自动乳腺全容积成像在乳腺导管原位癌诊断中的应用价值

doi:10.3877/cma.j.issn.1672-6448.2015.01.015

目的

探讨自动乳腺全容积成像（ABVS）在乳腺导管原位癌（DCIS）诊断中的应用价值。

方法

回顾性分析2010年12月至2012年12月杭州市第一人民医院收治的经手术病理证实的67例乳腺DCIS患者的钼靶X线、常规超声及ABVS表现。钼靶X线、常规超声及ABVS表现，钼靶X线、常规超声及ABVS的乳腺DCIS检出率比较采用非参数Cochran′s Q test比较，进一步组间两两比较采用McNemar test。

结果

钼靶X线、常规超声及ABVS表现为肿块（伴或不伴微钙化）的乳腺DCIS分别为13例（19%）、22例（33%）、25例（37%），常规超声、ABVS表现为肿块（伴或不伴微钙化）的乳腺DCIS均多于钼靶X线，且差异均有统计学意义（χ²=7.11、10.08，P均<0.05），而常规超声与ABVS表现为肿块（伴或不伴微钙化）的乳腺DCIS差异均无统计学意义。钼靶X线、常规超声及ABVS表现为单纯或伴发微钙化的乳腺DCIS分别为42例（63%）、30例（45%）、39例（58%），钼靶X线、ABVS表现为单纯或伴发微钙化的乳腺DCIS均多于常规超声，且差异均有统计学意义（χ²=8.64、5.82，P均<0.05），而钼靶X线与ABVS表现为单纯或伴发微钙化的乳腺DCIS差异均无统计学意义。钼靶X线、常规超声及ABVS的乳腺DCIS检出率分别为84%、70%及91%，钼靶X线、ABVS的乳腺DCIS检出率均高于常规超声，且差异均有统计学意义（χ²=4.92、9.39，P均<0.05），但ABVS与钼靶X线的乳腺DCIS检出率差异无统计学意义。

结论

ABVS能提高超声对乳腺DCIS的检出率，与钼靶X线诊断效能相仿。

关键词: 乳腺导管原位癌, 超声检查, 钼靶X线, 自动

Objective

To investigate the value of the automated breast volume scanner (ABVS) in the diagnosis of ductal carcinoma in situ (DCIS).

Methods

Sixty-seven patients who were diagnosed as DCIS by histopathology from December, 2010 to December, 2012 were retrospectively analyzed. Their image results and detection rates of mammography, conventional ultrasound and ABVS were analyzed and compared by Nonparametric Cochran's Q test, and the further comparison were performed between groups by McNemar test.

Results

The cases diagnosed as mass (with or without microcalcifications) by mammography, conventional ultrasound and ABVS were 13 (19%), 22 (33%) and 25 (37%), respectively. The detection rates of conventional ultrasound and ABVS were higher than mammography, and the differences were statistically significant (?χ²=7.11, 10.08, both P<0.05). However, the detection rate of mass between conventional ultrasound and ABVS were not statistically different (P>0.05). The cases diagnosed as simple microcalcification or associated with microcalcification by mammography, conventional ultrasound and ABVS were 42 (63%), 30 (45%) and 39 (58%), respectively. The detection rates of simple microcalcification or associated with microcalcifications by mammography and ABVS were higher than conventional ultrasound, and the differences were statistically significant (?χ²=8.64, 5.82, both P<0.05). However, the detection rate of simple microcalcification or associated with microcalcifications between conventional ultrasound and ABVS were not statistically different (P>0.05). The detection rates of DCIS by mammography, conventional ultrasound and ABVS were 84%, 70% and 91%. The detection rates of DCIS by mammography and ABVS were higher than conventional ultrasound, and the differences were statistically significant. But the rate between mammography and ABVS showed no statistical significance.

Conclusions

ABVS can improve the ultronic detection rate of breast DCIS. Its detection rate is similar with mammography performance.

Key words: Ductal carcinoma in situ, Ultrasonography, Mammography, Automated

图1~4 微钙化型乳腺导管原位癌超声声像图、钼靶X线图及病理图。图1为常规超声示右乳外上象限腺体内未见明显点状强回声；图2为自动乳腺全容积成像冠状面示腺体内可见多个细小点状强回声堆积（箭头所示）；图3为右乳钼靶X线侧斜位示乳腺内微钙化；图4为病理诊断为中分化导管内癌，微钙化灶清晰可见（HE，×100）

图5~8 肿块伴微钙化型乳腺导管原位癌超声声像图、钼靶X线图及病理图。图5为常规超声示左乳不规则低回声区，边界不清；图6为自动乳腺全容积成像冠状面示自乳头上方可见向外周延伸的低回声带及分支状分布的点状强回声（箭头所示）；图7为钼靶X线头足位示其为致密型腺体，内未发现明确肿块，仅见粗大钙化，未见微钙化；图8为病理诊断为中分化导管内癌，肿瘤细胞形成筛状或微乳头状结构，腔内可见坏死和微钙化（HE，×40）

图9~12 结构紊乱型乳腺导管原位癌超声声像图、钼靶X线图及病理图。图9为常规超声示左乳外上腺体结构紊乱，未见明确肿块及钙化；图10为自动乳腺全容积成像冠状面示紊乱的腺体呈典型"太阳征"，并未见明确肿块回声（箭头所示）；图11为钼靶X线侧斜位示腺体紊乱呈星芒状改变，与ABVS表现一致；图12为病理诊断为中分化导管内癌（HE，× 40）

图13~16 导管扩张型乳腺导管原位癌超声声像图、钼靶X线图及病理图。图13为常规超声示左乳导管扩张，管腔内实性中等回声团填充，并可见几个细小点状强回声（箭头所示）；图14为自动乳腺全容积成像冠状面示导管呈串珠样扩张，管腔内见点状实性中等回声及强回声（箭头所示）；图15为钼靶X线侧斜位未发现明确肿块，钙化及导管扩张征象；图16为病理诊断为高分化导管内癌，导管上皮增生成微乳头状（HE，×40）

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