乳腺浸润性导管癌与浸润性小叶癌在数字化乳腺摄影中的X线表现及其病理基础研究
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摘要
目的:通过分析乳腺浸润性导管癌与浸润性小叶癌在数字化乳腺摄影中的X线表现,并探讨导致其结果的病理学基础,以提高二者的诊断正确性;从而提高乳腺癌患者的生存率。
方法:本组资料选自河北医科大学第四医院2008.1—2009.10经病理证实的254例乳腺癌,其中178例浸润性导管癌和76例浸润性小叶癌,患者均为女性。浸润性导管癌:年龄最小者26岁,最大者77岁,中位年龄为45岁。浸润性小叶癌:年龄最小者31岁,最大者69岁,中位年龄为48岁。两组均以40-50岁之间发病率最高。影像学资料的采集:使用SIEMENS Movation DR进行乳腺摄影,所有病例均常规拍摄内外侧斜位及头足轴位,其中部分病例采用局部加压放大技术及乳管造影技术。图像处理系统采用Barco5M竖屏,并由两位以上有丰富经验的影像学诊断主任医师联合阅片进行诊断,出据影像学诊断报告。病理科采集临床手术的标本并制作成切片,有两位以上有丰富经验的病理学诊断主任医师联合分析出据病理报告,并对其进行病理分级。并应用SPSS13.0软件对数据进行X2检验,P<0.05为具有统计学意义。
结果:1浸润性导管癌和浸润性小叶癌在数字化乳腺摄影中的主要X线表现:对254例乳腺癌病例(其中浸润性导管癌178例,浸润性小叶癌76例)术前拍摄的数字化乳腺摄影片进行总结分析。浸润性导管癌的主要X线征象为:单纯肿块、单纯钙化、肿块合并钙化,少数表现为结构扭曲及不对称致密影。而浸润性小叶癌的X线主要征象为:结构扭曲、局限性不对称致密影以及二者合并钙化,少数表现为肿块和钙化。具体征象如下:1.1单纯肿块X线表现为在两个投照体位上均能显示的占位性病变。浸润性导管癌共73例,病理分级为3级,其中Ⅰ、Ⅱ级58例、Ⅲ级15例。浸润性小叶癌共9例。1.1.1肿块的边缘可以分为清晰边缘、小分叶边缘、模糊性边缘、浸润性边缘以及星芒状边缘。浸润性导管癌共73例,其中边缘清晰的肿块10例;边缘呈小分叶的肿块3例;边缘模糊的肿块15例;边缘浸润的肿块23例;边缘呈星芒状的肿块22例。而浸润性小叶癌共9例,其中,边缘清晰地肿块1例;边缘呈小分叶的肿块1例;边缘模糊的肿块2例;边缘浸润的肿块3例;边缘呈星芒状的肿块2例。1.1.2肿块的位置好发部位以外上象限为主,其次是内上象限和乳晕后区。178例浸润性导管癌患者中,外上象限84例,外下象限15例,内下象限11例,内上象限41例,乳晕后方27例。而76例浸润性小叶癌中,外上象限32例,外下象限7例,内下象限5例,内上象限19例,乳晕后方13例。1.2单纯钙化钙化形态多种多样,可散在分布,也可成簇状分布。浸润性导管癌共24例,其中Ⅰ、Ⅱ级20例、Ⅲ级4例。而浸润性小叶癌共4例。1.3肿块合并钙化钙化可与肿块同时出现,钙化可位于肿块内、边缘或周围,分布亦无规律,可成团或散在分布。浸润性导管癌共46例,其中Ⅰ、Ⅱ级31例、Ⅲ级15例。而浸润性小叶癌共6例。1.4结构扭曲主要X线征象包括病变处乳腺小梁局限性增粗、僵直,走形方向改变,或者从一点出发的放射状高密度影和局灶性收缩,亦或者在实质的边缘发生扭曲,但无具体肿块形态。浸润性导管癌共14例,其中Ⅰ、Ⅱ级14例、Ⅲ级0例。而浸润性小叶癌共17例。1.5结构扭曲合并钙化浸润性导管癌共14例,其中Ⅰ、Ⅱ级13例、Ⅲ级1例。而浸润性小叶癌共12例。1.6不对称致密影X线表现为看不到明显的肿块形态,乳腺某一区域在两个投照体位上均表现密度异常增高或两侧乳腺比较发现不对称的较致密区。浸润性导管癌共4例,其中Ⅰ、Ⅱ级2例、Ⅲ级2例。而浸润性小叶癌共21例。1.7不对称致密影合并钙化浸润性导管癌共3例,其中Ⅰ、Ⅱ级3例、Ⅲ级0例。而浸润性小叶癌共7例。2 X线导管造影表现254例患者中,有21例以乳头血性或无色溢液而又行导管造影检查。造影表现为造影剂在导管内呈断断续续充盈(断续征),并伴有不规则充盈缺损者6例;乳腺导管受压、狭窄、扭曲、中断者5例;内壁失去光滑,变得凹凸不平,形状如虫蚀样改变者3例;导管形态较僵硬,粗细不均者3例;导管被截断者1例;导管造影阴性者3例。3浸润性导管癌的病理分级与钙化、肿块及结构扭曲的关系浸润性导管癌III级的肿块率高于I、II级(χ2=4.267,P=0.039); I、II级的结构扭曲率高于III级者(χ2=5.980,P=0.014);病理分级与有无钙化无明显相关性(χ2=0.501,P=0.479),与不对称致密影亦无明显相关性(χ2=0.268,P=0.636)。4浸润性导管癌和浸润性小叶癌其单纯肿块的边缘与病理分型之间的关系经统计学分析(χ2=2.326,P=0.783>0.05)无统计学意义,认为浸润性导管癌及浸润性小叶癌在肿瘤边缘形态的改变方面无明显差异。
结论:浸润性导管癌的X线主要征象为:单纯肿块;单纯钙化;肿块合并钙化,少数表现为结构扭曲及不对称致密影。而浸润性小叶癌的X线主要征象为:结构扭曲;不对称致密影;以及结构扭曲或不对称致密影合并钙化,少数表现为肿块和钙化。浸润性导管癌III级的肿块率高于I、II级; I、II级的结构扭曲率高于III级者;分级与有无钙化及不对称致密影无明显相关性。浸润性导管癌和浸润性小叶癌其单纯肿块的边缘形态与病理分型之间无相关性。
Objective: To analysis digital mammography sign of invasive ductal carcinoma and invasive lobular carcinoma and to discuss the pathological basis;To improve both of the diagnostic accuracy and breast cancer’s survival.
Methods: The study included 254 histopathologically proven breast carcinoma patients in the Fourth Hospital of Hebei Medical University, including 178 cases of invasive ductal carcinoma and 76 cases of invasive lobular carcinoma. They were all female. The patients of invasive ductal carcinoma: the range of age was 26-77 years old,means age was 45 years old. And the patients of invasive lobular carcinoma: the range of age was 31-69 years old,means age was 48 years old.In the two groups, the age which had the highest incidence rates was 40-50 years old. The collection of imaging information: Image data collection: we used SIEMENS Movation DR for mammography and Barco5M vertical screen for image processing system. All patients took photographs for mediolateral oblique (MLO) view and cranio caudal (CC) view, parts adopted magnification mammography and galactography. Two experiential imaging directors diagnosed and brought forth diagnosis reports.The collections of pathology data: Collected surgery specimens and made in slice ups, Two experiential directors diagnosed . Then they brought forth diagnosis( including pathological grade).Form these data, we found the relationship between invasive ductal carcinoma’s pathological grade and calcification,mass,or structural distortions and the relationship between the mass’s edge and the types of invasive breast carcinoma. All results were caculated in a statistics software (SPSS Version 13.0), P<0.05 was considered to be ststistically signnificant.
Results : 1 the main signs of invasive ductal carcinoma and invasive lobular carcinoma in the digital mammography To analysis digital mammography sign of 254 cases of breast cancer (178 cases with invasive ductal carcinoma, 76 cases with invasive lobular carcinoma).The major signs of invasive ductal carcinoma had simple mass,simple calcification, mass with calcification, small number expressed as structural distortions and asymmetric. And the major signs of invasive lobular carcinoma had structural distortion; asymmetric, and structural distortion or asymmetric with calcification, small numbers expressed as mass and calcification.The major signs were following: 1.1 The simple mass’s signs were the space-occupying lesions could appear on the two positions. They inclulded 73 cases invasive ductal carcinoma(58 cases ofⅠ,Ⅱgrades, 15 cases ofⅢgrade).and 9 cases invasive lobular carcinoma. 1.1.1 The boundary of mass could be divided into well-defined, light-lobulated, fuzzy, invasion, as well as astral-shaped. In the invasive ductal carcinoma, well-defined (10 case), light-lobulated (3 cases), fuzzy (15 cases), invasion (23 cases), and astral-shaped (22 cases).And in the invasive lobular carcinoma, well-defined (1 case), light-lobulated (1 case), fuzzy (2 cases), invasion (3 cases), and astral-shaped (2 cases). 1.1.2 The predilection site of tumor was the outer upper quadrant, followed by the upper-inner quadrant and areola area. Among 178 cases of ductal carcinoma patients, 84 cases of upper-outer quadrant, 15 cases of lower-outer quadrant, 11 cases of lower-inner quadrant, 41 cases of upper-inner quadrant, and 27 cases of areola rear. Among the 76 cases of invasive lobular carcinoma, 32 cases of upper-outer quadrant, 7 cases of lower-outer quadrant, 5 cases of lower-inner quadrant, 19 cases of upper-inner quadrant, and 13 cases of areola rear. 1.2 The shape of calcification was varied, which could be scattered, and clusters-shape. Invasive ductal carcinoma were 24 cases, including 20 cases ofⅠ,Ⅱgrades, 4 cases ofⅢgrade. And invasive lobular carcinoma were 4 cases. 1.3 mass with calcification: Calcification could be simultaneous with the mass, also could be located with in the tumor, edge or around. The distribution was irregularity, to be together or scattered. Invasive ductal carcinoma were 46 cases, including 31 cases ofⅠ,Ⅱgrades, 15 cases of Ⅲgrade. And invasive lobular carcinoma were 6 cases. 1.4 structural distortion The mian signs included breast trabecular localized thickening, stiffness, the change of direction, or the high-density shadow and focal contraction came from a point of view radially, or the edge of parenchymal was distorted, but no specific mass. Invasive ductal carcinoma were 14 cases, including 14 cases ofⅠ,Ⅱgrades, 0 case ofⅢgrade. And invasive lobular carcinoma were 17 cases. 1.5 structural distortion with calcification: Invasive ductal carcinoma were 14 cases, including 13 cases ofⅠ,Ⅱgrades, 1 case ofⅢgrade. And invasive lobular carcinoma were 12 cases.1.6 asymmetric The X-ray findings didn’t see the obvious for the mass, there was abnormal increasing density in the two breast projection position, or comparison of the both sides , they showed asymmetry. Invasive ductal carcinoma were 4 cases, including 2 cases ofⅠ,Ⅱgrades, 2 cases ofⅢgrade. And invasive lobular carcinoma were 21 cases. 1.7 asymmetric with calcification Invasive ductal carcinoma were 3 cases, including 3 cases ofⅠ,Ⅱgrades, 0 case ofⅢgrade. And invasive lobular carcinoma were 7 cases. 2 sign of galactography: In 254 cases,21 cases were checked-up by galactography because of nipple discharge. Contrast agents in ducts lost of continuum(6 cases); The ducts of mammary gland were pressed, distorted or intermitted(6 cases); The walls of ducts’were dissatisfied and lost smooth like worm’s eroding(3 cases); The ducts’form was ankylosis and asymmetry(3 cases); Galactography had no visual mamary gland abnormal(3 cases).3 the relationship between invasive ductal carcinoma’s pathological grade and calcification, mass,or structural distortions GradeⅢIDC was more likely to be associated with a mass when findings were seen on mammogram. (χ2 =4.267,P=0.039), and grade I and gradeⅡIDC were more likely to be associated with distortion (χ2 =5.980,P=0.014). But the pathological grade had no relationship with calcification(χ2 =0.501, P=0.479)and asymmetric(χ2 =0.268, P=0.636) 4 the relationship between the edge of mass and the types of invasive breast carcinoma Form both of them mass’s edge, the invasive ductal carcinoma’s every circumstances seemed to common. However, obtained by statistical analysis, it was no statistical significance(χ2=2.326,P=0.783>0.05). It was no relationship between the simple mass’s edge and the types of invasive breast carcinoma.
Conclusion: The major signs of invasive ductal carcinoma had simple mass; simple calcification; mass with calcification, small number of the performance of structural distortion and asymmetric. And the major signs of invasive lobular carcinoma had structural distortion; asymmetric;, and structural distortion or asymmetric with calcification, small numbers expressed as mass and calcification. GradeⅢIDC was more likely to be associated with a mass when findings were seen on mammogram, and grade I and gradeⅡIDC were more likely to be associated with distortion. But the pathological grade had no relationship with calcification and asymmetric. It was no relationship between the simple mass’s edge and the types of invasive breast carcinoma.
方法:本组资料选自河北医科大学第四医院2008.1—2009.10经病理证实的254例乳腺癌,其中178例浸润性导管癌和76例浸润性小叶癌,患者均为女性。浸润性导管癌:年龄最小者26岁,最大者77岁,中位年龄为45岁。浸润性小叶癌:年龄最小者31岁,最大者69岁,中位年龄为48岁。两组均以40-50岁之间发病率最高。影像学资料的采集:使用SIEMENS Movation DR进行乳腺摄影,所有病例均常规拍摄内外侧斜位及头足轴位,其中部分病例采用局部加压放大技术及乳管造影技术。图像处理系统采用Barco5M竖屏,并由两位以上有丰富经验的影像学诊断主任医师联合阅片进行诊断,出据影像学诊断报告。病理科采集临床手术的标本并制作成切片,有两位以上有丰富经验的病理学诊断主任医师联合分析出据病理报告,并对其进行病理分级。并应用SPSS13.0软件对数据进行X2检验,P<0.05为具有统计学意义。
结果:1浸润性导管癌和浸润性小叶癌在数字化乳腺摄影中的主要X线表现:对254例乳腺癌病例(其中浸润性导管癌178例,浸润性小叶癌76例)术前拍摄的数字化乳腺摄影片进行总结分析。浸润性导管癌的主要X线征象为:单纯肿块、单纯钙化、肿块合并钙化,少数表现为结构扭曲及不对称致密影。而浸润性小叶癌的X线主要征象为:结构扭曲、局限性不对称致密影以及二者合并钙化,少数表现为肿块和钙化。具体征象如下:1.1单纯肿块X线表现为在两个投照体位上均能显示的占位性病变。浸润性导管癌共73例,病理分级为3级,其中Ⅰ、Ⅱ级58例、Ⅲ级15例。浸润性小叶癌共9例。1.1.1肿块的边缘可以分为清晰边缘、小分叶边缘、模糊性边缘、浸润性边缘以及星芒状边缘。浸润性导管癌共73例,其中边缘清晰的肿块10例;边缘呈小分叶的肿块3例;边缘模糊的肿块15例;边缘浸润的肿块23例;边缘呈星芒状的肿块22例。而浸润性小叶癌共9例,其中,边缘清晰地肿块1例;边缘呈小分叶的肿块1例;边缘模糊的肿块2例;边缘浸润的肿块3例;边缘呈星芒状的肿块2例。1.1.2肿块的位置好发部位以外上象限为主,其次是内上象限和乳晕后区。178例浸润性导管癌患者中,外上象限84例,外下象限15例,内下象限11例,内上象限41例,乳晕后方27例。而76例浸润性小叶癌中,外上象限32例,外下象限7例,内下象限5例,内上象限19例,乳晕后方13例。1.2单纯钙化钙化形态多种多样,可散在分布,也可成簇状分布。浸润性导管癌共24例,其中Ⅰ、Ⅱ级20例、Ⅲ级4例。而浸润性小叶癌共4例。1.3肿块合并钙化钙化可与肿块同时出现,钙化可位于肿块内、边缘或周围,分布亦无规律,可成团或散在分布。浸润性导管癌共46例,其中Ⅰ、Ⅱ级31例、Ⅲ级15例。而浸润性小叶癌共6例。1.4结构扭曲主要X线征象包括病变处乳腺小梁局限性增粗、僵直,走形方向改变,或者从一点出发的放射状高密度影和局灶性收缩,亦或者在实质的边缘发生扭曲,但无具体肿块形态。浸润性导管癌共14例,其中Ⅰ、Ⅱ级14例、Ⅲ级0例。而浸润性小叶癌共17例。1.5结构扭曲合并钙化浸润性导管癌共14例,其中Ⅰ、Ⅱ级13例、Ⅲ级1例。而浸润性小叶癌共12例。1.6不对称致密影X线表现为看不到明显的肿块形态,乳腺某一区域在两个投照体位上均表现密度异常增高或两侧乳腺比较发现不对称的较致密区。浸润性导管癌共4例,其中Ⅰ、Ⅱ级2例、Ⅲ级2例。而浸润性小叶癌共21例。1.7不对称致密影合并钙化浸润性导管癌共3例,其中Ⅰ、Ⅱ级3例、Ⅲ级0例。而浸润性小叶癌共7例。2 X线导管造影表现254例患者中,有21例以乳头血性或无色溢液而又行导管造影检查。造影表现为造影剂在导管内呈断断续续充盈(断续征),并伴有不规则充盈缺损者6例;乳腺导管受压、狭窄、扭曲、中断者5例;内壁失去光滑,变得凹凸不平,形状如虫蚀样改变者3例;导管形态较僵硬,粗细不均者3例;导管被截断者1例;导管造影阴性者3例。3浸润性导管癌的病理分级与钙化、肿块及结构扭曲的关系浸润性导管癌III级的肿块率高于I、II级(χ2=4.267,P=0.039); I、II级的结构扭曲率高于III级者(χ2=5.980,P=0.014);病理分级与有无钙化无明显相关性(χ2=0.501,P=0.479),与不对称致密影亦无明显相关性(χ2=0.268,P=0.636)。4浸润性导管癌和浸润性小叶癌其单纯肿块的边缘与病理分型之间的关系经统计学分析(χ2=2.326,P=0.783>0.05)无统计学意义,认为浸润性导管癌及浸润性小叶癌在肿瘤边缘形态的改变方面无明显差异。
结论:浸润性导管癌的X线主要征象为:单纯肿块;单纯钙化;肿块合并钙化,少数表现为结构扭曲及不对称致密影。而浸润性小叶癌的X线主要征象为:结构扭曲;不对称致密影;以及结构扭曲或不对称致密影合并钙化,少数表现为肿块和钙化。浸润性导管癌III级的肿块率高于I、II级; I、II级的结构扭曲率高于III级者;分级与有无钙化及不对称致密影无明显相关性。浸润性导管癌和浸润性小叶癌其单纯肿块的边缘形态与病理分型之间无相关性。
Objective: To analysis digital mammography sign of invasive ductal carcinoma and invasive lobular carcinoma and to discuss the pathological basis;To improve both of the diagnostic accuracy and breast cancer’s survival.
Methods: The study included 254 histopathologically proven breast carcinoma patients in the Fourth Hospital of Hebei Medical University, including 178 cases of invasive ductal carcinoma and 76 cases of invasive lobular carcinoma. They were all female. The patients of invasive ductal carcinoma: the range of age was 26-77 years old,means age was 45 years old. And the patients of invasive lobular carcinoma: the range of age was 31-69 years old,means age was 48 years old.In the two groups, the age which had the highest incidence rates was 40-50 years old. The collection of imaging information: Image data collection: we used SIEMENS Movation DR for mammography and Barco5M vertical screen for image processing system. All patients took photographs for mediolateral oblique (MLO) view and cranio caudal (CC) view, parts adopted magnification mammography and galactography. Two experiential imaging directors diagnosed and brought forth diagnosis reports.The collections of pathology data: Collected surgery specimens and made in slice ups, Two experiential directors diagnosed . Then they brought forth diagnosis( including pathological grade).Form these data, we found the relationship between invasive ductal carcinoma’s pathological grade and calcification,mass,or structural distortions and the relationship between the mass’s edge and the types of invasive breast carcinoma. All results were caculated in a statistics software (SPSS Version 13.0), P<0.05 was considered to be ststistically signnificant.
Results : 1 the main signs of invasive ductal carcinoma and invasive lobular carcinoma in the digital mammography To analysis digital mammography sign of 254 cases of breast cancer (178 cases with invasive ductal carcinoma, 76 cases with invasive lobular carcinoma).The major signs of invasive ductal carcinoma had simple mass,simple calcification, mass with calcification, small number expressed as structural distortions and asymmetric. And the major signs of invasive lobular carcinoma had structural distortion; asymmetric, and structural distortion or asymmetric with calcification, small numbers expressed as mass and calcification.The major signs were following: 1.1 The simple mass’s signs were the space-occupying lesions could appear on the two positions. They inclulded 73 cases invasive ductal carcinoma(58 cases ofⅠ,Ⅱgrades, 15 cases ofⅢgrade).and 9 cases invasive lobular carcinoma. 1.1.1 The boundary of mass could be divided into well-defined, light-lobulated, fuzzy, invasion, as well as astral-shaped. In the invasive ductal carcinoma, well-defined (10 case), light-lobulated (3 cases), fuzzy (15 cases), invasion (23 cases), and astral-shaped (22 cases).And in the invasive lobular carcinoma, well-defined (1 case), light-lobulated (1 case), fuzzy (2 cases), invasion (3 cases), and astral-shaped (2 cases). 1.1.2 The predilection site of tumor was the outer upper quadrant, followed by the upper-inner quadrant and areola area. Among 178 cases of ductal carcinoma patients, 84 cases of upper-outer quadrant, 15 cases of lower-outer quadrant, 11 cases of lower-inner quadrant, 41 cases of upper-inner quadrant, and 27 cases of areola rear. Among the 76 cases of invasive lobular carcinoma, 32 cases of upper-outer quadrant, 7 cases of lower-outer quadrant, 5 cases of lower-inner quadrant, 19 cases of upper-inner quadrant, and 13 cases of areola rear. 1.2 The shape of calcification was varied, which could be scattered, and clusters-shape. Invasive ductal carcinoma were 24 cases, including 20 cases ofⅠ,Ⅱgrades, 4 cases ofⅢgrade. And invasive lobular carcinoma were 4 cases. 1.3 mass with calcification: Calcification could be simultaneous with the mass, also could be located with in the tumor, edge or around. The distribution was irregularity, to be together or scattered. Invasive ductal carcinoma were 46 cases, including 31 cases ofⅠ,Ⅱgrades, 15 cases of Ⅲgrade. And invasive lobular carcinoma were 6 cases. 1.4 structural distortion The mian signs included breast trabecular localized thickening, stiffness, the change of direction, or the high-density shadow and focal contraction came from a point of view radially, or the edge of parenchymal was distorted, but no specific mass. Invasive ductal carcinoma were 14 cases, including 14 cases ofⅠ,Ⅱgrades, 0 case ofⅢgrade. And invasive lobular carcinoma were 17 cases. 1.5 structural distortion with calcification: Invasive ductal carcinoma were 14 cases, including 13 cases ofⅠ,Ⅱgrades, 1 case ofⅢgrade. And invasive lobular carcinoma were 12 cases.1.6 asymmetric The X-ray findings didn’t see the obvious for the mass, there was abnormal increasing density in the two breast projection position, or comparison of the both sides , they showed asymmetry. Invasive ductal carcinoma were 4 cases, including 2 cases ofⅠ,Ⅱgrades, 2 cases ofⅢgrade. And invasive lobular carcinoma were 21 cases. 1.7 asymmetric with calcification Invasive ductal carcinoma were 3 cases, including 3 cases ofⅠ,Ⅱgrades, 0 case ofⅢgrade. And invasive lobular carcinoma were 7 cases. 2 sign of galactography: In 254 cases,21 cases were checked-up by galactography because of nipple discharge. Contrast agents in ducts lost of continuum(6 cases); The ducts of mammary gland were pressed, distorted or intermitted(6 cases); The walls of ducts’were dissatisfied and lost smooth like worm’s eroding(3 cases); The ducts’form was ankylosis and asymmetry(3 cases); Galactography had no visual mamary gland abnormal(3 cases).3 the relationship between invasive ductal carcinoma’s pathological grade and calcification, mass,or structural distortions GradeⅢIDC was more likely to be associated with a mass when findings were seen on mammogram. (χ2 =4.267,P=0.039), and grade I and gradeⅡIDC were more likely to be associated with distortion (χ2 =5.980,P=0.014). But the pathological grade had no relationship with calcification(χ2 =0.501, P=0.479)and asymmetric(χ2 =0.268, P=0.636) 4 the relationship between the edge of mass and the types of invasive breast carcinoma Form both of them mass’s edge, the invasive ductal carcinoma’s every circumstances seemed to common. However, obtained by statistical analysis, it was no statistical significance(χ2=2.326,P=0.783>0.05). It was no relationship between the simple mass’s edge and the types of invasive breast carcinoma.
Conclusion: The major signs of invasive ductal carcinoma had simple mass; simple calcification; mass with calcification, small number of the performance of structural distortion and asymmetric. And the major signs of invasive lobular carcinoma had structural distortion; asymmetric;, and structural distortion or asymmetric with calcification, small numbers expressed as mass and calcification. GradeⅢIDC was more likely to be associated with a mass when findings were seen on mammogram, and grade I and gradeⅡIDC were more likely to be associated with distortion. But the pathological grade had no relationship with calcification and asymmetric. It was no relationship between the simple mass’s edge and the types of invasive breast carcinoma.
引文
1李树玲.乳腺肿瘤学[M].北京:科学技术文献出版社,2000.209-221
2 Irwig L, Houssami N, Vliet van C. New Technologies in Screening for Breast Cancer: a Systematic Review of Their Accuracy[J].Br J Cancer, 2004, 90(11): 2118-2122
3 Boyle P, Leon ME, Maisonneuve P, etal. Cancer control in women[J]. Update 2003. Int J Gynaecol Obstet,2003;83(Suppl 1):179-202
4 Sickles E. Breast imaging: from1965 to the present. Radiology, 2000,215:1
5 Obenauer S, Hermann KP, Schorn C,et al. Full-field digital mammography: dose-dependent detect ability ofbreast lesions and micro-calcinosis [J].Rofo, 2000, 172(12): 1052- 1056
6 Pisano ED, Parham CA. Digital mammography, sestamibi breast.Scintigraphy , and positron emission tomography breast imaging. Radio. Clin North Am,2000, 38:861-869
7 Feig SA, Yaffe MJ. Digital mammography. Radiographics, 1998, 18: 893-901
8 Schonhofen H, Arnold W, Hess T, et al. Digital mammography: experiences in its clinical application. Rofo Fortschr Geb RontgenstrNeuen Bildgeb Verfahr, 1998, 169:45-52
9 Fischer U, Baum F, Obenauer S,et al. Comparative study inpatientswith micro-calcifications: full-field digital mammography vs screen-film mammography[ J]. Eur Radio,l 2002, 12 (11):2679-2683
10陆忠烈,蒋伟浩,王立章.乳腺癌钼靶X线征象分析(附114例报告)[J].实用放射学杂志,2006,22(6):740-742
11胡永升.现代乳腺影像诊断学[M].北京:科学出版社,2001.45-57
12 Kopans Db. Atlas of Breast Imaging[M]. Philadelphia: Williams and Wilkins,1998.97-101
13 Lamb PM, Perry NM, Vinnicombe SJ, etal Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radio, 2000, 40
14何俊诗.乳腺浸润性导管癌的钼靶X线和MRI表现[J]?中国医学影像学杂志, 2003, 11(6):412-413
15 Buchanan JB, Spratt JS, Heuser LS. Tumor growth, doubling times, and the inability of the radiologist to diagnose certain cancers [J]. Radiol Clin North Am. 1983; 21 (1): 115-126
16刘秀建,《乳腺疾病X线诊断图谱》.人民卫生出版社,2009,178
17 D′Orsi CJ, Newell MS. BI-RADS decoded: detailed guidance on potentially confusing issues [J]. Radiol Clin North Am, 2007, 45(5): 751-763
18 Peter Armstrong(美)著.邱健泰,王仲祺,黄忠英,等译.影像诊断学[M].沈阳:辽宁科学技术出版社,2001.98-99.
19 Sigfusson BF, Andersson I,Aspergren K,et al. Clustered breast calcifications. Acta Radiol, 1983,24:273
20董郡主编.病理学〔M〕.第2版.北京:人民卫生出版社,1996.733-746
21顾雅佳.规范乳腺X线报告[J].中华放射学杂志,2003;381.(9):903
22 Mendelson EB , Harris KM, bovhi i`1, et al. Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation. AJR 1989 s 153: 265
23 Newstead GM,Baute PB, Toth HK. Invasive lobular and ductal carcinoma: mammographic findigns and stage at diagnosis. Radiology 1992;184,623
1 Boyle P, Leon ME, Maisonneuve P, et al. Cancer control in women[J]. Update 2003. Int J Gynaecol Obstet,2003;83(Suppl 1): 179-202
2 Irwig L, Houssami N, Vliet van C. New Technologies in Screening for Breast Cancer:a Systematic Review of Their Accuracy[J].Br JCancer, 2004,90(11):2118-2122
3 Tabar L, Duffy SW, Vitak B, Chen H, Prevost TC. The natural history of breast cancer.Cancer1999;86:449–462
4 Tabar L, Chen H, Duffy SW, etal. Anovel method for prediction of long-term outcome of women with T1a, T1b, and 10–14 mm invasive breast cancers: aprospective study. Lancet 2000; 355: 429– 433
5 American College of Radiology. Breast imaging reporting and data system (BI-RADS) Reston, Va: American College of Radiology, 2003
6 Harvey JA, Fechner RE, Moore MM. Apparentipsilateral decrease in breast size on mammography: asign of infiltratin globular carcinoma. Radiology 2000;214:883–889
7 Berg JW, Hutter RV. Breast cancer. Cancer 1995; 75(1suppl): 257–269
8 Hilleren DJ, Andersson IT, Lindholm K,Linnell FS. Invasive lobular carcinoma: mammographic findings in a10-year experience. Radiology 1991; 178:149–154
9 Tabar L, Dean PB. Teaching atlas of mammography. 3rded. NewYork , NY:Thieme,2001
10 Bassett LW, Hirbawi IA, DeBruhl N, Hayes MK. Mammographic positioning: evaluation from the view box. Radiology 1993; 188: 803–806
11 Lee EH, Wylie EJ, Bourke AG, Bastiaan De Boer W. Invasive ductalcarcinoma arising in a breas thamartoma: two case reports and a review of the literature.ClinRadiol 2003;58:80–83
12 Breucq C, Verfaillie G, Perdaens C, Vermeiren B, Stadnik T. Lobular carcinoma located in a breas thamartoma. Breast J2005; 11 508–509
13 Thurfjell EL, Lernevall KA, Taube AA. Benefit of independent double reading in a population-based mammography screening program. Radiology 1994;191:241–244
14 Freer TW, Ulissey MJ. Screening mammography with computer- aided detection: prospective study of12,860 patients in a community breast center. Radiology2001;220:781–786
15 Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology1995;196:123–134
16 Sickles EA. Periodic mammographic follow-up of probably benign lesions: resultsin3184 consecutive cases. Radiology 1991;1 79: 463– 468
17 TaplinSH, IchikawaLE, Kerlikowske K,etal. Concordance of breast imaging reporting and data system assessments and management recommendations in screening mammography. Radiology 2002; 222: 529–535
18 Rosen EL, Baker JA, Soo MS. Malignant lesions Initially subjected to shortter mmammographic followup. Radiology 2002; 223:221–228
2 Irwig L, Houssami N, Vliet van C. New Technologies in Screening for Breast Cancer: a Systematic Review of Their Accuracy[J].Br J Cancer, 2004, 90(11): 2118-2122
3 Boyle P, Leon ME, Maisonneuve P, etal. Cancer control in women[J]. Update 2003. Int J Gynaecol Obstet,2003;83(Suppl 1):179-202
4 Sickles E. Breast imaging: from1965 to the present. Radiology, 2000,215:1
5 Obenauer S, Hermann KP, Schorn C,et al. Full-field digital mammography: dose-dependent detect ability ofbreast lesions and micro-calcinosis [J].Rofo, 2000, 172(12): 1052- 1056
6 Pisano ED, Parham CA. Digital mammography, sestamibi breast.Scintigraphy , and positron emission tomography breast imaging. Radio. Clin North Am,2000, 38:861-869
7 Feig SA, Yaffe MJ. Digital mammography. Radiographics, 1998, 18: 893-901
8 Schonhofen H, Arnold W, Hess T, et al. Digital mammography: experiences in its clinical application. Rofo Fortschr Geb RontgenstrNeuen Bildgeb Verfahr, 1998, 169:45-52
9 Fischer U, Baum F, Obenauer S,et al. Comparative study inpatientswith micro-calcifications: full-field digital mammography vs screen-film mammography[ J]. Eur Radio,l 2002, 12 (11):2679-2683
10陆忠烈,蒋伟浩,王立章.乳腺癌钼靶X线征象分析(附114例报告)[J].实用放射学杂志,2006,22(6):740-742
11胡永升.现代乳腺影像诊断学[M].北京:科学出版社,2001.45-57
12 Kopans Db. Atlas of Breast Imaging[M]. Philadelphia: Williams and Wilkins,1998.97-101
13 Lamb PM, Perry NM, Vinnicombe SJ, etal Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radio, 2000, 40
14何俊诗.乳腺浸润性导管癌的钼靶X线和MRI表现[J]?中国医学影像学杂志, 2003, 11(6):412-413
15 Buchanan JB, Spratt JS, Heuser LS. Tumor growth, doubling times, and the inability of the radiologist to diagnose certain cancers [J]. Radiol Clin North Am. 1983; 21 (1): 115-126
16刘秀建,《乳腺疾病X线诊断图谱》.人民卫生出版社,2009,178
17 D′Orsi CJ, Newell MS. BI-RADS decoded: detailed guidance on potentially confusing issues [J]. Radiol Clin North Am, 2007, 45(5): 751-763
18 Peter Armstrong(美)著.邱健泰,王仲祺,黄忠英,等译.影像诊断学[M].沈阳:辽宁科学技术出版社,2001.98-99.
19 Sigfusson BF, Andersson I,Aspergren K,et al. Clustered breast calcifications. Acta Radiol, 1983,24:273
20董郡主编.病理学〔M〕.第2版.北京:人民卫生出版社,1996.733-746
21顾雅佳.规范乳腺X线报告[J].中华放射学杂志,2003;381.(9):903
22 Mendelson EB , Harris KM, bovhi i`1, et al. Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation. AJR 1989 s 153: 265
23 Newstead GM,Baute PB, Toth HK. Invasive lobular and ductal carcinoma: mammographic findigns and stage at diagnosis. Radiology 1992;184,623
1 Boyle P, Leon ME, Maisonneuve P, et al. Cancer control in women[J]. Update 2003. Int J Gynaecol Obstet,2003;83(Suppl 1): 179-202
2 Irwig L, Houssami N, Vliet van C. New Technologies in Screening for Breast Cancer:a Systematic Review of Their Accuracy[J].Br JCancer, 2004,90(11):2118-2122
3 Tabar L, Duffy SW, Vitak B, Chen H, Prevost TC. The natural history of breast cancer.Cancer1999;86:449–462
4 Tabar L, Chen H, Duffy SW, etal. Anovel method for prediction of long-term outcome of women with T1a, T1b, and 10–14 mm invasive breast cancers: aprospective study. Lancet 2000; 355: 429– 433
5 American College of Radiology. Breast imaging reporting and data system (BI-RADS) Reston, Va: American College of Radiology, 2003
6 Harvey JA, Fechner RE, Moore MM. Apparentipsilateral decrease in breast size on mammography: asign of infiltratin globular carcinoma. Radiology 2000;214:883–889
7 Berg JW, Hutter RV. Breast cancer. Cancer 1995; 75(1suppl): 257–269
8 Hilleren DJ, Andersson IT, Lindholm K,Linnell FS. Invasive lobular carcinoma: mammographic findings in a10-year experience. Radiology 1991; 178:149–154
9 Tabar L, Dean PB. Teaching atlas of mammography. 3rded. NewYork , NY:Thieme,2001
10 Bassett LW, Hirbawi IA, DeBruhl N, Hayes MK. Mammographic positioning: evaluation from the view box. Radiology 1993; 188: 803–806
11 Lee EH, Wylie EJ, Bourke AG, Bastiaan De Boer W. Invasive ductalcarcinoma arising in a breas thamartoma: two case reports and a review of the literature.ClinRadiol 2003;58:80–83
12 Breucq C, Verfaillie G, Perdaens C, Vermeiren B, Stadnik T. Lobular carcinoma located in a breas thamartoma. Breast J2005; 11 508–509
13 Thurfjell EL, Lernevall KA, Taube AA. Benefit of independent double reading in a population-based mammography screening program. Radiology 1994;191:241–244
14 Freer TW, Ulissey MJ. Screening mammography with computer- aided detection: prospective study of12,860 patients in a community breast center. Radiology2001;220:781–786
15 Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology1995;196:123–134
16 Sickles EA. Periodic mammographic follow-up of probably benign lesions: resultsin3184 consecutive cases. Radiology 1991;1 79: 463– 468
17 TaplinSH, IchikawaLE, Kerlikowske K,etal. Concordance of breast imaging reporting and data system assessments and management recommendations in screening mammography. Radiology 2002; 222: 529–535
18 Rosen EL, Baker JA, Soo MS. Malignant lesions Initially subjected to shortter mmammographic followup. Radiology 2002; 223:221–228