观察钼靶微钙化阴性乳腺单纯性导管内癌患者超声及病理表现。

选取2010年1月至2016年2月在山东省千佛山医院就诊的40例乳腺单纯性导管内癌患者钼靶表现微钙化阴性病灶。分析钼靶微钙化阴性病灶超声表现，并根据声像图特征将其分为肿块型与非肿块型。同时，分析钼靶微钙化阴性病灶病理学亚型及核级。肿块型与非肿块型乳腺单纯性导管内癌患者超声诊断准确率、超声表现为微钙化比例及病理学核级与亚型情况比较采用Fisher确切概率法。

40例钼靶微钙化阴性乳腺单纯性导管内癌患者病灶中，钼靶未发现异常者16例（40.0%），而超声未显示异常者仅1例（2.5%）。超声下，病灶更多表现为肿块型（75.0%，30/40），形状以圆形或卵圆形及不规则形为主，边缘呈细小分叶，内部呈不均质低回声与等回声，后方无回声特征，而非肿块型病灶（22.5%，9/40）则多表现为不均质中等回声合并导管扩张。40例钼靶微钙化阴性病灶5例（12.5%）超声下表现为微钙化。钼靶微钙化阴性病灶病理学上更多为中低核级（85.0%，34/40）与非粉刺亚型（87.5%，35/40）。肿块型病灶超声诊断准确率为73.3%（22/30），非肿块型病灶为33.3%（3/9），二者比较差异有统计学意义（P=0.047）。肿块型与非肿块型病灶在超声下表现为微钙化比例差异无统计学意义[10.0%（3/30）vs 22.2%（2/9），P=0.572]。肿块型与非肿块型病灶病理学核级及亚型差异均无统计学意义（P=1.000、0.070）。

钼靶微钙化阴性乳腺单纯性导管内癌患者超声表现以肿块型为主，病理表现更多为中低核级与非粉刺亚型，超声更容易发现钼靶微钙化阴性病灶，应作为钼靶X线检查的补充，协助乳腺导管内癌的诊断，避免漏诊。

To investigate the characteristic sonographic and pathological features of breast ductal carcinoma in situ (DCIS) without microcalcifications on mammography (MG).

Forty cases of DCIS without microcalcifications on MG were retrospectively reviewed. The 40 lesions were classified into mass and non-mass groups according to their sonographic findings. The pathological subtypes and nuclear grades of these cases were also analyzed. Fisher exact test was used to compare the differences of the sonographic accuracy rate, sonographic microcalcification rate, pathological nuclear grade and subtype rate between mass and non-mass groups.

No abnormal finding was found in sixteen cases (40.0%) on MG and only one case (2.5%) on ultrasonography (US), respectively. The most common sonographic feature of DCIS without microcalcifications on MG were masses (75.0%, 30/40), and other sonographic findings were round/oval and irregular shape, microlobulated margin, heterogeneous hypoechogenicity and isoechogenicity, and posterior acoustic feature. Ductal dilatations and heterogeneous isoechogenicity were present in most non-mass lesions of DCIS without microcalcifications on MG (22.5%, 9/40). The ultrasonographic microcalcifications were found in 5 cases of DCIS without microcalcifications on MG. The common pathological features of DCIS without microcalcifications on MG were medium-low nuclear grade (85.0%, 34/40) and noncomedo (87.5%, 35/40). The difference of US accuracy rate in mass and non-mass groups was statistically significant [73.3% (22/30) vs 33.3% (3/9), P=0.047]. The differences of US microcalcification rate, pathological subtype and nuclear grade were not significant (P=1.000, 0.070).

The mass appearance and medium-low nuclear grade were most common sonographic findings and pathological features of DCIS without microcalcifications on MG. Ultrasonography should be an helpful tool for improving the diagnostic sensitivity of mammography in breast DCIS.