乳腺结构扭曲征象的X线分析

目的描述乳腺结构扭曲征象的钼靶X线表现,提高诊断准确性。方法分析33例经组织病理学诊断乳腺结构扭曲病变的钼靶X线表现,包括密度、边缘、病变区结构及触诊检查特点。33例中,良性病变18例,恶性病变15例,其中术后改变5例,脂肪坏死伴有间质纤维化1例,囊性增生症6例,炎症4例,硬化性乳腺病2例,导管原位癌2例,浸润性导管癌6例,浸润性小叶癌3例,黏液癌2例,Paget病2例。结果33例乳腺结构不良,钼靶X线摄片表现为高密度17例,等密度16例。边缘有浸润10例,模糊12例,星芒状改变11例。结构消失17例,可分辨16例。触诊质硬14例,柔韧11例,斑片状增厚8例。边缘浸润及结构消失倾向恶性病变,差别有统计学意义（P值分别为0.01和0.025）,而其他征象及触诊在良、恶性病变间的差别无统计学意义。结论乳腺结构不良钼靶X线表现多样,分析其边界及结构有助于良恶性病变的鉴别诊断。

Mammographic manifestations of breast architectural distortion

Objective To describle mammographic features of breast architectural distortion in order to improve its diagnostic accuracy.Methods Mammographic manifestations of 33 breasts with histropathologic proved breast structure deformation, which occurred in 18 benign diseases and 15 malignant diseases, were retrospectively analyzed. Density, margin and structure of lesion were assessed. The underling entities included post-operation change (n=5), fat necrosis companied with stromal fibrosis(n=1), versicle hyperplasia (n=6) and inflammation (n=4), invasive ductal carcinoma(n=6), DCIS(n=2), infiltrating lobular carcinoma(n=3), mucinous carcinoma(n=2) and Paget (n=2). Results On mammogram, breast architectural distortion was high in 17 cases and iso-density in 16 cases. The margin of the lesions was infiltrating in 10 cases, poor defined in 12 cases, spiculatted changes in 11 cases. Structure of the lesions was disappeared in 17 cases, and was discriminable in 16 cases. They were hard in 14 cases, pliable in 11 cases and of patch thickness in 8 cases on palpate. Statistically significant mammographic findings favoring a diagnosis of companied with malignant lesion included infiltrating margin and structure disappearance with a P value of 0.01 and 0.025 respectively, while the other signs showed no statistic significant difference between benign and malignant lesions. Conclusion Although mammographic manifestations of breast architectural distortion can be variety, analysis of its margin and structure can be helpful for the differentiate diagnosis for benign and malignance of its underlying diseases.