超声检查对乳腺导管内癌的早期诊断价值

doi:10.3877/cma.j.issn.1672-6448.2016.04.013

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (04) : 297 -301. doi: 10.3877/cma.j.issn.1672-6448.2016.04.013

所属专题：乳腺超声；文献；

浅表器官超声影像学

超声检查对乳腺导管内癌的早期诊断价值

林僖¹, 林庆光¹, 李程¹, 李安华¹^,^†(

)

^1. 510060　广州，中山大学肿瘤防治中心超声科　华南肿瘤学国家重点实验室　肿瘤医学协同创新中心

收稿日期:2015-11-23 出版日期:2016-04-01
通信作者: 李安华
基金资助:
国家自然科学基金委青年基金项目(No.81301733); 广东省自然科学基金委自由申请项目(S2013010016623); 广东省中医药局自由申请项目(20121155)

The early diagnostic value of ultrasound in ductal carcinoma in situ of breast

Xi Lin¹, Qingguang Lin¹, Cheng Li¹, Anhua Li¹^,^†()

^1. Department of Ultrasound, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation, Center for Cancer Medicine, Guangzhou 510060, China

Received:2015-11-23 Published:2016-04-01
Corresponding author: Anhua Li
About author:
Corresponding author: Li Anhua, Email: lianhua58@126.com

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目的

评价超声检查对乳腺导管内癌（DCIS）的早期诊断价值。

方法

回顾性分析2005年5月至2015年6月中山大学肿瘤防治中心收治的经穿刺活检或手术病理证实的261例DCIS患者的超声声像图特征，将其分为七类：肿块型、单根导管扩张型、多根导管扩张型、囊实性导管扩张型、单根导管扩展型、多根导管扩展型、导管扩张扩展型。采用χ²检验比较有钙化的病例超声诊断准确率与无钙化的病例超声诊断准确率的差异。

结果

本组261例DCIS患者，2例超声漏诊，超声检查检出率为99.23%（259/261）,超声诊断准确率为83.40%（216/259）。其中肿块型98例，导管改变型161例。各超声分类的诊断准确率分别为：肿块型82.65%（81/98），单根导管扩张型80.00%（8/10），多根导管扩张型82.19%（60/73），囊实性导管扩张型66.67%（8/12），单根导管扩展型0，多根导管扩展型87.76%（43/50），导管扩张扩展型100%（16/16）。经钼靶或病理证实的有钙化的病例179例（包括导管内钙化和病灶内钙化），占69.11%（179/259）。有钙化的病例超声诊断准确率为93.85%（168/179），无钙化的病例超声诊断准确率为67.50%（54/80），有钙化的病例超声诊断准确率高于无钙化的病例超声诊断准确率，且差异有统计学意义（χ²=14.54，P<0.01）。

结论

DCIS超声诊断准确率与其超声分类和有无钙化密切相关。准确判读DCIS超声分类对其早期诊断具有重要的指导意义和应用价值。

关键词: 超声检查, 乳腺导管内癌, 诊断

Objectives

To evaluate the early diagnostic value of ultrasound in ductal carcinoma in situ (DCIS) of breast.

Methods

The sonographic characteristics in 261 cases of pathologically-confirmed DCIS from May, 2005 to June, 2015 in Sun Yat-sen University Cancer Center were retrospectively analyzed and the sonograms were divided into mass or ductal change including dilation and extension. The Chi-square test was used to determine the difference of ultrasound diagnostic accuracy between with and without microcalcifications cases.

Results

Two (1.14%) of the 261 lesions were not visible on sonography. The detection rate was 99.23% (259/261) and the diagnostic accuracy was 83.40% (216/259). Sonography revealed a mass in 98 cases (37.84%), ductal changes in 161 cases (62.16%). The diagnostic accuracy of each type was 82.65% (mass), 80.00% (single ductal dilatation), 82.19% (multiple ductal dilatation), 66.67% (mixed echogenicity), 0 (single ductal extension), 87.76% (multiple ductal extension), 100% (mixed type) respectively. Microcalcifications were visible on sonography in 179 (69.11%) of the 259 lesions. The diagnostic accuracies with and without microcalcifications were 93.85% and 67.50%. The diagnostic accuracy in cases with microcalcifications was higher than those without microcalcifications and there was significant difference between these two groups (χ²=14.54, P<0.01).

Conclusions

The diagnostic accuracy of DCIS has close relationship with ultrasound classification and microcalcifications. The accurate interpretation of ultrasound classification is essential for its clinical application and the early diagnosis of DCIS.

Key words: Ultrasonography, Ductal carcinoma in situ, Diagnosis

图1 乳腺导管内癌超声声像图分类及定义

图9，10 导管扩张扩展型乳腺导管内癌超声声像图。示多根导管膨胀伴实性填充，内可见密集点状强回声，病灶沿导管方向扩展（箭头所示）并形成类似特征的病灶。图9、10显示为相连的导管

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