乳腺浸润性导管癌的X线诊断

目的：分析乳腺浸润性导管癌的高频钼靶X线特征，提高术前X线正确诊断率。方法：回顾性分析经手术病理证实的41例乳腺浸润性导管癌的X线表现。结果：41例乳腺浸润性导管癌中，显示结节或肿块影35例，占85．37％，X线测量肿块大小比临床扪及小有31例，占显示肿块的病例88．57％；显示毛刺状改变23例，占56．1％；有微小钙化17例，占41．46％。结论：乳腺浸润性导管癌在X线上有特征性表现。乳腺高频钼靶X线检查在此病的早期诊断中有重要意义。     

乳腺浸润性导管癌X线表现

目的：分析乳腺浸润性导管癌Ｘ线钼靶检查特征,提高浸润性导管癌的影像学诊断水平。方法：１０５例乳腺浸润性导管癌经手术病理证实,分别摄乳腺Ｘ线钼靶轴、侧位及腋窝斜位片,观察浸润性导管癌影像学特征及腋窝淋巴结表现。结果：①肿块：边缘不规则,分叶、毛刺、星芒状及肿块周围细小结节等（９７．１％）;②钙化：细沙粒样、短小梭形、细条样呈团簇状（５１．４％）;③腋窝淋巴结肿大;形态不规则、分叶、边界不清、密度均匀     

Mammographic features of ductal carcinoma in situ (DCIS) present on previous mammography.

AIM: To review previous mammograms of women found later to have DCIS and identify features which may have been missed or misinterpreted as benign. METHODS: The previous mammograms of 50 women who developed DCIS were analysed. The mammographic features at diagnosis and on the prior mammograms were compared. RESULTS: 11 (22%) of the previous mammograms were in retrospect abnormal; 5 (45%) of these had previously been assessed for the abnormality. All showed microcalcification. The following features were commoner at diagnosis than on previous films; rod shaped calcification (64 vs. 27%, P = 0.03) and a ductal distribution of calcification (76 vs. 45%, P = 0.05). Predominantly punctate calcification (64 vs. 12%, P = 0.001) and less than 10 calcifications in the cluster (54 vs. 24%, P = 0.05) were more common on the previous films. No difference was found in the frequency of granular calcification, branching calcification, irregularity in density, size or shape of calcification between the two groups. CONCLUSION: Features of DCIS missed on previous mammography include small cluster size, less than 10 calcifications in the cluster, the absence of rod shaped calcifications, the absence of a ductal distribution and the presence of predominantly punctate calcification. Features frequently seen both at diagnosis and on previous films which might have allowed earlier diagnosis were granular calcifications which vary in size, density and shape in an irregularly shaped cluster. Focal clustered calcification deserves aggressive investigation.     

Mammographic pattern of microcalcifications in the preoperative diagnosis of comedo ductal carcinoma in situ: histopathologic correlation.

OBJECTIVE: The comedo subtype of ductal carcinoma in situ (DCIS) is more aggressive than noncomedo DCIS. Differentiating noncomedo DCIS from the more aggressive comedo subtypes on mammography would allow the surgeon to excise comedo DCIS with a wider margin. The mammographic features of microcalcifications associated with nonpalpable comedo DCIS, noncomedo DCIS and benign disease were compared to determine the usefulness of this finding in diagnosis of comedo DCIS. METHODS: The authors retrospectively and blindly reviewed the mammograms of 91 consecutive patients in whom DCIS was diagnosed by needle localization and surgical excision. An equal number of cases of benign microcalcifications were also reviewed. Microcalcifications were evaluated with respect to pattern, density, configuration and size. These results were correlated with the pathologic findings. RESULTS: All 16 cases (100%) of linear branching calcifications and 34 (80%) of the 43 cases of linear calcifications were associated with comedo DCIS (p < 0.001). The number of calcifications, the density and the size of clustering were not diagnostic of comedo DCIS. Granular calcifications occurred in noncomedo DCIS and in benign disease associated with noncalcifying DCIS. CONCLUSION: Comedo DCIS is suggested by the presence of linear and linear branching microcalcifications on mammography.     

Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision

OBJECTIVE: This investigation compares the frequency of histologic underestimation of breast carcinoma that occurs when a large-core needle biopsy reveals atypical ductal hyperplasia or ductal carcinoma in situ with the automated 14-gauge needle, the 14-gauge directional vacuum-assisted biopsy device, and the 11-gauge directional vacuum-assisted biopsy device. SUBJECTS AND METHODS: Evaluation of 428 large-core needle biopsies yielding atypical ductal hyperplasia (139 lesions) or ductal carcinoma in situ (289 lesions) was performed. The results of subsequent surgical excision were retrospectively compared with the needle biopsy results. RESULTS: For lesions initially diagnosed as ductal carcinoma in situ, underestimation of invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device when compared with the automated 14-gauge needle (10% versus 21%, p < 0.05) but was not significantly less frequent when compared with the 14-gauge directional vacuum-assisted device (10% versus 17%, p > 0.1). For lesions diagnosed initially as atypical ductal hyperplasia, underestimation of ductal carcinoma in situ and invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device compared with the 14-gauge directional vacuum-assisted device (19% versus 39%, p = 0. 025) and with the automated 14-gauge needle (19% versus 44%, p = 0. 01). CONCLUSION: The frequency of histologic underestimation of breast carcinoma in lesions initially diagnosed as atypical ductal hyperplasia or ductal carcinoma in situ using large-core needle biopsy is substantially lower with the 11-gauge directional vacuum-assisted device than with the automated 14-gauge needle and with the 14-gauge directional vacuum-assisted device.     

Pure ductal carcinoma in situ: a range of MRI features

OBJECTIVE: The purpose of this article is to describe and illustrate the variety of common morphologic features, enhancement patterns, and kinetics of pure ductal carcinoma in situ (DCIS) on dynamic contrast-enhanced MRI of the breast, using the American College of Radiology BI-RADS lexicon. CONCLUSION: Breast MRI plays an important role in the detection of DCIS, which most often appears as nonmass clumped enhancement, in a ductal or segmental distribution, with variable enhancement kinetics.     

Mammographic appearance of calcifications as a predictor of intraductal carcinoma histologic subtype

We reviewed 109 consecutive cases of intraductal carcinoma to evaluate the association between histologic subtype (comedo = 35, non-comedo = 71, mixed = 3) and calcification type, as assessed by histology (amorphous vs. crystalline) or by mammography (coarsely granular, irregular shape, linear, branching vs. fine granular, irregular, or more or less regular oval or circular forms). Calcifications were microscopically or mammographically detected in 90.8% and 76.1% of cases, respectively, and a significant association was found between microscopic (amorphous) and mammographic (coarse granular, linear, branching) calcified types and histologic comedo subtypes (P <0.001). Nevertheless, accurate prediction of the histologic subtype on the basis of mammographic calcifications occurred only in 78.3% of cases with calcifications, and in 59.6% of all cases. Mammography is not a reliable method to predict DCIS histologic subtype at the present time. Correspondence to: S. Ciatto     

US of ductal carcinoma in situ.

Little is known about the ultrasonographic (US) features of ductal carcinoma in situ (DCIS) of the breast because this entity usually manifests as pure mammographic calcifications and is rarely evaluated with US. US findings were recorded in 70 patients with DCIS and then analyzed and correlated with mammographic and histologic findings. A microlobulated mass with mild hypoechogenicity, ductal extension, and normal acoustic transmission was the most common US finding in DCIS. Spiculated margins, marked hypoechogenicity, a thick echogenic rim, and posterior acoustic shadowing at US often suggested the presence of invasion. US performed with a 10-13-MHz transducer and optimal technique can be used as a complement to mammography in detecting and evaluating DCIS of the breast, as it demonstrates breast lesions associated with malignant microcalcifications in most cases. The main benefit of identifying a US abnormality in women with mammographically detected DCIS is to allow the use of US to guide interventional procedures (eg, needle biopsy, needle localization). US may also be helpful in detecting DCIS without calcifications and in evaluating disease extent in women with dense breasts. Nevertheless, further research is needed to delineate the role of US in the evaluation of patients with DCIS.     

乳腺导管原位癌及其微浸润的磁共振成像评价

目的与X线片、超声检查比较，评价MPd对乳腺导管原位癌及其微浸润诊断的正确率和界定病灶范围的准确性。方法经手术病理证实、术前行乳腺MR检查的乳腺导管原位癌及导管原位癌伴微浸润连续病例17例，其中13例同时行X线检查、16例行超声检查。以病理资料作为金标准，作对照分析。结果（1）MR检查14例病灶有强化，11例表现为非块状强化，其中6例呈段样强化，2例呈区域性强化，导管样强化、多灶性局灶性强化、双乳大致对称的弥漫性强化各1例。这11例中有2例伴病变侧增强前的乳头后大导管扩张，其中1例增强后大导管强化，这2例均以乳头滴血为临床症状。2例块样强化表现为信号均匀、形态不规则的肿块。混合有肿块和非块样强化的1例，为信号均匀、边缘光整的卵圆形肿块伴肿块周围线样强化。（2）13例行X线检查，2例阴性；单纯钙化表现6例；钙化伴其他征象2例；非钙化病灶3例。8例含钙化的病灶中，恶性钙化5例，交界性钙化3例；钙化簇状分布5例，区域性分布2例，弥漫分布1例。（3）16例行超声检查，4例阴性，1例诊为良性病变，其余11例作出了正确的术前诊断，表现为不规则的低回声区内伴有点状的强回声改变。（4）以病理检查测量的大小作为金标准，对病灶范围界定方面MRI符合13例（13／17），高估2例；X线诊断符合7例（7／13），高估3例，低估1例；超声符合7例（7／16），高估2例，低估3例。差异无统计学意义（P=0．161）。结论乳腺导管原位癌及原位癌伴微浸润MRI表现具有特征性，联合X线和MR检查能提高其正确诊断。     

乳腺导管原位癌伴微浸润与导管原位癌的临床病理及X线表现对比分析

目的对比分析乳腺导管原位癌伴微浸润(DCISM)与导管原位癌(DCIS)的X线及临床病理表现及DCISM的预测因子。方法收集2016年1月至2020年7月在青岛大学附属医院经手术病理证实的DCISM及DCIS患者626例,患者术前均接受乳腺X摄影检查。参照乳腺影像报告和数据系统(BI-RADS)标准对DCISM与DCIS患者X线表现进行分类诊断。采用χ²检验或Fisher确切概率法分析DCISM与DCIS患者临床病理及X线表现的差异性,应用单因素和多因素二元logistic回归分析探讨与DCISM相关的危险因素。结果626例患者中,DCISM患者171例,DCIS患者455例。单因素回归分析表明,肿瘤直径≥2.7cm、高核级别、粉刺性坏死、淋巴结阳性、Ki67高表达、雌激素受体及孕激素受体阴性是DCISM的预测因子(P<0.05)。多因素回归分析显示,肿瘤直径≥2.7cm(OR 2.229,95%CI 1.505~3.301,P<0.001)、高核级别(OR 1.711,95%CI 1.018~2.875,P=0.043)、淋巴结阳性(OR 4.140,95%CI 1.342~12.773,P=0.013)是DCISM的独立预测因子(P<0.05)。乳腺X线摄影中,DCIS与DCISM患者的病变类型、有无钙化及钙化分布差异具有统计学意义(χ²分别为17.42、9.65、9.10,P<0.05),17.6%(80/455)的DCIS患者表现为隐匿性病变,49.1%(84/171)的DCISM表现为钙化伴肿块、非对称致密、结构扭曲。团簇状钙化多见于DCIS(41.5%,120/289),而区域性钙化在DCISM中更普遍(35.9%,47/131)。结论乳腺X线摄影表现为钙化性病变及区域性钙化在DCISM中更常见。肿瘤直径≥2.7cm、高核级别、淋巴结阳性是DCISM的独立预测因子。     

Mammographic features predicting an extensive intraductal component in early-stage infiltrating ductal carcinoma.

Several studies have shown that the presence of an extensive intraductal component in patients with infiltrating ductal carcinoma is a major factor for predicting local recurrence after breast-conserving surgery and radiotherapy. A prospective study of 101 consecutive mammograms in patients with stage I or II infiltrating ductal carcinoma was performed to determine the predictive values of mammographic features in determining the presence or absence of an extensive intraductal component. Thirty-five (35%) of the lesions contained a pathologically verified extensive intraductal component. Sixty-five percent (22/34) of lesions showing mammographic evidence of calcifications with or without a mass were associated with an extensive intraductal component (p less than .001). Lesions with calcifications greater than 3 cm in extent were significantly (p less than .05) more likely to have an extensive intraductal component (9/10; 90%) than those with calcifications less than 3 cm in extent (13/24; 54%). Only 17% (8/46) of patients in whom mammograms showed only a mass or architectural distortion and 24% (5/21) of patients who had a mass palpable clinically or who had normal findings on mammograms had lesions with an extensive intraductal component. We conclude that infiltrating ductal carcinomas associated with calcifications on mammography, especially if the calcifications are extensive, are likely to be associated with an extensive intraductal component. Carcinomas without calcifications that show masses or architectural distortion on mammography, or carcinomas with palpable masses and normal findings on mammography, are unlikely to have an extensive intraductal component.     

乳腺导管原位癌及微浸润的MR影像学表现

目的 总结乳腺导管原位癌及其微浸润的MR影像学表现.方法 回顾性分析经手术和病理证实的乳腺导管原位癌和微浸润病例30例.所有病例均于术前进行MR成像.结果 MR检出所有病例,敏感性为100％.10例呈肿块样强化(33.3％).20例呈非肿块样强化(66.7％).内部强化不均匀4例(20％),强化均匀2例(10％),内部卵石状强化和簇状小环状强化共11例(55％),另3例病灶呈点簇状强化(15％).所有病例时间-信号强度(TIC)曲线呈流出型12例,平台型18例.结论 乳腺导管原位癌及其微浸润的MR特征性表现为非肿块样强化并其内部卵石状及簇状小环状强化,时间-信号强度曲线呈平台型及流出型.     

Characteristics of ductal carcinoma in situ in magnetic resonance imaging

PURPOSE: The aim of this study was to evaluate typical dynamic and morphological characteristics of ductal carcinoma in situ (DCIS) in magnetic resonance imaging (MRI). An optimized diagnosis of DCIS is considered to be valuable for radiologists and clinicians, especially for early and successful treatment planning. MATERIALS AND METHODS: Magnetic resonance examinations of 74 patients with pure DCIS were evaluated. Categories were established for signal increase (C1=the same enhancement as glandular tissue; C2=slow and continuous; C3=strong initial and slow further increase; C4=strong initial increase and plateau phenomenon; and C5=strong initial increase followed by a washout phenomenon) and morphological findings (M0=no pattern observed; M1=linear or linear-branched; M2=segmental dotted or granular; M3=segmental homogenous; and M4=focal spotlike). All cases were associated with histopathological results. RESULTS: Regarding the 74 DCIS lesions, 37 (50%) showed a signal increase typical of malignancy (C4 and C5). Among all cases, 33.3% of G1 lesions, 68.4% of G2 lesions, and 55.5% of G3 lesions presented a C4 or C5 enhancement. Furthermore, 55.4% (n=41) showed a segmental dotted enhancement (M2), whereas 17.6% showed a focal spotlike enhancement (M4). The morphological features of the other lesions were as follows: 12.2% homogeneous (M3) and 4.0% linear (M1). In 8 cases (10.8%), no significant pattern was observed (M0). Combining dynamic and morphological characteristics, 68.9% presented an appearance comparable with the appearance of invasive breast cancer in MRI. CONCLUSIONS: Ductal CIS lesions show typical morphological and kinetic, but heterogeneous, characteristics in MRI, comparable with the histopathological variety of the disease. For detecting pure DCIS cases early and precisely, a combination of dynamic and morphological criteria seems to be important.     

X线检查中乳腺导管原位癌钙化的组织病理学特征

目的 探讨通过乳腺导管原位癌(DCIS)X线片上的钙化表现判断DCIS生物学行为的可能性.方法 参照BIRADS标准及最新WHO关于DCIS分类、分级标准,回顾性分析行乳腺X线检查有钙化表现并经手术病理证实的70例DCIS的乳腺X线表现.结果 ①多形不均质钙化与线样分支状钙化在DCIS病理分级中存在显著差异(P＜0.008).②钙化成簇分布与腺叶区段性分布在DCIS病理分级中存在显著差异(P＜0.008).结论 仔细分析乳腺X线检查中钙化灶的形态、分布特点,对推测DCIS的病理分级、评估预后有很大价值.