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。     

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。     

数字钼靶X线摄影对早期乳腺癌诊断的应用研究

目的评价早期乳腺癌的数字钼靶x线摄影表现。方法收集我院自2003年10月至2013年3月共10150名乳腺检查及体检者,回顾性分析经手术病理证实的56例早期乳腺癌的数字钼靶x线片,分析其临床表现、年龄特征、病理类型及x线表现特征。结果①无临床表现者49例,发病年龄27～76岁,其中40～49岁年龄段者占总病例数的42％,X线表现钙化27例（其中18例无肿块）,小结节19例（34％）。非对称性局限性密度增高影伴结构扭曲或紊乱10例（18％）;未扪及肿块者22例（39％）;导管原位癌（DCIS）及导管原位癌伴早期浸润37例（66％）,浸润性导管癌17例（30％）,浸润性小叶癌2例（4％）。②乳腺数字钼靶X线可显示早期乳腺癌病变微细结构。结论数字钼靶x线成像可以更清晰地显示乳腺病变的特征,对早期乳腺癌的诊断具有重要意义和价值。     

乳腺导管原位癌的全数字化钼靶X线诊断

目的探讨乳腺导管原位癌（BDCIS）的全数字化乳腺钼靶X线征象。方法回顾分析30例经手术及病理检查证实为BDCIS的全数字化乳腺钼靶X线表现。常规摄影双侧乳腺轴位（CC位）及侧斜位（MLO位）摄片。结果 30例中26例有病灶内钙化,其中单纯钙化18例,肿块伴钙化3例,结构扭曲伴钙化5例;3例为单纯肿块,其中,边缘光滑、密度均匀的圆形肿块2例,边缘有毛刺、密度不均匀的类圆型肿块1例;1例为单纯结构扭曲。结论 BDCIS全数字化乳腺钼靶X线表现以钙化为主,还应重视肿块、结构扭曲以及局部非对称致密影等征象。     

乳腺导管原位癌的钼靶X线诊断(附20例报告)

目的 探讨乳腺导管原位癌的钼靶X线征象.方法 分析20例经手术及病理证实的乳腺导管原位癌的钼靶X线表现.常规摄影双侧乳腺轴位(CC位)及侧斜位(MLO位)摄片.结果 20例中,16例钙化,3例单纯肿块,1例为小灶致密影.结论 导管原位癌(DCIS)X线表现以钙化为主,还应重视肿块、小灶致密影等征象.     

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.     

青年性乳腺癌CR钼靶影像与病理对照研究

目的探讨钼靶CR摄影在青年性乳腺癌诊断中的价值。方法回顾性分析50例35岁以下经病理证实的青年乳腺癌的X线表现。结果浸润性小叶癌26例,浸润性导管癌24例。肿块影13例,单纯钙化7例,结构扭曲5例,片状阴影16例,片状阴影伴钙化4例,肿块伴钙化5例,晕环征6例。结论钼靶CR摄影仍然是青年性乳腺癌最佳和首选的检查方法。     

三阴性乳腺癌钼靶与超声特征探讨

＿目的：探讨三阴性乳腺癌（TNBC）钼靶X线和超声影像特征。方法：回顾性分析54例TNBC患者的钼靶X线和超声影像资料。结果：TNBC 肿瘤组织学分级高,在钼靶 X 线上常表现为肿块（69．8％）,很少表现为肿块伴钙化（15．1％）、单纯钙化（1．9％）、局限性非对称致密（9．4％）或结构扭曲（3．8％）。肿块形状主要为圆形或椭圆形（62．2％）,很少表现为不规则形（17．8％）。肿块常为清晰边缘（35．6％）,毛刺边缘（11．1％）少见。在超声检查中,TNBC 主要表现为肿块（87．0％）,很少表现肿块伴钙化（9．3％）、单纯钙化（0％）或结构扭曲（3．7％）。肿块形状主要为圆形或椭圆形（51．9％）,其次是不规则形（48．1％）。肿块常为清晰边缘（48．1％）,毛刺边缘（5．8％）少见。肿块内部回声以低回声和混杂回声为主,肿块后方回声衰减少见,弹性评分多为4或5。结论：TNBC钼靶X线和超声表现更倾向于良性肿瘤的特点,了解其影像特征有助于提高TNBC的诊断水平。     

乳腺癌的钼靶X线表现与病理对照分析

目的 探讨乳腺癌的钼靶X线表现的病理基础.方法 分析55例乳腺癌的钼靶X线表现与病理类型.结果 乳腺癌的钼靶X线表现肿块45例,少见征象如局灶性致密病变2例和单纯沙泥样及多形钙化6例;阴性表现2 例.病理类型:3例侵润性小叶癌,显微镜下见边界清楚的癌巢形如牛眼或靶盘,有些呈单个细胞侵润性生长;4例为单纯癌特点,癌细胞的主质与间质成分数量差不多相等伴有少量纤维组织增生;6例为髓样癌显微镜下肿瘤细胞周围明显可见淋巴结细胞、浆细胞侵润;32例为侵润性导管癌镜下以导管内癌成分为主,部分癌细胞穿破管壁间质侵润性生长,侵润成分未超过半量.伴有钙化的肿块27例,均为沙泥样钙化呈簇状分布在肿块内及边缘.结论 钼靶X线检查对乳腺癌的诊断有重大的临床意义.     

Nonpalpable breast cancer: mammographic appearance as predictor of histologic type.

PURPOSE: To investigate the association between mammographic appearance and histologic diagnosis of nonpalpable breast cancers. MATERIALS AND METHODS: Mammographic characteristics of 317 consecutive clinically nonpalpable breast cancers in patients treated with breast-conserving surgery were reviewed. Malignant lesions were categorized as spiculated masses, other lesions, calcifications, and combined findings. Calcifications were characterized as amorphous, pleomorphic, or fine linear and branching. Logistic regression was used for the evaluation. Odds ratios (ORs) represent the magnitude of the association between a histologic diagnosis and a mammographic finding. RESULTS: Spiculated mass without calcifications (n = 150) and calcifications alone (n = 79) accounted for three of four cancers. A spiculated mass without calcifications was strongly associated with invasive cancers (OR = 12). Calcifications alone were strongly associated with ductal carcinoma in situ (DCIS) (OR = 19). In a decreasing order, the following invasive cancers were each associated with spiculated lesions without calcifications: ductal carcinoma grade 1 (OR = 28), ductal carcinoma grade 2 (OR = 17), lobular carcinoma (OR = 11), and ductal carcinoma grade 3 (OR = 4.6). Fine linear and branching calcifications alone were associated with not only DCIS nuclear grades 3 (OR = 17) and 2 (OR = 9.7) but also with invasive ductal carcinoma grade 3 (OR = 13). CONCLUSION: Mammographic appearance can be a predictor of histologic diagnosis in three of four nonpalpable breast cancers.     

早期乳腺癌的CR表现及病理基础

目的评价早期乳腺癌的CR表现及其病理基础。方法回顾性分析经病理证实的43例早期乳腺癌的CR片,包括导管原位癌及导管原位癌伴微浸润30例、浸润性导管癌12例和浸润性小叶癌1例,观察早期乳腺癌的CR表现,并与病理对照。结果(1)43例早期乳腺癌中,CR表现钙化21例(49%),结节15例(35%),非对称性局限性密度增高影伴结构紊乱7例(16%)。(2)乳腺数字化图像可以显示早期乳腺癌病变的细微结构。结论乳腺CR成像对早期乳腺癌的诊断具有重要意义。     

Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings

PURPOSE: To determine and quantitate the radiological characteristics of tubular carcinoma of the breast, to report clinical and pathologic findings and to define findings at follow-up. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 32 histopathologically proven pure tubular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up and histopathological results. RESULTS: Fifty-nine percent of the patients (n=19) presented with a palpable mass. The mammographic findings were a mass in 23 (72%), a mass with microcalcifications in 2 (6%), asymmetric focal density in 1 (3%), architectural distortion in 1 (3%) and negative in 5 (16%) of the 32 patients. Most (96%) masses had spiculated margins. US depicted 30 masses in 29 patients, all of which were hypoechoic, mostly (n=27, 90%) with posterior acoustic shadowing. The cancer was clinically occult in 41% (n=13), mammographically occult in 16% (n=5), and sonographically occult in 6% (n=2) of the patients. Histologically, the tumor was multifocal in 3% (n=1) of the patients. Four (13%) patients developed contralateral breast carcinoma at follow-up. CONCLUSION: Tubular carcinoma has a variety of presentations, but it is mostly seen on mammography as a small spiculated mass, and on sonography as an irregular mass with posterior acoustic shadowing. Although tubular carcinoma is known as a well-differentiated tumor with excellent prognosis, the mammographic follow-up of the contralateral breast is important.     

Breast MR imaging in patients with axillary node metastases and unknown primary malignancy.

PURPOSE: To assess the usefulness of magnetic resonance (MR) imaging of the breast in patients with malignant axillary adenopathy and unknown primary malignancy. MATERIALS AND METHODS: Between October 1993 and December 1997, 38 women with malignant axillary adenopathy and negative mammographic and physical examination findings underwent contrast material-enhanced MR imaging. Sixteen patients were excluded due to axillary tail cancer (n = 7), lack of follow-up (n = 4), second primary malignancy (n = 3), or chemotherapy before MR imaging (n = 2). The study population comprised the remaining 22 patients. Histopathologic findings were available in 20 patients; follow-up MR imaging findings were available in two patients. RESULTS: MR imaging depicted a primary breast cancer in 19 patients (86%; identified at excisional biopsy or mastectomy in 17, resolved on follow-up MR images during treatment in two). MR imaging depicted 4-30-mm cancers (mean, 17 mm), which correlated closely with histopathologic size. Two patients (9%) had false-negative findings: (a) One had a 2-mm invasive ductal carcinoma, and (b) one had 17- and 20-mm invasive ductal carcinomas. Of the 19 patients, 11 underwent mastectomy, seven underwent breast-conservation therapy, and one did not undergo a surgical procedure. CONCLUSION: MR imaging is very sensitive for the detection of mammographically and clinically occult breast cancer in patients with malignant axillary adenopathy. In these patients, MR imaging offers potential not only for cancer detection but also for staging the cancer within the breast, which may be useful for treatment planning.     

MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results

PURPOSE: To investigate the role of screening magnetic resonance (MR) imaging in the detection of synchronous contralateral breast cancer in patients with newly diagnosed breast cancer. MATERIALS AND METHODS: Between January 1999 and July 2001, 182 patients with newly diagnosed breast cancer (after either core or excisional biopsy with positive or close margins of resection) underwent bilateral contrast material-enhanced MR imaging at 1.5 T with a dedicated bilateral breast multicoil array. The contralateral breast was imaged for cancer screening. Family history of breast cancer, index cancer histology, breast density, and age at diagnosis of first breast cancer were assessed as potential risk factors for synchronous contralateral breast cancer. RESULTS: Fifteen patients (8.2%) had a suspicious enhancing lesion depicted in the contralateral breast. Seven patients (3.8%) had malignant results: ductal carcinoma in situ (DCIS) in four, invasive ductal carcinoma with DCIS in two, and invasive ductal carcinoma in one. Eight patients (4.4%) had benign results: fibrocystic changes in four, atypical ductal hyperplasia in two, atypical lobular hyperplasia and focal lobular carcinoma in situ in one, and ductal hyperplasia in one. Six patients with negative MR findings underwent prophylactic mastectomy; no malignancy was found. No significant differences were noted among patients with true-positive (n = 7), false-positive (n = 8), or negative (n = 167) MR findings with regard to family history of breast cancer (P <.27), index cancer histology (P <.19), breast density (P <.34), or age at diagnosis of first breast cancer (P <.10). CONCLUSION: The preliminary results demonstrate the feasibility of using MR imaging of the breast in a screening role, specifically to evaluate the contralateral breast in patients with newly diagnosed breast cancer to detect mammographically and clinically occult synchronous breast cancer.     

乳腺癌MRI研究

目的：探讨MRI对乳腺癌的综合诊断价值。材料和方法：随机选择临床和（或）乳腺钼靶片疑有肿瘤的患者进行前瞻性系列MRI检查，将其中58例乳腺癌作为研究对象。女性57例，男性1例。所有病例均经手术病理或活检证实。分别从病灶的信号特点、形态学、强化模式及时间－信号强度曲线等方面进行分析和诊断，并评估MRI的综合价值。结果：58例乳腺癌中浸润性导管癌48例，导管原位癌3例，浸润性小叶癌3例，小叶原位癌1例，髓样癌2例及纤维腺瘤恶变1例。根据乳腺癌病灶的信号及形态学、强化模式、时间－信号强度曲线及各因素的综合诊断正确率分别为89．7％、77．6％，79．3％－91．4％和94．8％，病灶的检出率达100％。结论：MRI检查对乳腺癌检出和定性诊断具有重要价值。     

Breast cancer: reliability of mammographic appearance as a predictor of hormone receptor status.

The association of mammographic appearance with hormone receptor status was investigated in 397 patients with primary breast cancers. The mammographic appearance was classified as type 1, spiculated (n = 159); type 2, structural changes (density) (n = 102); type 3, calcifications (n = 30); type 4, circumscribed opacity (n = 65); and type 5, not visible on mammogram (n = 41). Univariate analysis showed a significant association with estrogen receptor (ER) status for age (less than 50 vs greater than or equal to 50 years), tumor TNM category (those in category 1 vs those in higher categories), and mammographic appearance; with progesterone receptor status, the association was significant only for age. Multivariate analysis adjusted for potential confounders confirmed a significant association between ER status and mammographic appearance (ER status was more likely with type 1 than with the other mammographic types), but the strength of the association was limited. The mammographic appearance of breast cancer is not a reliable method to predict hormone receptor status for clinical purposes.     

Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy

PURPOSE: To retrospectively determine the degree of underestimation of breast carcinoma diagnosis in papillary lesions initially diagnosed at core-needle biopsy. MATERIALS AND METHODS: Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. Mammographic database review (1994-2003) revealed core biopsy diagnoses of benign papilloma (n=38), atypical papilloma (n=15), sclerotic papilloma (n=6), and micropapilloma (n=4) in 57 women (mean age, 57 years). Excisional or mammographic follow-up (>or=2 years) findings were available. Patients with in situ or invasive cancer in the same breast or patients without follow-up were excluded. Findings were collected from mammography, ultrasonography, core technique, core biopsy, excision, and subsequent mammography. Reference standard was excisional findings or follow-up mammogram with no change at 2 years. Associations were examined with regression methods. RESULTS: In 38 of 63 lesions, surgical excision was performed; in 25 additional lesions (considered benign), follow-up mammography (24-month minimum) was performed, with no interval change. In 15 lesions, 14-gauge core needle was used; in 48, vacuum assistance (mean cores per lesion, 8.7). Carcinoma was found at excision in 14 of 38 lesions. Core pathologic findings associated with malignancy were benign papilloma (n=1), sclerotic papilloma (n=1), micropapilloma (n=2), and atypical papilloma (n=10). Frequency of malignancy was one (3%) of 38 benign papillomas, 10 (67%) of 15 atypical papillomas, two (50%) of four micropapillomas, and one (17%) of six sclerotic papillomas. Excisional findings included lobular carcinoma in situ (n=2), ductal carcinoma in situ (n=7), papillary carcinoma (n=2), and invasive ductal carcinoma (n=3). Low-risk group (micropapillomas and sclerotic and benign papillomas) was compared with high-risk atypical papilloma group. Core findings were associated with malignancy at excision for atypical papilloma (P=.006). Lesion location, mammographic finding, core number, or needle type were not associated (P>.05) with underestimation of malignancy at excision. CONCLUSION: Benign papilloma diagnosed at core biopsy is infrequently (3%) associated with malignancy; mammographic follow-up is reasonable. Because of the high association with malignancy (67%), diagnosis of atypical papilloma at core biopsy should prompt excision for definitive diagnosis.     

伴乳头溢液乳腺癌的乳腺导管造影表现与病理对照研究

目的:分析伴有乳头溢液乳腺癌的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法:临床表现有乳头溢液并经手术、病理证实的乳腺癌23例,回顾性分析其乳腺导管造影的影像表现,并与手术病理结果进行对比分析。结果:23例中原位癌8例,浸润性导管癌10例(包括单纯癌6例、乳头状癌4例),导管癌早期浸润3例,乳头状瘤病恶变2例。病理上诊断早期癌13例(56.5%),其中8例临床未触及乳腺肿块。乳腺导管造影主要表现:导管内充盈缺损并伴有不同程度的导管扩张12例;乳腺肿瘤侵蚀导管形成潭湖征5例;溢液导管受乳腺肿块推挤,导管变形3例;导管持续显影、管壁不规则伴广泛微钙化灶1例。本组中乳腺导管造影诊断乳腺癌的符合率为82.6%。结论:乳腺导管造影对伴有乳头溢液乳腺癌的检出是一项安全、有效的检查方法,能准确观察到肿块与溢液导管的位置关系、溢液导管受侵蚀程度,而且还能检测出临床触诊阴性的早期乳腺癌。     

Tubulolobular carcinoma of the breast: clinical, mammographic and sonographic findings

PURPOSE: To determine and quantitate radiologic characteristics of tubulolobular carcinoma of the breast and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 26 histopathologically proven tubulolobular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up, and histopathological results. RESULTS: At physical examination, palpable mass was present in 85% (n=22) of the patients. The mammographic findings were mass in 17 (65%), asymmetric focal density in 2 (8%), architectural distortion in 2 (8%) and negative mammograms in 5 (19%) of the 26 patients. US depicted 25 masses in 24 patients, all of which were hypoechoic, with spiculated (n=13) or microlobulated (n=12) margins. The cancer was clinically occult in 12% (n=3), mammographically occult in 19% (n=5), and radiologically occult in 4% (n=1) of the patients. Histologically, the mean size of the tumor was 1.7cm and 18 (69%) patients were node negative. CONCLUSION: Tubulolobular carcinoma of the breast usually manifests clinically as a firm, immobile mass and mammographically as a spiculated or ill-defined, irregular, isodense mass without microcalcifications. Common findings on sonography include a homogeneously hypoechoic, spiculated or microlobulated mass with posterior acoustic shadowing or normal acoustic transmission. Tubulolobular carcinoma should be included in the differential diagnosis for breast masses with these imaging features.