乳腺复杂硬化性病变与浸润性乳腺癌的MR影像比较及病理分析
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摘要
目的:比较乳腺复杂硬化性病变(CSL)与浸润性癌(IC)的MR影像差异及病理特点。方法:回顾性分析27例经病理证实的CSL病例,与同期33例IC病例进行对比分析,对患者的病理及MRI资料进行分析比较。结果:CSL组患者平均年龄为45.7±8.4岁,IC组为57.8±14.2岁(P=0.000)。CSL病灶大小1.19±0.64cm,IC为2.14±1.35cm(P=0.001)。59.3%的CSL和69.7%的IC病例MRI表现两者相似。T1WI低信号有25例IC(75.8%),13例CSL(48.1%),有统计学差异(P=0.027);T2WI信号强度(P=0.386)和STIR信号强度(P=0.093)无统计学差异。时间-信号强度曲线(TIC)19例CSL病例Ⅰ型、7例Ⅱ型,20例IC病例为Ⅲ型曲线。33例IC中3例边缘环形强化,CSL均无。CSL平均ADC值0.00137mm2/s,IC为0.00104mm2/s。结论:与CSL相比,IC多发生于老年妇女,直径较大,T1WI信号较低,ADC值小于0.0012mm2/s,TIC最常见Ⅲ型。
Purpose: Complex sclerosing lesions(CSL) of the breast are the result of entrapment and distortion of benign ductal and lobular components by fibroelastoticscars. They often mimic invasive carcinoma(IC) on imaging and pathologic examinations resulting in misdiagnosis. Methods: To investigate the magnetic resonances imaging(MRI) and pathologic features of these lesions, 27 cases surgically excised and pathologically confirmed CSL cases which were also with MRI data available were identified from our hospital database from the period of October 2014 to December 2017. Thirty-three invasive carcinoma cases diagnosed in the same period of time were also selected for comparison. These patients' pathology results and MRI data were analyzed and compared. Results: The average age of the CSL group was 45.7±8.4 years and that of the IC group was 57.8±14.2 years(P=0.000). The average diameter of CSL was 1.19±0.64 cm and that of invasive carcinoma was 2.14±1.35 cm(P=0.001). 59.3% of CSL cases and 69.7% of IC cases were with similar MRI features. Comparison of MRI features of CSL and IC groups was made. There was statistical difference of T1 WI signal intensity between the two groups, but there was no statistical difference of T2 WI or STIR signal intensity between them. The TIC pattern of the lesions were: CSL(19 cases type I,7 cases type Ⅱ), IC(20 cases type Ⅲ). The mean ADC value of the lesions were: CSL(0.00137 mm2/s) vs. IC(0.00104 mm2/s). Three out of 33 IC cases show rim enhancement while no one in CSL cases. Conclusions: Our data suggest that compared to CSL, IC tend to occur in older women with larger lesion diameter. IC is often with lower signal intensity on T1 WI, ADC value less than 0.0012 mm2/s, and most commonly type Ⅲ TIC pattern.
Purpose: Complex sclerosing lesions(CSL) of the breast are the result of entrapment and distortion of benign ductal and lobular components by fibroelastoticscars. They often mimic invasive carcinoma(IC) on imaging and pathologic examinations resulting in misdiagnosis. Methods: To investigate the magnetic resonances imaging(MRI) and pathologic features of these lesions, 27 cases surgically excised and pathologically confirmed CSL cases which were also with MRI data available were identified from our hospital database from the period of October 2014 to December 2017. Thirty-three invasive carcinoma cases diagnosed in the same period of time were also selected for comparison. These patients' pathology results and MRI data were analyzed and compared. Results: The average age of the CSL group was 45.7±8.4 years and that of the IC group was 57.8±14.2 years(P=0.000). The average diameter of CSL was 1.19±0.64 cm and that of invasive carcinoma was 2.14±1.35 cm(P=0.001). 59.3% of CSL cases and 69.7% of IC cases were with similar MRI features. Comparison of MRI features of CSL and IC groups was made. There was statistical difference of T1 WI signal intensity between the two groups, but there was no statistical difference of T2 WI or STIR signal intensity between them. The TIC pattern of the lesions were: CSL(19 cases type I,7 cases type Ⅱ), IC(20 cases type Ⅲ). The mean ADC value of the lesions were: CSL(0.00137 mm2/s) vs. IC(0.00104 mm2/s). Three out of 33 IC cases show rim enhancement while no one in CSL cases. Conclusions: Our data suggest that compared to CSL, IC tend to occur in older women with larger lesion diameter. IC is often with lower signal intensity on T1 WI, ADC value less than 0.0012 mm2/s, and most commonly type Ⅲ TIC pattern.
引文
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[10]许道洲,罗树彬.乳腺癌磁共振及病理特征与血管内皮因子研究.中国医学计算机成像杂志,2010,16:285-289.
[11]Teifke A,Behr O,Schmidt M,et al.Dynamic MR imaging of breast lesions:correlation with microvessel distribution pattern and histologic characteristics of prognosis.Radiology,2006,239:351-360.
[2]Menezes G LG,Knuttel F M,Stehouwer B L,et al.Magnetic resonance imaging in breast cancer:A literature review and future perspectives.World J Clin Oncol,2014,10:61-70
[3]Femandez-Aguilar S,Simon P,Buxant F,et a1.Tubular carcinoma of the breast and associated intra-epithelial lesions:a comparative study with invasive low grade ductal carcinomas.Official Journal of the European Society of Pathology,2005,447:683-687.
[4]Yoshida A,Hayashi N,Akiyama F,et al.Ductal carcinoma in situ that involves sclerosing adenosis:high frequency of bilateral breast cancer occurrence Clinical Breast Cancer,2012,12:398-403
[5]回允中.外科病理学.北京:北京大学医学出版社,2006:507
[6]Kim SH,Cha ES,Park CS,et al.Imaging features of invasive lobular carcinoma:comparison with invasive ductal carcinoma.Jpn JRadiol,2011,29:475-482
[7]Visscher DWI,Nassar A,DegnimAC,et al.Sclerosingadenosis and risk of breast cancer.Breast Cancer Res Treat,2014,144:205-212.
[8]Kuhl CK,Schild HH.Dynamic image interpretation of MRI of the breast.J Magn Reson Imaging,2000,12:965-974.
[9]Orel SG,Schnall MD.MR imaging of the breast for the detection,diagnosis,and staging of breast cancer.Radiology,2001,220:13-30.
[10]许道洲,罗树彬.乳腺癌磁共振及病理特征与血管内皮因子研究.中国医学计算机成像杂志,2010,16:285-289.
[11]Teifke A,Behr O,Schmidt M,et al.Dynamic MR imaging of breast lesions:correlation with microvessel distribution pattern and histologic characteristics of prognosis.Radiology,2006,239:351-360.