尤超, 顾雅佳, 彭卫军, et al. MRI in the differential diagnosis of breast ductal cancerin situ[J]. China Oncology, 2014, 24(6): 463-468. DOI: 10.3969/j.issn.1007-3969.2014.06.011.
背景与目的:乳腺导管原位癌(ductal carcinoma in situ,DCIS)属于乳腺浸润性癌的前驱病变,是一类非全身性的导管内局部病变,与其他导管内病变在影像上存在相似之处。本研究旨在探讨乳腺MRI鉴别诊断DCIS与其他乳腺导管内病变的价值。方法:回顾性分析2011年7月—2012年2月于复旦大学附属肿瘤医院行乳腺MRI检查并经手术病理证实的DCIS患者24例、DCIS伴微浸润(breast ductal carcinoma in situ with microinvasion,DCIS-MI)9例、乳腺导管内乳头状瘤(breast intraductal papilloma,BIDP)20例临床资料。以DCIS为研究主体,分析3种病变MRI及动态增强表现。结果:DCIS与DCIS-MI的病灶强化形态、强化方式、时间-信号强度曲线(TIC)、病灶伪彩图像间差异均无统计学意义(P>0.05),而DCIS与BIDP的病灶强化形态、强化方式、TIC、病灶伪彩图像间差异均有统计学意义(P<0.05)。DCIS以导管样(8/24)及段样强化(6/24)为主、病灶伪彩图像为红色(22/24)、TIC以Ⅲ型(12/24)为主要特征性表现;BIDP以乳头后局灶性强化为主(13/20)、病灶伪彩图像为非红色(14/20)、TIC以Ⅱ型(11/20)为主要特征性表现。结论:MRI较难鉴别DCIS与DCIS-MI,但具有鉴别诊断DCIS与BIDP的价值。
Abstract
Background and purpose: Ductal carcinoma in situ (DCIS)
is precursor lesions of invasive breast cancer
belongs to non-systemic ductal lesions
which is similar to other ductal lesions on imaging. This study aimed to investigate the differential diagnostic value of MRI in DCIS between DCIS with microinvasion (DCIS-MI) and breast intraductal papilloma (BIDP). Methods: All the cases were surgico-pathologically confirmed. Twenty-four patients were DCIS
9 patients were DCIS-MI
and 20 patients were BIDP. The MRI charateristics of DCIS
DCIS-MI and BIDP were analyzed and compared. Results: DCIS and DCIS-MI’s performance in the form of MRI is difficult to differentiate (P0.05). Compared with BIDP
the ductal and segmental enhancement
type Ⅲ time-signal intensity curve (TIC)
and the red pseudo-color image were associated with the DCIS. The local area enhancement
type Ⅱ TIC
and no-red pseudo-color image were associated with BIDP. Conclusion: MRI is a useful for differentiate between DCIS and BIDP