曲。②浸润性导管癌占乳腺癌的大部分,乳腺癌的病理基础不同,导致了不同类型的X线表现。③X线摄影对乳腺癌有很高的诊断价值,尤其对临床检查阴性的患者,但对致密性乳腺还是有一定的局限性。     

乳腺导管癌的X线表现及其病理基础

目的:分析乳腺导管癌的X线表现及其病理基础,提高对其认识.方法:搜集经手术病理证实的乳腺癌57例,包括浸润性导管癌45例,导管原位癌12例,观察X线表现并与病理结果对照.结果:①X线表现为肿块35例,钙化22例,结构致密或扭曲13例;35例肿块除2例显示边界清晰的良性征象外,其他均为恶性边缘征象的肿块;典型恶性钙化多见(18/22),且钙化除单纯钙化外可同时伴发肿块或结构致密.②45例浸润性导管癌主要表现为肿块34例,结构致密或紊乱10例,以上两者伴钙化10例.③12例原位导管癌中全部表现为典型恶性钙化,且单纯钙化均出现于原位导管癌而未见于浸润性导管癌中.结论:乳腺导管癌的常见X线表现为肿块、钙化和结构致密,单纯钙化首先考虑原位导管癌,其余征象均首先考虑浸润性导管癌.     

乳腺癌的X线表现及病理基础

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     

乳腺浸润性导管癌的钼靶X线表现与病理对照研究

目的：分析乳腺浸润性导管癌的钼靶X线表现的病理基础。方法：回顾性分析86例浸润性导菅癌并与病理分型对照。结果：浸润性导管癌最常见的钼靶X线表现为不规则高密度肿块影、边缘毛刺状72例、伴钙化（28例）；局部腺体密度增高影5例；单纯泥沙样钙化堆9例。结论：不规则高密度肿块影及肿块边缘毛刺、微小钙化，在判断浸润性导管癌的病理分型及伴有纤维增生，具有显著意义。在一定程度上可为临床治疗方法的选择提供参考。     

乳腺癌钼靶X线征象分析(附114例报告)

目的探讨乳腺癌钼靶X线表现、X线分型和病理关系,以提高乳腺癌诊断水平。方法收集经手术病理证实、有完整影像资料的乳腺癌114例,回顾分析其钼靶X线征象及与病理关系。结果乳腺癌分5型:肿块型34例,肿块伴钙化型27例,钙化型28例,结构异常型21例,隐匿型4例。浸润性导管癌最多,占61.4%,其次是单纯癌,占20.1%。结论肿块型、肿块伴钙化型和钙化型乳腺癌钼靶X线表现具有特征性,乳腺钼靶X线摄影能明确诊断。结构异常型乳腺癌X线表现不典型,认识其X线征象,可明显提高乳腺癌的影像诊断率。     

乳腺癌钼靶X线表现特征(118例分析)

目的：探讨乳腺癌的钼靶X线诊断价值。方法：回顾性分析经手术病理证实的118例乳腺癌的钼靶X线表现。结果：浸润性导管癌70例（59．3％）,导管原位癌17例（14．4％）,黏液腺癌7例（5．9％）,髓样癌5例（4．2％）,微小癌1例,其他类型癌18例。X线表现为肿块的80例（68．6％）,微钙化57例（48．3％）。肿块伴钙化31例（31／118,26．3％）,仅见微钙化13例（13／118,11％）,结构扭曲伴微钙化7例,局灶性致密伴钙化6例,仅表现为结构扭曲6例,异常血管影41例（34．7％）。结论：微钙化是导管原位癌常见的基本X线征象。结构扭曲和局灶性致密是乳腺癌容易忽略的特殊X线表现。异常血管影是乳腺癌重要合并征象。使用点压技术是提高X线诊断率的重要手段。     

相位对比乳腺钼靶成像对乳腺癌的诊断价值

目的:探讨相位对比乳腺钼靶成像(phase-contrast mammography,PCM)对乳腺癌的诊断价值。方法:回顾性分析经手术病理证实的115例乳腺癌的PCM表现。结果:115例乳腺癌中,浸润性导管癌92例,导管原位癌7例,黏液腺癌5例,髓样癌7例,浸润性小叶癌4例。X线表现为单纯钙化8例(6.96%),单纯肿块51例(44.35%),钙化伴肿块44例(38.26%),结构扭曲2例(1.74%),局灶性致密9例(7.83%),弥漫性分布1例(0.87%)。按照BI-RADS分类诊断标准,本组乳腺癌术前诊断符合率为94.78%(109/115)。结论:PCM有助于微钙化及不典型肿块等的检出。钙化、肿块和结构扭曲是乳腺癌的常见征象;大导管相及血管异常是乳腺癌的特殊征象;乳头内陷、腋窝淋巴结肿大等为常见的合并征象。     

浸润性非特殊型乳腺癌的钼靶X线表现与病理对照分析

目的:分析不同组织类型浸润性非特殊型乳腺癌(NSIBC)的钼靶X线征象,并与肿瘤的组织类型对照分析。材料和方法:回顾性分析65例NSIBC的钼靶X线征征象及组织学表现。并通过X线征象推测其组织学类型。结果:具有诊断价值的征象:髓样癌为无钙化的边界清楚肿块,浸润性导管癌为短棒样钙化及大导管相,单纯癌包括带有毛刺的边界不清的肿块、沙粒样钙化、皮肤增厚及乳头内陷。浸润性小叶癌的表现缺乏特征性。结论:不同组织类型的NSI-BC具有不同的X线特征,依据X线特征可初步判断NSIBC的组织类型。     

溢液性乳腺癌的乳腺导管造影表现及病理基础

目的:分析溢液性乳腺癌的乳腺导管造影表现及其病理基础,为临床提供可靠的诊断依据,以提高早期乳腺癌的诊治水平。方法:临床表现为乳头溢液并经手术、病理证实的乳腺癌患者26例,回顾性观察其乳腺导管造影表现,并与病理结果对比分析。结果:26例中,导管原位癌8例;浸润性导管癌5例;导管原位癌伴早期浸润7例;复合型癌3例,其中导管原位癌合并浸润性小叶癌2例,浸润性导管癌合并浸润性小叶癌1例;导管内乳头状瘤病癌变3例,其中乳腺X线平片未发现异常5例,毛刺或分叶状肿块2例,肿块伴钙化9例,多形性钙化灶10例。乳腺导管造影主要表现:导管内充盈缺损伴有不同程度导管扩张;导管管壁浸润破坏对比剂渗漏,形成"潭湖征";导管管壁不规则,呈"虫蚀样"改变或"断续征"。本组乳腺导管造影诊断乳腺癌的符合率为88.4%。结论:乳腺导管造影是溢液性乳腺癌诊断的安全而有效的检查方法,具有很高的定性、定位诊断价值,尤其对临床触诊阴性的早期乳腺癌能作出较准确的诊断,提高了早期乳腺癌的检出率。     

Bilateral breast carcinomas: do they have similar mammographic features?

AIMS: This study compared the mammographic appearance, site and histological features of synchronous and metachronous bilateral breast carcinomas. METHODS: Site, type of abnormality and background pattern seen on the diagnostic mammograms of 63 women with bilateral breast carcinoma were compared. The histological type and grade of all the carcinomas were verified by histological review. RESULTS: There was a tendency for the contralateral tumour to have similar mammographic features to those of the initial tumour. In patients in whom the first carcinoma was visible purely as a mass, the contralateral carcinoma had a similar appearance in 82% (P < 0.001). When the original tumour showed mammographic calcification the contralateral tumour did so in 65% (P< 0.001). Normal mammography or calcification alone were seen almost exclusively in women with a dense background pattern (100% and 92% respectively) while masses and calcification with masses were seen in women with dense and fatty patterns (58% and 35% dense respectively). When the mammographic site of the contralateral tumour was compared with that of the first tumour no significant correlation could be demonstrated. There was a significant trend for contralateral carcinomas to be of the same histological grade (P < 0.005) but not histological type. CONCLUSIONS: Contralateral carcinomas often have a similar mammographic appearance to the first tumours. Two factors may be responsible: (i) the tendency for contralateral carcinomas to be of the same histological grade and (ii) the influence of mammographic background pattern on the radiological appearance of breast carcinoma. This knowledge may assist in the interpretation of follow-up mammography in patients with a previous breast carcinoma.     

乳腺黏液腺癌X线摄影表现与病理对照分析

目的探讨乳腺黏液腺癌X线摄影表现的病理学基础。方法回顾性分析30例乳腺黏液腺癌（单纯型19例,混合型11例）的X线摄影表现,并分析其病理特点。结果①乳腺黏液腺癌最常见的x线表现为肿块（25例）,伴或不伴钙化。少见征象为局部不对称性致密影伴钙化（5例）;②单纯型黏液腺癌X线表现多为边缘小分叶,混合型黏液腺癌X线摄影多表现为边缘浸润,两者差异有统计学意义;③肿块的形状、大小、密度情况在判断黏液腺癌的病理分型上无统计学意义。结论不同亚型的乳腺黏液腺癌的X线摄影表现不完全一致,单纯型黏液腺癌最常见的表现为边缘小分叶的肿块,较少伴钙化;混合型黏液腺癌最常见的表现为边缘浸润的肿块,多伴细小、多形性钙化。     

Tubular carcinoma of the breast: mammographic and sonographic features

OBJECTIVE: The purpose of this study was to define specific mammographic and sonographic features of tubular carcinoma of the breast. MATERIALS AND METHODS: Seventeen pathologically confirmed cases of tubular carcinoma were characterized retrospectively by two radiologists. Mammograms and sonograms were available for all patients. RESULTS: Fifteen of the 17 tubular carcinomas appeared as irregularly shaped masses with spiculated margins on mammography. Sixteen of the 17 masses had central densities. Spicules longer than the diameter of the central lesion were noted in eight (53%) of 15 tubular carcinomas. Eight tubular carcinomas had associated calcifications, with calcifications suspected of being malignant in four cases. On sonography, 15 hypoechoic masses were seen. The margins of the masses on sonography were described as ill-defined in 14 (93%) of the 15 cases. Posterior acoustic shadowing was present in 14 of the 15 cases. CONCLUSION: Tubular carcinomas are usually seen on mammography as irregularly shaped masses with central densities and spiculated margins, and most tubular carcinomas can be identified on sonography as hypoechoic masses with ill-defined margins and posterior acoustic shadowing. Although the mammographic and sonographic features of tubular carcinoma are not sufficiently specific to differentiate tubular carcinomas from radial scars, sonography can be useful for guiding biopsies and evaluating for multifocal and multicentric disease.     

乳管内乳头状瘤临床X线表现与病理对照分析

目的：探讨乳头状瘤Ｘ线平片、导管造影的Ｘ线表现及其与临床、病理的关系。材料与方法：回顾性分析２１例乳管内乳头状瘤的临床特点,乳房Ｘ线平片,导管造影表现及病理改变;并根据病变大小、形态,病变处导管形态及二者的关系,在导管造影片上进行Ｘ线分型且与病理改变进行对比。结果：２１例均有单个乳孔溢液,血性１８例,乳晕区触及肿块３例。乳房Ｘ线平片示乳晕下区肿块４例,左乳晕下区扩张导管１例。导管造影：２１例均示导管内充盈缺损,其中１９例并导管扩张。管内型９例,囊内型９例,实体型３例。Ｘ线表现与病理改变一致。结论：乳管内乳头状瘤最常见的临床表现是单个乳孔溢液,乳腺Ｘ线平片征象少;导管造影特点是管内充盈缺损,对乳头状瘤具有确诊价值。     

乳腺黏液癌的钼靶X线表现及病理分子生物学特点

目的：研究乳腺黏液癌钼靶X线表现及病理、分子生物学特点。方法：对21例乳腺黏液癌进行回顾性分析,总结其钼靶X线表现、病理基础,免疫组化检测P53、雌激素受体（ER）、孕激素受体（PR）、c-erbB-2表达状态。结果：钼靶X线表现：肿块16例,仅表现为钙化2例;结构变形3例。病理：单纯型15例,混合型6例。21例中,P53阳性8例、阴性13例;ER阳性16例、阴性5例;PR阳性18例、阴性3例。结论：乳腺黏液癌钼靶X线表现具有不同病理基础,分子生物学特点提示其预后较好。本研究为探讨其X线表现与病理学、分子生物学之间的相关性提供了参考。     

Metaplastic carcinoma of the breast: clinical,mammographic, and sonographic findings with histopathologic correlation

OBJECTIVE: The purpose of this study was to investigate the mammographic and sonographic findings of metaplastic carcinoma of the breast and to correlate the radiologic features with clinical and histopathologic findings. CONCLUSION: Metaplastic carcinoma of the breast often manifests as a rapidly growing, palpable mass that has high density on mammography and may be microlobulated on sonography. Complex echogenicity with solid and cystic components may be seen sonographically and is related to necrosis and cystic degeneration found histopathologically. Although it is a rare breast malignancy and these features are not unique, metaplastic carcinoma should be included in the differential diagnosis for breast masses with these imaging features.     

Mucinous (colloid) breast cancer: mammographic and US features with histologic correlation

OBJECTIVE: Mucinous carcinoma of the breast presents with different survival rates in pure and mixed types. The purpose of this study was to correlate the mammographic and ultrasonographic findings of mucinous carcinoma with histologic features in different types and mucin rates. MATERIAL AND METHODS: Thirty-four patients (2.3%) had mucinous cancer after retrospective review of the 1439 breast cancers diagnosed between 1990 and 1996. Twenty-seven patients, 19 pure and eight mixed type of mucinous carcinomas of the breast, were included in this study to evaluate the imaging findings. In 22 of these, the microscopic slides were available and re-evaluated to estimate the volume of extracellular mucin. The volume of the extracellular mucin was classified histologically as: (+), less than 50% of mucin; (++), 50-80% of mucin; and ( ), more than 80% of mucin. Mammographic features with emphasis on margin characteristics and sonographic echo pattern of tumors were correlated with histologic findings. RESULTS: Ten cases (53%) of pure mucinous type carcinomas had a circumscribed mass lesion on the mammograms. The well-defined, lobulated margins of the masses were well correlated with pure histologic type (P<0.01; chi(2) analysis) Two-thirds of these tumors had high volume extracellular mucin. All mixed type mucinous carcinomas demonstrated poorly defined or spiculated margins with no relation to the mucin rates (P<0.01). The sonographic appearances of the tumors showed correlation with histologic types. Most of the pure type carcinomas (53%) were seen with isoechogenic echo texture relative to that of subcutaneous fat, while all of the mixed type carcinomas were hypoechogenic (P<0.01). CONCLUSION: The mammographic and sonographic features of mucinous breast carcinoma show differences in pure and mixed types of the tumor. The most common mammographic appearance of pure mucinous carcinomas with high percentages of mucin is a mass lesion having well-defined margins, which is isoechogenic relative to fat on the sonographic examination. Pure type of carcinomas with small percentages of mucin and mixed type carcinomas have more aggressive imaging characteristics.     

Local tumor recurrence following breast-conservation therapy: correlation of histopathologic findings with detection method and mammographic findings.

PURPOSE: To correlate histopathologic findings with detection method and mammographic appearance in primary and locally recurrent breast carcinoma after breast-conservation therapy. MATERIALS AND METHODS: Medical records and mammographic findings were retrospectively reviewed; 26 patients with 27 local recurrences after breast-conservation therapy were identified. RESULTS: Primary histopathologic findings included six in situ and 20 invasive carcinomas. Of the 27 recurrences, 19 (70%) were at or adjacent to the lumpectomy site and eight (30%) were elsewhere in the breast. All primary ductal carcinoma in situ (DCIS) cases manifested mammographically as microcalcifications and recurred as DCIS with microcalcifications. Eleven primary invasive carcinomas (10 masses, one case of microcalcifications) were detected only mammographically, three were detected only with physical examination, and six (six masses) were detected with both. Among these 20 recurrences, 14 (five masses, nine cases of microcalcifications) were detected only mammographically, one was detected only with physical examination, and five (five masses) were detected with both. Seventeen (85%) of 20 primary invasive carcinomas recurred invasively: 16 (94%) with similar histopathologic findings and eight (47%) with similar mammographic findings. CONCLUSION: In local recurrence after breast-conservation therapy for DCIS, histopathologic findings, detection method, and mammographic findings are usually similar. Histopathologic findings of primary invasive breast carcinoma and local recurrence are usually similar, but the detection method and mammographic findings vary. This is relevant to the interpretation of new clinical or mammographic findings following lumpectomy.     

乳腺癌X线表现特征与C-erbB-2表达的相关性研究

目的:分析乳腺癌X线特征与C-erbB-2表达的相关性。材料和方法:回顾性分析经乳腺X线摄影以及手术病理证实的160个乳腺癌,将X线所见按照ACR创立并推荐的BI-RADS,分为肿块(大小、边缘、形态),钙化(分布、形态)进行描述,并与C-erbB-2的表达进行对照,分析其相关性。结果:乳腺癌C-erbB-2的阳性表达与单纯钙化有显著的相关性,C-erbB-2阳性表达的X线特征为单纯钙化。结论:乳腺癌X线表现的某些特征与C-erbB-2的表达具有显著的相关性,根据X线表现可以大概推测C-erbB-2的表达情况。     

Focal fibrosis of the breast: imaging characteristics and histopathologic correlation

PURPOSE: To characterize mammographic and ultrasonographic (US) features of focal fibrosis of the breast (FFB), to compare the radiologic and histopathologic findings, to investigate the incidence of FFB, and to determine if histopathologic diagnosis of FFB is an acceptable diagnosis for specific mammographic and US findings. MATERIALS AND METHODS: Retrospective review of findings from 1,268 surgical excisional and 796 percutaneous breast biopsies (290 US-guided, 370 stereotactically guided, and 136 vacuum-assisted stereotactically-guided) revealed 44 (2.1%) diagnoses of FFB. Mammographic and US features were correlated with histopathologic types. RESULTS: Thirty-seven (84%) of the 44 lesions diagnosed as FFB were visualized on mammograms and appeared as six (14%) circumscribed masses, two (5%) lobulated masses, one (2%) microlobulated mass, 11 (25%) obscured masses, two (5%) architectural distortions, and 15 (34%) asymmetric densities. Seven palpable lesions were not visualized on mammograms. Thirty-three of the 44 lesions were evaluated at US; 25 (76%) of 33 were visible. Twenty (80%) of 25 were well-defined hypoechoic masses; three (12%), ill-defined masses; and two (8%), marked shadowing without visible mass. At histopathologic examination, 17 (39%) of the 44 lesions were characterized as mass-like fibrosis; 14 (32%), as nodular fibrosis; 12 (27%), as haphazard fibrosis; and one (2%), as septal fibrosis. Histopathologic type and specific imaging findings did not correlate statistically. CONCLUSION: FFB is a histopathologic entity that has a wide spectrum of imaging findings. It is an acceptable histopathologic result of percutaneous breast biopsy, provided that careful radiologic-histopathologic clinical correlation is performed.