中国癌症杂志 ›› 2014, Vol. 24 ›› Issue (9): 707-712.doi: 10.3969/j.issn.1007-3969.2014.09.011

• 综述 • 上一篇    下一篇

钙化灶的影像学评估和化学成分分析在乳腺癌诊疗中的价值

黄乃思 综述,吴炅 审校   

  1. 复旦大学附属肿瘤医院乳腺外科,复旦大学上海医学院肿瘤学系,上海200032
  • 出版日期:2014-09-30 发布日期:2014-11-12
  • 通信作者: 吴炅 E-mail:wujiong1122@vip.sina.com

Breast calcification plays a major role in breast cancer: form radiology assessment to chemical composition analysis

HUANG Nai-si, WU Jiong   

  1. Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Published:2014-09-30 Online:2014-11-12
  • Contact: WU Jiong E-mail: wujiong1122@vip.sina.com

摘要:

乳腺钙化灶在乳腺癌的早期诊断、监控复发及判断预后方面有重要意义。目前乳腺钙化形成的机制尚不明确。肿瘤微环境中生理性矿化调节因子的失调,可能是钙化产生的重要原因。传统的诊断方法主要依赖于影像学上钙化灶的形态学特征和分布特点,它们与乳腺癌的病理类型、肿瘤生物学特性有关。与形态学相比,乳腺钙化灶的化学成分可能与肿瘤性质关系更为密切。依照化学成分,乳腺钙化可以分为两型,I型为二水草酸钙,出现在良性病变中;Ⅱ型为羟基磷灰石,见于增生性病变,多为恶性。同时,Ⅱ型钙化中碳酸盐的含量与肿瘤恶性程度相关。虽然数字乳腺断层融合X线摄影等技术的出现优化了钙化灶的影像学诊断方法,但依旧不能提供钙化灶化学成分的信息,也不能准确界定肿瘤的性质。最新的研究利用拉曼光谱可以无创地获取钙化的化学成分信息,用于区分良恶性钙化灶,可能是未来诊断的发展方向。

关键词: 乳腺癌, 钙化灶, 化学成分, 诊断

Abstract:

Breast calcification plays an important role in breast cancer in various areas, such as early-stage diagnosis, recurrence monitoring and prognosis prediction. However, the mechanism of breast calcifications remains elusive. One proposed mechanism is based on an imbalance between the enhancers and inhibitors of physiological mineralization. Traditionally, the classification of breast calcification is based on the assessment of morphology and distribution. These radiology features are closely related to pathology and biological behavior of tumor. However, chemical composition of calcifications can provide us with more information about tumor status. Calcifications could be divided into two categories according to chemical composition. Type I (calcium oxalate) is found in benign breast disease, while type (hydroxyapatite) is found in proliferative lesions, mostly to be associated with malignancy. Moreover, carbonate concentrations in type calcifications is related to pathology grades. Despite emerging imaging technologies such as digital breast tomosynthesis, they are unable to yield any information on chemical composition of breast calcifications and thus cannot provide a definitive marker for classifying benign and malignant lesions. Recent researches show that using Raman spectroscopy, the chemical information of calcification could be obtained noninvasively and might provide us with a better mode for calcification diagnosis in the future.

Key words: Breast cancer, Calcification, Chemical composition, Diagnosis