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。     

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.     

乳腺癌高频钼靶X线表现与临床病理关系的探讨

目的 探讨乳腺癌的X线特点与临床病理的关系.方法 将176例乳腺癌的病灶X线特点与临床资料、病理类型、腋淋巴结转移情况对照分析.结果 以单纯钙化为表现的乳腺癌多为年轻者,50岁以下占84.4%(27/32);以钙化合并肿块者多为老年者,50岁以上占53.8%(28/52).导管内癌和导管内癌早期浸润的乳腺癌X线表现多为单纯钙化,占51.9%(14/27).以钙化合并毛刺样肿块为表现的乳腺癌腋淋巴结转移率高,约69.4%(25/36);以单纯蠕虫样钙化、单纯毛刺样肿块及单纯非蠕虫样钙化为表现者,腋淋巴结转移率亦较高.结论 乳腺癌X线特点与临床病理具有一定的相关性.     

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。     

全数字化乳腺摄影技术在乳腺癌诊断中的应用价值

目的 探讨全数字化乳腺摄影技术(FFDM)在乳腺癌诊断中的应用价值.方法 搜集本院2006-04-2007-11门诊病例及健康体检者行FFDM检查者2900例,其中经手术病理证实的乳腺癌53例,分析其年龄分布特征,病理类型及X线表现特征.结果 53例乳腺癌的发病年龄为36～8l岁,其中40～59年龄段者占到总病例的66%.X线表现为单纯肿块者24例(45.3%).肿块合并钙化者17例(32.1%),单纯钙化者4例(7.6%).结构紊乱者5例(9.4%),结构紊乱并钙化者3例(5.6%).病理结果:浸润性导管癌43例,黏液腺癌4例,乳腺小叶癌2例,Paget病4例.结论 FFDM可以更清晰的显示乳腺病变的特征,对乳腺癌的早期诊断具有重要价值.     

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。     

乳腺癌的不同病理类型的表现与X线征象分析

目的探讨乳腺癌的X线表现特征,提高诊断水平。方法回顾性分析经手术病理证实的174个乳腺癌的X线表现特征并与病理分型对照。结果乳腺导管内癌X线特征为单纯微钙化、小肿块;浸润性导管癌为肿块影,尤其是毛刺样肿块合并钙化为其特征性表现;浸润性小叶癌表现为不合并簇状微钙化的肿块;粘液癌表现为边界清楚之较大肿块。结论乳腺癌不同病理组织学类型的X线表现特征不同,根据X线表现可推测乳腺癌的病理分型。     

微小乳腺癌的全数字化乳腺摄影诊断分析

目的 探讨微小乳腺癌的X线特征.方法 回顾性分析行全数字化乳腺摄影(FFDM)检查并经手术病理证实的41例微小乳腺癌的X线特征、病理类型及癌灶大小与淋巴结转移之间的关系.结果 41例微小乳腺癌发生于左侧乳腺22例(53.66%),右侧乳腺19例(46.34%).X线表现:肿块23例(56.10%),单纯钙化7例(17.07%),结构扭曲5例(12.20%),非对称性致密影6例(14.63%).病理学结果:浸润性导管癌34例,黏液癌1例,非特异性导管癌2例,浸润性导管内癌1例,单纯癌1例,鳞癌1例,小管癌1例.微小乳腺癌同侧淋巴结转移率(4.9%)明显低于同期大乳腺癌组(27.3%)(χ2=6.620 3,P<0.05).结论 微小乳腺癌淋巴结转移率低,全数字化乳腺摄影对诊断微小乳腺癌有重要价值.     

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.     

Invasive papillary carcinoma of the breast: mammographic appearance

The mammographic findings in 18 patients with invasive papillary carcinoma were studied retrospectively. The mammograms of 10 patients showed a multinodular pattern, and seven patients had solitary nodules. One patient had an irregular, ill-defined mass in the retroareolar region. Two patients were found to have carcinoma in the contralateral breast, and two patients had intraductal carcinoma adjacent to the invasive papillary carcinoma. The varied mammographic features that may occur with this rare breast malignancy are discussed.     

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。     

Invasive lobular and ductal carcinoma: mammographic findings and stage at diagnosis.

The authors reviewed 316 cases of breast carcinoma diagnosed from January 1, 1986, to December 31, 1989. Clinical data and mammograms were available for all patients. Of the 316 carcinomas, 272 (86.1%) were invasive; 37 (13.6%) of these represented pure invasive lobular carcinoma (ILC). Twenty-five (68.5%) of the 37 patients with ILC and 161 (70.3%) of the 229 patients with invasive ductal carcinoma (IDC) presented with clinically palpable masses. Asymmetric opacities and architectural distortion were the predominant mammographic signs in 21 (57%) of the cases of ILC but only 32 (13.6%) of the cases of IDC. Malignant calcifications were not present in any of the patients with ILC but were present in 110 (47%) of those with IDC. Of the ILC lesions, 29 (85%) [corrected] had the same opacity as that of normal fibroglandular tissue, and the mammographic findings were often subtle and seen initially on one view only. There was no substantial difference in the TNM stage at diagnosis between the two study groups.     

Carcinoma within fibroadenomas: mammographic features

The mammographic features of carcinoma originating within a fibroadenoma in 24 patients were studied by means of retrospective review of pathologic slides. Histologic examination showed that the lesions were lobular carcinoma in situ (LCIS) (seven patients), ductal carcinoma in situ (DCIS) (13 patients), synchronous LCIS and invasive lobular carcinoma (one patient), and synchronous LCIS and DCIS (three patients). In all patients the mammographic manifestation was a mass 1.0 cm or greater in diameter; 14 masses were 1-2 cm in diameter, and the remainder were more than 2 cm in diameter. Features that were considered suspect included large size, indistinct margins, and clustered microcalcifications. In three patients, microcalcifications within the mass raised suspicion of malignancy. At histologic examination these microcalcifications were associated with the intraductal carcinoma harbored in the fibroadenoma in only one of these patients. Fibroadenomas that harbor carcinoma may be indistinguishable from common benign fibroadenomas, but their occurrence is rare. In this study, a single patient had invasive lobular carcinoma; all the other lesions were in situ lesions.     

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.     

Male breast disease: clinical,mammographic, and ultrasonographic features

PURPOSE: To describe and quantitate the radiological (mammographic and ultrasonographic) characteristics of male breast disease and to report the clinical and pathological findings. MATERIALS AND METHODS: Two-hundred-thirty-six male patients with different male breast diseases, diagnosed at our institution between January 1990 and July 2001, were retrospectively evaluated. The history, physical examination, mammographic and ultrasonographic findings were analyzed. RESULTS: The spectrum of the disease in 236 male patients were gynecomastia (n=206), primary breast carcinoma (n=14), fat necrosis (n=5), lipoma (n=3), subareolar abscess (n=2), epidermal inclusion cyst (n=1), sebaceous cyst (n=1), hematoma (n=1), myeloma (n=1), and metastatic carcinoma (n=2). The distribution of patterns of gynecomastia were; 34% (n=71) nodular, 35% (n=73) dendritic and 31% (n=62) diffuse glandular. Gynecomastia was unilateral in 55% (n=113) and bilateral in 45% (n=93) of the patients. Male breast cancer presented as a mass without microcalcifications in 86% (n=12) and with microcalcifications in 7% (n=1) of patients. The mass was obscured by gynecomastia, partially in two, totally in one patient. The location of the mass was retroareolar in 46% (n=6) and eccentric to the nipple in 54% (n=7) of patients. On ultrasonography (US), the contours were well-circumscribed in 20% (n=3) and irregular in 80% (n=12) of the masses. CONCLUSION: Male breast has a wide spectrum of diseases, some of which have characteristic radiological appearances that can be correlated with their pathologic diagnosis. In the evaluation of the male breast, mammography and US are essential and should be performed along with physical examination.     

乳腺浸润性小叶癌和导管癌X线表现

本文回顾性总结206例浸润性乳腺癌,其中小叶癌24例,导管癌182例.通过对两组资料的分析对比,提出不对称致密影(37.5%),乳腺结构紊乱(25%)为浸润性小叶癌(ILC)的主要X线表现,而浸润性导管癌(IDC)则分别为5.5%和2.1%.结合文献简要讨论了有关小叶癌的X线的病理特点.     

Relationships between age, mammographic features and pathological tumour characteristics in non-palpable breast cancer

Non-palpable breast cancers are often in situ or smaller and have less nodal and distant metastases than palpable lesions. They represent a heterogeneous group of tumours, which may have different prognostic behaviour. We analysed a retrospective series of 982 non-palpable breast cancers assessed histologically at the National Cancer Institute of Milan from 1985 to 1995, following pre-operative mammography-guided localization. The association between mammographic data (parenchymal pattern and findings), patient age and tumour histology was investigated by review of clinical records and statistical modelling. We also investigated the association between the presence or absence of microcalcification as a mammographic finding and pathological tumour characteristics (tumour size, axillary nodes status and grading) or receptor status for oestrogen (ER) and progesterone (PgR). In situ disease or invasive tumour with an intraductal component, whether extensive or not, were commoner in young women and mammography more frequently showed a dense parenchymal pattern and microcalcifications in these cases. In older women (55 years or more), a fatty breast pattern, nodular opacities with or without microcalcifications, and invasive tumours of the ductal, lobular, mixed or other types were closely related. When the relationships between mammographic findings, pathological tumour characteristics and receptor status were investigated for invasive cancers, there was an association between the presence of microcalcifications and less favourable tumour characteristics.     

Paget's disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases

PURPOSE: To determine and quantitate radiologic characteristics of Paget's disease 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 52 histologically proved Paget's disease of the breast. Analysis included history, findings at physical examination, mammography and sonography (US) and histologic type of Paget's disease. RESULTS: At physical examination, palpable mass (n=33, 63%), nipple erythema-eczema-ulceration (n=17, 33%) and blood-stained nipple discharge (n=5, 10%) were noted. Among 17 patients who had clinically evident Paget's disease, the mammographic findings were isolated microcalcifications in 3 (18%), mass associated with microcalcifications in 5 (29%), mass in 2 (12%) and negative in 7 (41%) patients. In the 35 patients with clinically inevident Paget's disease, these mammographic findings were 43% (n=15), 34% (n=12), 20% (n=7) and 3% (n=1), respectively. US depicted 43 masses in 35 patients, all of which were lobulated or irregularly contoured, mostly (n=41, 95%) without posterior acoustic shadowing. The cancer was clinically occult in 10% (n=5), mammographically occult in 15% (n=8) and radiologically occult in 13% (n=7) of the 52 patients. Histologically, the tumor was multifocal and/or multicentric in 11 (21%) patients. CONCLUSION: The clinical features of Paget's disease are characteristic and should alert the clinician to the likelihood of an underlying carcinoma, which should be evaluated radiologically. However, as Paget's disease is primarily a clinical diagnosis and mammograms may be negative, screening programs without clinical examination may result with delay in diagnosis. As a result, both clinical and imaging findings are complementary and should be correlated to confirm or exclude a diagnosis of Paget's disease.