摘要
目的以病理学诊断为标准,比较超声和磁共振成像(MRI)诊断乳腺癌导管内浸润的价值。方法 60名患者共有62例浸润性乳腺癌。乳腺癌导管内浸润的超声影像学特征为:①可见与肿块相连的扩张导管;②卫星病灶与癌性肿块在同一节段而不伴有导管的扩张;③癌性肿块与卫星病灶之间有乳腺导管扩张。乳腺癌导管内浸润的MRI影像学特征为:①在癌性肿块的边缘有条索状强化;②癌性肿块周围有卫星病灶围绕;③癌性肿块与卫星病灶之间有桥形强化。乳腺导管内的浸润性病变被分为朝向乳头和朝向外周两类。结果病理证实,大于15 mm的、向乳头方向浸润的导管浸润性病变在62例乳腺癌中为18例(29.9%),向外周浸润的导管浸润性病变在62例乳腺癌中为3例(4.8%),有1例癌变距离乳头过近而不能判定其浸润方向。在17例乳头方向浸润的癌变中,超声检查和MRI能准确地检测出向乳头的浸润性病变分别为14例和8例,超声检出向乳头的浸润性病变的敏感度、特异度、准确性分别为86.5%、87.3%、87.1%,而MRI则分别为51%、78.1%、71.1%,当把这两种诊断方法的结果进行综合考虑,敏感度上升至92.7%。结论超声检查比MRI在检出向乳头的乳腺导管浸润性病变方面更敏感,两种方法联合诊断乳腺癌导管内浸润的敏感度则更高。
Objective To compare the value of ultrasound （US） and magnetic resonance imaging （MRI） in detection of extent and direction of intraductal infiltration around invasive breast cancer in comparison with histopathological findings. Methods In 60 patients with invasive breast cancer （62 tumor masses）, the features of intraductal infiltration were classified as：（1）Solid ductal dilatation radiated from the tumor;（2） the presence of satellite lesions in same segment without ductal dilatation ;（3）duct dilatation between main tumor and satellite lesions. The criteria for detection of intraductal infiltration by MRI were as follows：（1）strand - like enhancement on the margin of main tumor; （2）satellite lesions around main tumor, or （3）bridge - like enhancement between main tumor and satellite lesions. The direction of intraductal infiltration could be classified as towards nipple and towards periphery. Results Diffuse intraductal infiltration （ ≥15 mm） towards the nipple had been histopathologically proven in 18 of 62 （29.9%） cancer masses, and diffuse intraductal infiltration towards periphery had been histopathologically proven in 3 of 62 （4.8 % ） cancer masses. One cancer mass was located too close to the nipple, hence its direction could not possibly be measured. Ultrasonography and MRI could accurately detect diffuse intraductal filtration towards the nipple in 14 and 8 cancer masses respectively of 17 cancer masses. Sensitivity, specificity and accuracy for detection of diffuse intraductal infiltration towards the nipple by uhrasonography were 86.5%, 87.3% and 87.1% respectively. Sensitivity, specificity and accuracy for detection of diffuse intraductal infiltration towards the nipple by MRI were 51%, 78.1% and 71. 1% respectively. When the results of both diagnostic methods namely uhrasonography and MRI were in combination, their sensitivity might increase to 92.7%. Conclusion Ultrasound is more sensitive than MRI in the delineation of intraductal infiltration extension towards the nipple, and combination of ultrasound and MRI can provide more sensitive result in diagnosis of diffuse intraductal infiltration of breast cancer.
出处
《临床和实验医学杂志》
2014年第6期483-486,共4页
Journal of Clinical and Experimental Medicine
关键词
乳腺癌
导管内浸润
超声
磁共振成像
Breast cancer
Intraductal infiltration
Ultrasound
Magnetic resonance imaging
