切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (03) : 226 -231. doi: 10.3877/cma.j.issn.1672-6448.2017.03.012

所属专题： 乳腺超声； 文献；

浅表器官超声影像学

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
刘德泉1, 丁红宇2,†(), 崔晶3, 史浩4, 张凯5, 范凤景5, 李菲6   
  1. 1. 271000　泰安，泰山医学院；252800　聊城，高唐县人民医院超声科
    2. 250014　济南，山东省千佛山医院超声诊疗科
    3. 250014　济南，山东省千佛山医院病理科
    4. 250014　济南，山东省千佛山医院影像科
    5. 271000　泰安，泰山医学院
    6. 250014　济南，山东大学齐鲁医学部
  • 收稿日期:2016-06-05 出版日期:2017-03-01
  • 通信作者: 丁红宇

Sonographic findings and pathological features of ductal carcinoma in situ without microcalcifications on mammography

Dequan Liu1, Hongyu Ding2,†(), Jing Cui3, Hao Shi4, Kai Zhang5, Fengjing Fan5, Fei Li6   

  1. 1. Tai Shan Medical College, Taian 271000, China; Department of Ultrasound, People′s Hospital of Gaotang, Liaocheng 252800, China
    2. Department of Diagnostic Ultrasound, Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
    3. Department of Pathology, Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
    4. Department of Medical Imaging, Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
    5. Tai Shan Medical College, Taian 271000, China
    6. School of Medicine, Shandong University, Jinan 250014, China
  • Received:2016-06-05 Published:2017-03-01
  • Corresponding author: Hongyu Ding
  • About author:
    Corresponding author: Ding Hongyu, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

刘德泉, 丁红宇, 崔晶, 史浩, 张凯, 范凤景, 李菲. 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[J]. 中华医学超声杂志（电子版）, 2017, 14(03): 226-231.

Dequan Liu, Hongyu Ding, Jing Cui, Hao Shi, Kai Zhang, Fengjing Fan, Fei Li. Sonographic findings and pathological features of ductal carcinoma in situ without microcalcifications on mammography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(03): 226-231.

目的

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。

方法

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。

结果

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）。

结论

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。

关键词: 乳腺肿瘤, 癌，导管内，非浸润性, 超声检查, 病理学
Objective

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

Methods

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.

Results

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).

Conclusions

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.

Key words: Breast neoplasms, Carcinoma, intraductal, noninfiltrating, Ultrasonography, Pathology
图3，4 42岁钼靶微钙化阴性乳腺导管内癌患者非肿块型声像图合并微钙化。图3为右乳钼靶片，可见片状密度增高影，提示乳腺增生；图4为右乳声像图，显示内上象限腺体局限性结构紊乱，边缘模糊不清，内可见点状强回声并导管不规则扩张。术后病例证实为高核级非粉刺型乳腺导管内癌
表1 40例钼靶微钙化征阴性DCIS患者的病理亚型及核分级情况（例）
分型 例数 病理亚型 核分级
粉刺型 非粉刺型 高核级 中低核级
肿块型 30 2 28 5 25
非肿块型 9 3 6 1 8
P值a ? 0.070 1.000
[1]
龙泉伊，李宏江. 乳腺导管内癌的诊断与治疗[J]. 华西医学, 2011, 26(7):1000-1002.
[2]
顾雅佳，王玖华，涂小予, 等. 乳腺导管原位癌的钼靶X线表现与病理对照研究[J]. 中华放射学杂志, 2002, 36(3):240-244.
[3]
朱庆莉，姜玉新，刘赫, 等. 常规超声结合超声弹性成像对乳腺导管内癌诊断的初步探讨[J]. 中国医学影像技术, 2008, 2(4):683-686.
[4]
Scoggins ME, Fox PS, Kuerer HM, et al. Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients [J]. AJR Am J Roentgenol, 2015, 204(4):878-888.
[5]
王建伟，林僖，赵静, 等. 超声与钼靶联合诊断乳腺导管内癌[J/CD]. 中华医学超声杂志(电子版), 2011, 8(6):45-48.
[6]
刘新杰，罗民，周冬仙, 等. 钙化与非钙化乳腺癌临床病理特征的比较[J]. 现代肿瘤医学, 2007, 15(11):1575-1577.
[7]
Berg WA, Campassi C, Langenberg P, et al. Breast imaging reporting and data system [M]// Encyclopedia of cancer. Berlin Heidelberg Springer, 2012: 1769-1777.
[8]
Lakhani SR, Ellis IO, Schnitt SJ, et al. WHO classification of tumours of the breast (IARC WHO Classification of Tumours) [M]. 4th ed. Lyon: IARC Press, 2012: 30-68.
[9]
Gradishar WJ, Anderson BO, Balassanian R, et al. Breast Cancer Version 2. 2015 [J]. J Natl Compr Canc Netw, 2015, 13(4):448-475.
[10]
杨光，张祥宏. 微钙化乳腺癌在钼靶片诊断中的价值及进展[J]. 国际医学放射学杂志, 2005, 28(6):410-412.
[11]
Neal CH, Coletti MC, Joe A, et al. Does digital mammography increase detection of high-risk breast lesions presenting as calcifications? [J]. AJR Am J Roentgenol, 2013, 201(5):1148-1154.
[12]
章瑜，梅海炳，王颖. 乳腺数字摄影中钙化灶对良恶性病变的诊断价值[J]. 中国医学影像技术, 2015, 32(4):567-570.
[13]
Newstead GM, et al. MR imaging of ductal carcinoma in situ [J]. Magn Reson Imaging Clin N Am, 2010, 18(2):225-240.
[14]
路红，付丽. 乳腺导管内癌的影像学与病理学对照研究进展[J/CD]. 中华乳腺病杂志(电子版), 2010, 4(6):5-8.
[15]
贺琰，王小燕，凌冰, 等. 乳腺导管内癌的超声图像及造影特征与病理对照分析[J]. 中国超声医学杂志, 2015, 31(6):494-497.
[16]
Moon WK, Im JG, Koh YH, et al. US of mammographically detected clustered microcalcifications [J]. Radiology, 2000, 217(3):849-854.
[17]
Yang WT, Tse GM. Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ [J]. AJR Am J Roentgenol, 2004, 182(1):101-110.
[18]
Shin HJ, Kim HH, Kim SM, et al. Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features [J]. AJR Am J Roentgenol, 2008, 190(2):516-525.
[19]
Lee MH, Ko EY, Han BK, et al. Sonographic findings of pure ductal carcinoma in situ [J]. J Clin Ultrasound, 2013, 41(8):465-471.
[20]
蒋蓓琦，贺其志，章华, 等. 乳腺导管内癌超声声像图特征和临床病理的相关性研究[J]. 现代肿瘤医学, 2010, 18(2):287-290.
[21]
Hashimoto BE, Kramer DJ, Picozzi VJ. High detection rate of breast ductal carcinoma in situ calcifications on mammographically directed high-resolution sonography [J]. J Ultrasound Med, 2001, 20(5):501-508.
[22]
Huang CS, Wu CY, Chu JS, et al. Microcalcifications of non-palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology [J]. Ultrasound Obstet Gynecol, 1999, 13(6):431-436.
[23]
Holland R. Ductal carcinoma in situ (DCIS) [J]. Breast Cancer Res, 2002, 4(1):1-1.
[24]
Rauch GM, Kuerer HM, Scoggins ME, et al. Clinicopathologic, mammographic, and sonographic features in 1187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status [J]. Breast Cancer Res Treat, 2013, 139(3):639-647.
[25]
Burstein HJ, Polyak K, Wong JS, et al. Ductal carcinoma in situ of the breast [J]. N Engl J Med, 2004, 350(14):1430-1441.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 唐玮, 何融泉, 黄素宁. 深度学习在乳腺癌影像诊疗和预后预测中的应用[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 323-328.
[11] 康夏, 田浩, 钱进, 高源, 缪洪明, 齐晓伟. 骨织素抑制破骨细胞分化改善肿瘤骨转移中骨溶解的机制研究[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 329-339.
[12] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[13] 施杰, 李云涛, 高海燕. 腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 353-361.
[14] 伍秋苑, 陈佩贤, 邓裕华, 何添成, 周丹. 肠道微生物在乳腺癌中的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 362-365.
[15] 徐军, 姬园园, 陈君平, 王健. 伴菊形团结构的脑膜瘤合并颅骨侵犯一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 916-919.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号