乳腺髓样癌的X线表现--与病理对照并与纤维腺瘤鉴别

目的　评价乳腺X线片鉴别髓样癌与纤维腺瘤以及鉴别典型髓样癌与不典型髓样癌的可能性。资料与方法　回顾性分析乳腺髓样癌 2 7例 ,纤维腺瘤 34例 ,观察X线片表现 ,并与病理进行对照。结果　乳腺髓样癌与纤维腺瘤均以无钙化的肿块常见 ,各占 78%和 74 %。髓样癌为高密度肿块 (19/2 5 ) ,纤维腺瘤多为等密度肿块 (19/2 8) ,两者有显著性差异 (P =0 .0 0 1) ;髓样癌边缘多呈浸润性或小分叶状改变 (2 3/2 5 ) ,而纤维腺瘤表现或为边缘清晰 ,或呈某一投照位置边缘清晰、而另一位置不能见肿块的特殊改变 (2 5 /2 8) ,两者有显著性差异 (P <0 .0 0 1)。 2 7例髓样癌中 ,9例为不典型髓样癌 ,典型髓样癌与不典型髓样癌在肿块形状 (P =0 .6 70 )、边缘 (P =0 .394 )及密度(P =0 .6 37)改变上无明显差异。结论　乳腺髓样癌的X线表现有一定的特征 ,与其病理基础密切相关 ,可与纤维腺瘤作出鉴别。髓样癌病理上又可分为典型髓样癌与不典型髓样癌 ,两者在X线片上无法鉴别

Mammographic Appearances of Breast Medullary Carcinoma:Comparison with Pathology and Differentiation with Fibroadenoma

Objective To evaluate mammography in distinguishing medullary carcinoma from fibroadenoma and in distinguishing true from atypical medullary carcinoma.Materials and Methods Mammographic findings of 27 medullary carcinomas and 34 fibroadenomas were retrospectively analyzed. The findings were compared with pathologic results.Results The most common finding was non-calcified mass for both medullary carcinoma (78%) and fibroadenoma (74%). Usually, the mass was of high-density for medullary carcinoma (19/25) and of iso-density for fibroadenoma (19/28), with significant difference between two tumors (P=0.001). Most medullary carcinomas showed an infiltrating or lobulated border (23/25), while most fibroadenomas had a clear border or could be demonstrated only on a certain direction exposure (25/28), with significant difference between two tumors (P<0.001). Of 27 medullary carcinomas, 9 were atypical. No obvious difference in tumor's shape (P=0.670), margin (P=0.394) and density (P=0.637) existed between the true and the atypical medullary carcinomas. Conclusion Breast medullary carcinoma has certain mammographic features, which are well correlated with its pathology and based on which differentiation from fibroadenoma can be made. Pathologically, medullary carcinoma can be further divided into true type and atypical type. Nevertheless, it is almost impossible to make a correct differentiation of the two types on the mammogram.