原发性乳腺淋巴瘤

恶性淋巴瘤为一全身性疾病,好发于淋巴结。结外器官发病率低,其中以消化道、肺等部位相对多见。乳腺恶性淋巴瘤临床少见,且以转移性肿瘤（Secondly breast lymphoma,SBL）为主。原发性乳腺恶性淋巴瘤（Primary breast lymphoma,PBL）极少见,仅占乳腺恶性肿瘤的0．04％-0．53％,占恶性淋巴瘤的0．38％-0．70％。PBL多见于50岁以上妇女,以B细胞来源为主,右侧多见,少数为双侧发病。病因尚不明确。与乳腺癌相比,临床表现和影像学检查均无特异性。确诊主要依靠细针穿刺或术后病理检查。预后差,易早期局部复发或远处转移。现有研究趋向于以CHOP方案化疗为主的综合治疗方案,避免采用扩大的手术治疗。很多学者建议早期鞘内注射化疗。     

Primary non-Hodgkin malignant lymphoma of the breast. An immunohistochemical study of seven patients and literature review of 152 patients with breast lymphoma in Japan.

BACKGROUND. The breast is rarely a primary site for extranodal malignant lymphoma. Most reported primary non-Hodgkin malignant lymphomas of the breast (PBL) are of B-cell phenotype. METHODS. Histologic and immunohistochemical analyses of seven patients with PBL and a statistical analysis of 152 patients with PBL reported in the Japanese literature were performed. RESULTS. Malignant lymphoma could not be predicted preoperatively with clinical and radiologic findings; breast carcinoma, fibroadenoma, and phyllodes tumor were the preoperative diagnoses. All patients were women; they ranged in age from 31 to 80 years (mean, 57.6 years). The right breast was involved initially in five patients. In four, only the breast was involved (Stage I), whereas in three, the ipsilateral axillary lymph nodes (Stage II) were involved at diagnosis. According to the Working Formulation, all patients belonged to the intermediate grade and were classified as having diffuse large cell (five patients) or mixed (two patients) lymphoma. Immunophenotypic analysis revealed that all patients had B-cell lymphoma. No patients had lymphoepithelial lesions, which is the characteristic feature in categorizing a lymphoma as a mucosa-associated lymphoid tissue (MALT) lymphoma. A statistical analysis of the patient reported in the Japanese literature has divided PBL into two types: a bilateral type that affects younger women and a unilateral type that has a broad age distribution, but preponderantly occurs in older women. The age and stage at diagnosis were significant prognostic factors in predicting the survival time, but the location and size of the tumor at initial presentation, histopathologic type, terminal leukemic manifestation, and treatment modality were not. CONCLUSIONS. This study indicates that most PBL are diffuse large cell lymphoma of B-cell phenotype and that the age and stage at diagnosis are significant prognostic factors.     

DWI结合时间-信号强度曲线评价乳腺病变性质的研究

目的:探讨MR扩散加权成像结合时间-信号强度曲线在评价乳腺病变性质上的应用价值.方法: 对117例乳腺病患者的134处病灶同时行MR扩散加权成像(b值=800s/mm2)和多时相增强MRI扫描.分别总结依据ADC值和时间-信号强度曲线评价乳腺良、恶性病变的统计学意义.统计综合考虑ADC值和时间-信号强度曲线类型评价乳腺良、恶性病变的敏感度、特异度和准确度.结果: 以1.20×10-3 mm2/s作为界值评价乳腺病变的性质,具有明显的统计学意义(P<0.05);以Ⅰ型曲线诊断乳腺良性病变,以Ⅱ、Ⅲ型曲线诊断乳腺癌,具有明显统计学意义(P<0.05).如单纯以ADC值≤>1.20×10-3 mm2/s且时间-信号强度曲线上表现为Ⅱ、Ⅲ型曲线来判定乳腺癌,而以ADC值>1.20×10-3 mm2/s且时间-信号强度曲线上表现为Ⅰ型曲线来判定乳腺良性病变,敏感度为82.7%,特异度69.8%,准确度77.6%.结论: 应用DWI和时间-信号强度曲线对乳腺病变的良恶性进行评价具有重要价值.     

Evaluation of dynamic studies of MR mammography for the diagnosis of intraductal lesions with nipple discharge

OBJECTIVES: We assessed the utility of dynamic magnetic resonance imaging (MRI) in differentiating benign from malignant lesions of the breast and then applied MRI to diagnose intraductal breast tumors with nipple discharge. METHODS: Gadolinium (Gd)-enhanced MR mammography was performed on 74 patients with breast tumors and 8 patients with nipple discharge. RESULTS: The steepest slopes of the contrast medium uptake (S slope) s from time-intensity curves were significantly different between malignant and benign lesions. At S slope threshold of 0.95% /second, malignancy was predicted with a sensitivity and specificity of 75% . Six of 8 cases with nipple discharge were successfully identified by MR ductography by injecting Gd-DTPA into discharging ducts. Among them, 2 non-invasive ductal carcinomas were differentiated from benign lesions by the S slope value. CONCLUSIONS: Dynamic MR mammography is an useful modality for differentiating breast lesions and has potential for evaluating intraductal lesions with nipple discharge.     

Primary breast lymphoma: an uncommon but curable disease

Primary malignant breast lymphoma (PBL) is a rare disease with an incidence of 0.04-0.5% of all malignant breast neoplasms. The majority of cases are B-cell lymphomas and the most common histologic type is diffuse large B-cell lymphoma (DLCL). In this study, we report our experience with three cases of PBL. The treatment was the same currently indicated for early stage aggressive NHL, i.e. anthracycline based chemotherapy followed by the involved field radiation therapy. Unfortunately, two patients underwent mastectomy to carry out correct diagnosis. The three patients are alive without any evidence of relapse after 24, 67 and 135 months of follow-up. Considering that aggressive NHL is very sensitive to chemotherapy, mastectomy should be avoided to preserve the quality of life of these patients, once surgery does not change the good prognosis of PBL.     

Angiogenesis and dynamic MR imaging gadolinium enhancement of malignant and benign breast lesions

Purpose. To determine whether dynamic magnetic resonance (MR) imagingenhancement parameters are associated with vessel density of malignant andbenign breast lesions. Materials and methods. Forty-five patients with 48breast lesions underwent gadolinium-enhanced spoiled gradient-recalled echo(SPGR) MR imaging followed by excisional biopsy and Factor VIII staining andvessel density measurement in the lesions. Results. The vessel densitieswere not significantly different in 25 malignant breast lesions as comparedto 23 benign breast lesions. Among all 48 lesions, greater MR enhancementshowed an association with increased vessel density. Seventy-four percent ofall lesions with MRI enhancement amplitude greater or equal to three timespost-precontrast ratio had vessel densities greater than the median of 172as compared to 34% of lesions with enhancement amplitude less thanthree times, p = 0.02. The rate and washout of MR enhancement showedno significant association with vessel density. Conclusion. Although thereis an overall significant association between greater MRI enhancementamplitude and vessel density, MRI gadolinium enhancement of breast lesionsis not an accurate predictor of vessel density.     

The evaluation of human breast lesions with magnetic resonance imaging and proton magnetic resonance spectroscopy

Purpose. MR spectroscopy (MRS) assists in lesion characterization and diagnosis when combined with magnetic resonance imaging (MRI). Cancerous lesions demonstrate elevated composite choline levels arising from increased cellular proliferation. Our study investigated if MR spectroscopy of the breast would be useful for characterizing benign and malignant lesions. Materials and methods. Single voxel proton MR spectroscopy (MRS) was acquired as part of an MR imaging protocol in 38 patients referred upon surgical consultation. The MR spectra were read independently in a blinded fashion without the MR images by three spectroscopists. The MRI exam was interpreted in two settings: (a) as a clinical exam with detailed histories and results from previous imaging studies such as mammography or ultrasound included and (b) as a blinded study without prior histories or imaging results. Results. Elevated choline levels were demonstrated by MRS in 19 of the 23 confirmed cancer patients. The sensitivity and specificity for determining malignancy from benign breast disease with MRS alone were 83 and 87%, respectively, while a blinded MRI review reported 95 and 86%, respectively. Conclusions. Proton MR spectroscopy provides a noninvasive, biochemical measure of metabolism. The technique can be performed in less than 10min as part of an MRI examination. MRI in combination with MRS may improve the specificity of breast MR and thereby, influence patient treatment options. This may be particularly true with less experienced breast MRI readers. In exams where MRI and MRS agree, the additional confidence measure provided by MRS may influence the course of treatment.     

Proton MR spectroscopy of the breast

Magnetic resonance imaging (MRI) of the breast has emerged as a highly sensitive modality. In addition to morphologic and kinetic analysis obtained from contrast-enhanced breast MRI, functional information has been needed for diagnosis of breast disease. In vivo proton (hydrogen 1 [¹H]) MR spectroscopy of the breast has demonstrated that choline (Cho) can be detected in breast cancers, whereas Cho is generally undetectable in normal breast tissue. Thus, breast MR spectroscopy has shown great promise as a way to differentiate between benign and malignant lesions and to gauge the effect of chemotherapeutic agents in patients with locally advanced breast cancer. Prior studies performed on 1.5-T MR imagers have reported sensitivities of 70–100% (average 89%; 149/168) and specificity of 67–100% (average 87%; 97/112) for breast MR spectroscopy. Moreover, the presence of a Cho peak in breast cancer may reflect the increased cell proliferation, with a decrease in this peak after treatment reflecting decreased viability of the tumor. With further development and the assessment of Cho quantity in the tumor, breast MR spectroscopy may be helpful in the elucidation of the biology of breast cancer.     

Dynamic contrast-enhanced MR imaging in screening detected microcalcification lesions of the breast: is there any value?

Purpose To prospectively evaluate whether dynamic contrast-enhanced magnetic resonance (MR) imaging findings can help predict the presence of malignancy when screening detected microcalcification lesions, and its contribution to patient management of stereotactic vacuum-assisted breast biopsy (SVAB). Materials and methods Dynamic contrast-enhanced breast MR imaging was performed when screening 100 detected microcalcification lesions not visualized by ultrasonography with 11-gauge SVAB. Definitive surgery was performed on all patients with the biopsy resulting in the diagnosis of breast cancer or atypical ductal hyperplasia (ADH). Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated on the basis of a BI-RADS (Breast Imaging Reporting and Data System) category and the absence or presence of contrast uptake in the area of microcalcification. Results The BI-RADS mammography category correlated with the diagnosis of breast cancer (ADH excluded): category 3 = 7% (4/55); category 4 = 48% (13/27); category 5 = 94% (17/18). After dynamic contrast-enhanced MR imaging, three of four malignancies with BI-RADS mammography category 3 were diagnosed as true positive. Therefore, the PPV of BI-RADS mammography category 3 with MR imaging was 1.8% (1/55). The PPV of contrast uptake of MR imaging was 86% (32/37), significantly higher than the 67% (30/45) PPV of BI-RADS mammography 4 and 5 (P = 0.033). The NPV of BI-RADS mammography 3 was 93% (51/55) versus 97% (61/63) NPV of MR imaging (P = 0.167). Conclusion In the evaluation of screening detected microcalcification lesions, dynamic contrast-enhanced breast MR imaging provides additional information with high PPV and NPV, and may therefore offer an alternative to SVAB for women who do not want to undergo SVAB with equivocal findings following full diagnostic mammographic assessment, but breast MR imaging with imperfect PPV and NPV cannot replace SVAB. Clinical relevance Dynamic contrast-enhanced breast MR imaging can demonstrate malignant microcalcifications detected by screening mammography and can be recommended in the evaluation of equivocal microcalcifications prior to SVAB.     

A Prospective Evaluation of T2-Weighted First-Pass Perfusion MR Imaging In Diagnosing Breast Neoplasms

Objective To compare the results from breast cancer patients who undergo T2-weighted first-pass perfusion imaging after dynamic contrast-enhanced T1-weighted imaging during the same examination, and to evaluate if T2-weighted imaging can provide additional diagnostic information over that obtained with T1-weighted imaging. Methods Twenty-nine patients with breast lesions verified by pathology (benign 12, malignant 17.) underwent MR imaging with dynamic contrast-enhanced T1-weighted imaging of the entire breasts, immediately followed by 6-sections of T2-weighted first-pass perfusion imaging of the lesions. The diagnostic indices were acquired by individual 3D T1-weighted enhancement rate criterion and the T2 signalintensity loss rate criterion. The sensitivity and specificity were calculated and the 2 methods were compared. Results With the dynamic.contrast-enhanced T1-weighted imaging, there was a significant differences between the benign and malignant breast lesions (t =2.563,P=0.016). However we found a considerable overlap between the signal intensity increase in the carcinomas and that in the benign lesions, for a sensitivity of 94% and a specificity of 25%. With T2-weighted first-pass perfusion imaging, there was a very significant difference between the benign and malignant breast lesions(t =4.777,P< 0.001), and the overlap between the signal intensity decrease in the carcinomas and that of the benign lesions on the T2-weighted images was less pronounced than the overlap in the T1-weighted images, for a sensitivity of 88% and a specificity of 75%. Conclusion T2-weighted first-pass perfusion imaging may help differentiate between benign and malignant breast lesions with a higher level of specificity. The combination of T1-weighted and T2-weighted imaging is feasible in a single patient examination and may improve breast MR imaging.     

DWI结合时间-信号强度曲线评价乳腺病变性质的研究

目的：探讨MR扩散加权成像结合时间-信号强度曲线在评价乳腺病变性质上的应用价值。方法：对117例乳腺病患者的134处病灶同时行MR扩散加权成像（b值=800s／mm^2）和多时相增强MRI扫描。分别总结依据ADC值和时间-信号强度曲线评价乳腺良、恶性病变的统计学意义。统计综合考虑ADC值和时间-信号强度曲线类型评价乳腺良、恶性病变的敏感度、特异度和准确度。结果：以1．20×10^-3mm^2／s作为界值评价乳腺病变的性质,具有明显的统计学意义（P〈0．05）;以Ⅰ型曲线诊断乳腺良性病变,以Ⅱ、Ⅲ型曲线诊断乳腺癌,具有明显统计学意义（P〈0．05）。如单纯以ADC值≤〉1．20×10^-3mm^2／s且时间-信号强度曲线上表现为Ⅱ、Ⅲ型曲线来判定乳腺癌,而以ADC值〉1．20×10^-3mm^2／s且时间-信号强度曲线上表现为Ⅰ型曲线来判定乳腺良性病变,敏感度为82．7％,特异度69．8％,准确度77．6％。结论：应用DWI和时间-信号强度曲线对乳腺病变的良恶性进行评价具有重要价值。     

乳腺磁共振在乳腺癌诊断治疗中的运用

乳腺MRI具有很好的软组织分辨率和无射线辐射等优点,对乳腺癌的早期诊断和局部分期明显优于乳腺X线摄影和超声检查。随着乳腺癌个体化、规范化综合治疗理念的推广,乳腺MRI在综合治疗中的作用日益受到重视,伴随对乳腺MRI临床应用的开展和研究的深入,其在乳腺癌分期中的评估、保乳手术病例术前的筛选、腋窝淋巴结转移原发不明者的诊断、新辅助化疗(neoadjuvant chemotherapy, NAC)的疗效评估、随访监测中的应用价值也得到了很好的评估。同时,乳腺MRI对肿瘤范围的客观准确的评估也是正确选择治疗方式的依据。     

Differentiation of benign and malignant breast tumors using Doppler spectral parameters including acceleration time index

Differentiation of breast cancer has been receiving increasing attention in attempts to minimize the numbers of excisional biopsies for benign tumors. Doppler spectral parameters, such as peak systolic velocity (PSV) and pulsatility index (PI), have been used but these are unable to differentiate breast cancers and benign tumors with adequate levels of specificity and sensitivity. The aim of this study was to determine whether the acceleration time index (ATI) could reliably differentiate breast tumors. In 102 breast masses, Doppler ultrasonography (US) was performed with a LOGIQ700MR. PSV, PI and ATI were calculated from intratumoral flow. Forty-eight malignant tumors were identified by histologic evaluation, 13 benign tumors were diagnosed by fine needle aspiration biopsy (FNAB) and 41 benign masses were diagnosed by characteristic gray-scale findings and long-term (>18 months) follow-up examinations. Doppler signals were detected in 35 of 54 (64.8%) benign lesions and in 46 of 48 (95.8%) breast cancers. PSV and PI value showed no statistical significance between malignant and benign lesions (PSV; p=0.1147, PI; 0.1506). ATI values were lower in benign lesions (p<0.0001). An ATI value of 0.14 seems to be the optimum threshold for the differentiation of benign and malignant lesions (79.4% sensitivity, 87.2% specificity). No malignant lesions were seen when the ATI value was <0.14 and the PI value was <1.1. ATI was found to be the most useful parameter for differentiating benign breast tumors from malignant ones.     

PET-CT in clinical oncology

Anatomic imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have been used for many years in clinical oncology. The emergence of positron emission tomography (PET) more than a decade ago was a major breakthrough in the early diagnosis of malignant lesions, as it was based on tumour metabolism and not on anatomy. The merger of both techniques into one thanks to PETCT cameras has made this technology the most important tool in the management of cancer patients. PET/CT with ¹⁸F-FDG is increasingly being used for staging, restaging and treatment monitoring for cancer patients with different types of tumours (lung, breast, colorectal, lymphoma, melanoma, head and neck etc.). At many institutions, PET/CT has replaced separately acquired PET and CT examinations for many oncologic indications. This replacement has occurred despite the fact that only a relatively small number of well designed prospective studies have verified imaging findings against the gold standard of histopathologic tissue evaluation. However, a large number of studies have used acceptable reference standards, such as pathology, imaging and other clinical follow-up findings, for validating PET/CT findings. The impact on the management of patients and the benefits from the information obtained from this anatomo-metabolic procedure justify the term “clinical oncology based on PET-CT” as a new concept to be applied in clinical practice. Supported by an unrestricted educational grant from Roche Farma S.A.     

磁共振成像动态增强对乳腺癌血管生成的研究

目的: 研究乳腺癌组织中微血管密度(MVD)及其分布、乳腺癌动态增强磁共振成像强化、腋淋巴结转移之间的相关性. 方法: 38例乳腺癌病例,手术前均行动态增强磁共振成像检查观察病灶中心、边缘的早期强化率(△SI)以及强化表现.对术后病理证实的乳腺癌31例,以正常乳腺组织为对照,采用免疫组化法检测MVD值在肿瘤中心及其边缘的分布,分析MRI△SI与MVD的相关性.根据MRI乳腺癌的强化表现分为边缘强化组、非边缘强化组,结合各组腋窝淋巴结转移率,分析乳腺癌不同MRI强化形式与预后的关系. 结果: 乳腺癌MVD边缘>MVD中心,△SI 边缘>△SI中心△SI随MVD值增高,△SI与MVD值有明显相关性.MRI边缘强化的11例,病灶边缘部分MVD高于中心部分,差异有显著性意义(P<0.01),非边缘性强化组20例,虽然病灶边缘部分MVD高于中心部分,但二者差异无显著性意义.边缘强化组淋巴结转移率为72%(8/11),非边缘强化组淋巴结转移率为35%(7/20),差异有显著性意义(P<0.01). 结论: MVD值的大小和分布与MR动态增强早期强化率和强化均匀性密切相关,在一定程度上反映了乳腺肿瘤血管生成特性及其预后.     

Molecular imaging of proliferation in malignant lymphoma

We have determined the ability of positron emission tomography (PET) with the thymidine analogue 3'-deoxy-3'-[(18)F]fluorothymidine (FLT) to detect manifestation sites of malignant lymphoma, to assess proliferative activity, and to differentiate aggressive from indolent tumors. In this prospective study, FLT-PET was done additionally to routine staging procedures in 34 patients with malignant lymphoma. Sixty minutes after i.v. injection of approximately 330 MBq FLT, emission and transmission scanning was done. Tracer uptake in lymphoma was evaluated semiquantitatively by calculation of standardized uptake values (SUV) and correlated to tumor grading and proliferation fraction as determined by Ki-67 immunohistochemistry. FLT-PET detected a total of 490 lesions compared with 420 lesions revealed by routine staging. In 11 patients with indolent lymphoma, mean FLT-SUV in biopsied lesions was 2.3 (range, 1.2-4.5). In 21 patients with aggressive lymphoma, a significantly higher FLT uptake was observed (mean FLT-SUV, 5.9; range, 3.2-9.2; P < 0.0001) and a cutoff value of SUV = 3 accurately discriminated between indolent and aggressive lymphoma. Linear regression analysis indicated significant correlation of FLT uptake in biopsied lesions and proliferation fraction (r = 0.84; P < 0.0001). In this clinical study, FLT-PET was suitable for imaging malignant lymphoma and noninvasive assessment of tumor grading. Due to specific imaging of proliferation, FLT may be a superior PET tracer for detection of malignant lymphoma in organs with high physiologic fluorodeoxyglucose uptake and early detection of progression to a more aggressive histology or potential transformation.     

Breast microcalcifications studied with 3D contrast-enhanced high-field magnetic resonance imaging: more accuracy in the diagnosis of breast cancer

AIMS: To evaluate the reliability of magnetic resonance imaging (MRI) performed with three-dimensional (3D) sequences in mammographically detected breast microcalcifications. METHODS: During an 8-month period, a group of 28 patients with mammographically detected microcalcifications suspicious for malignancy underwent MRI. Their ages ranged from 33 to 65 years. Examinations were performed with a 1.5 Tesia MR unit and a 3D T1 weighted sequence. Images were interpreted on the basis of morphologic parameters and dynamic behavior in the uptake of contrast medium (Gd-DTPA). Histologic findings were considered as the gold reference. RESULTS: Histologic analysis revealed invasive carcinoma in 7 patients, 3 of which were associated with foci of lobular carcinoma in situ. Intraductal carcinoma was diagnosed in 8 patients, 1 of which was associated with a tubular carcinoma. Benign lesions accounted for 13 patients. All the neoplastic conditions showed enhancement on MR images (sensitivity, 100%), whereas early and intense enhancement was noted in 5 of 13 benign lesions (specificity, 61%). The positive predictive value was 75% and negative predictive value, 100%. CONCLUSIONS: Although an overlap in the enhancement behavior of malignant and some benign lesions is clearly evident, a careful interpretation of MR images is helpful in detecting and mainly ruling out breast cancer combined with mammographically suspicious microcalcifications.     

三种不同磁共振扩散加权成像模型在鉴别乳腺良恶性病灶中的价值研究

背景与目的：近年来扩散加权成像(diffusion-weighted imaging,DWI)技术的开展及应用,大大提高了磁共振（magnetic resonance,MR）的特异度,其中体素内不相干运动（intravoxel incoherent motion,IVIM）模型和扩散峰度成像（diffusion kurtosis imaging,DKI）模型作为新兴技术,已在临床研究中取得一定的进展。该研究探讨DWI的单指数模型、IVIM模型和DKI模型在乳腺良恶性病灶中的鉴别诊断价值。方法：该研究为前瞻性研究,纳入标准：超声或X线BI-RADS 4类及以上患者。排除标准：① 乳腺MR检查前已进行穿刺检查、新辅助化疗或手术的患者;② 图像运动伪影较重。所有患者术前均行双侧乳腺MR检查,扫描序列包括快速反转恢复（turbo inversion recovery magnitude,TIRM）、多b值DWI（RS-EPI）和T1W动态增强扫描。选取病灶实性成分最大层面且避开明显坏死、囊变液化区绘制感兴趣区（region of interest,ROI）,分别测量单指数模型参数表观弥散系数（apparent diffusion coefficient,D_ADC）值、IVIM模型参数[真实扩散系数（tissue diffusivity coefficient,D_DT）、灌注相关扩散系数（perfusion-related diffusivity coefficient,D^*）、灌注分数（perfusion fraction,f）]和DKI模型参数[峰度系数（kurtosis coefficient,K）、扩散系数（diffusivity coefficient,D_DK）]。采用独立样本t检验分别比较乳腺良恶性病灶组织上述参数的差异。采用受试者工作特征（receiver operating characteristic,ROC）曲线评价3种模型参数的诊断效能。采用Z检验比较各参数曲线下面积（area under curve,AUC）的差异。结果：依据上述标准共纳入80例患者（83个病灶）,其中良性病灶38个,恶性病灶45个。3种不同扩散模型中D_ADC值、D_DT值、K值及D_DK值在鉴别乳腺良恶性病灶中差异均有统计学意义（P均＜0.05）,其最佳阈值分别为D_ADC值1.08×10^-3 mm²/s、D_DT值1.06×10^-3 mm²/s、K值0.756及D_DK值1.36×10^-3 mm²/s。而D*值和f值在良恶性病灶之间存在较大重叠,差异无统计学意义（P＞0.05）。ROC曲线显示,K值和DDT值在鉴别乳腺良恶性病灶的AUC值最高,分别为0.956和0.947,K值的灵敏度和特异度为91.1%和89.5%,D_DT值的灵敏度和特异度为93.3%和84.2%;D_ADC值和D_DK值其次,AUC分别为0.933和0.923,DADC值的灵敏度和特异度为88.9%和84.2%,D_DK值的灵敏度和特异度为91.1%和84.2%。最后,D_ADC值、D_DT值、K值及D_DK值在鉴别乳腺良恶性病灶中的ROC曲线的AUC差异均无统计学意义（P均＞0.05）。结论：三种不同扩散加权成像模型在鉴别乳腺良恶性病灶中均有较好的诊断价值,其中IVIM和DKI的诊断效能较单指数模型略高,但 三者间差异无统计学意义。单指数模型扫描时间短,后处理简单,在临床应用价值很高。     

MR imaging of triple-negative breast cancer

Little is known about the MR imaging features of triple-negative breast cancer (TNBC), but TNBC has a worse prognosis because it has no effective therapeutic targets, such as estrogen receptor for endocrine therapy and human epidermal growth factor receptor 2 (HER2) for anti-HER2 therapy. MR findings of a unifocal lesion, mass lesion type, smooth mass margin, rim heterogeneous enhancement, persistent enhancement pattern, and very high signal intensity on T2-weighted images are typical features of breast MR imaging associated with TNBC. Although TNBC can mimic a benign morphology, the early MR imaging recognition of TNBC could assist in both the pretreatment planning and the prognosis, as well as adding to our understanding of the biological behavior of TNBC.     

原发乳腺淋巴瘤4例并文献复习

目的：探讨原发乳腺淋巴瘤（primary breast lymphoma,PBL）的临床病理学特征、免疫表型、鉴别诊断.方法：对4例原发乳腺淋巴瘤的临床资料、光镜形态和免疫表型进行回顾性分析,并复习文献.病理诊断依据WHO关于淋巴造血组织肿瘤的分类（2008版）进行.采用免疫组织化学EnVision两步法行免疫表型检测,选用的抗体有CD20、CD3ε、CD79a、PAX-5、CD10、Bcl-6、MUM-1、CD5、Bcl-2、p53、细胞周期蛋白D1和Ki-67等.结果：4例均为女性,年龄38-79岁.其中2例发生于左乳腺,1例发生于右乳,1例双侧乳腺均有肿物.患者均表现为孤立性无痛包块.Ann Arbor分期：1例为Ⅰ期,2例为Ⅱ期,1例为Ⅳ期.其中3例行乳腺肿块单纯切除术,1例行乳腺改良根治术.术后2例放弃治疗,1例行CHOP方案治疗,1例行R-CHOP方案治疗.4例术后病理诊断结果均为弥漫大B细胞淋巴瘤,根据Hans免疫组化亚群分类,其中1例为生发中心源性,3例为非生发中心源性.大体上,肿瘤呈灰白或灰红色结节状,直径2.5-5cm,质地韧或较脆.2例获得随访资料,1例随访12个月仍健在,1例已随访24个月仍在治疗之中,未发现复发及转移迹象.结论：该组4例PBL均为DLBCL.光镜及免疫组化检查可确定诊断.其诊断应充分排除系统性淋巴瘤累及乳腺.预后与肿瘤细胞免疫组化亚群及临床分期相关.