154例乳腺癌新辅助化疗后X线表现与病理对照

目的：探讨X线平片对乳腺癌新辅助化疗后残余病灶的诊断准确性。方法：回顾性分析154例乳腺癌新辅助化疗患者的病例资料,将脂肪型及少量腺体型乳腺归为Ⅰ型,多量腺体型及致密型乳腺归为Ⅱ型。对所有病例进行术前X线表现与术后病理的对照分析。结果：本组中Ⅰ型35例,其中X线平片表现与术后病理一致者31例（88.58%）,不一致者4例（11.42%）,X线高估病灶范围3例,低估1例。Ⅱ型119例,一致者30例（25.21%）,不一致者89例（74.79%）,89例中高估者66例（其中44例X线仅表现为多形性钙化）,假阴性者23例。X线平片对Ⅰ型乳腺癌新辅助化疗后残余病变的诊断准确性高于Ⅱ型（P〈0.001）。结论：X线片对Ⅰ型乳腺癌新辅助化疗后残余病变诊断准确性明显高于Ⅱ型;X线片对Ⅱ型中仅表现为多形性钙化者,不能准确判断其癌灶是否残存以及病变范围。

Comparative Study of mammographic findings with pathologic changes in 154 breast cancer patients under neoadjuvant chemotherapy

Objective：To investigate the accuracy of mammographic evaluation of residual breast cancer after neoadjuvant chemotherapy.Methods：154 cases of breast cancer with neoadjuvant chemotherapy were retrospectively analyzed.The breast glands were divided into two types,typeⅠ containing more fat and lesser glands,and type Ⅱ with dense compact tissue and plenty glands.The pre-operative mammographic findings of all cases were compared with pathologic changes postoperatively.Results：Among 35 cases with typeⅠ,mammographic findings of 31 cases were consistent with postoperative pathology（88.58%）,4 cases（11.42%）of inconsistency,3 overestimated and one underestimated.In 119 cases with type Ⅱ,30（25.21%）cases were consistent with pathologic diagnosis and 89（74.79%）cases were inconsistent,including 66 cases of overestimation（only presented as pleomorphic calcification in 44 cases）and 23 of false-negative.Conclusion：The accurancy of mammographic evaluation for type Ⅰ is significantly higher than that of type Ⅱ（P〈0.001）in diagnosing residual breast cancer.For patients with only pleomorphic calcifications in typeⅡ,mammography can not accurately determine whether the residual foci exist and the scope of lesions.