乳腺Paget病临床及超声影像学特征
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摘要
目的总结分析乳腺Paget病的临床表现及超声图像特征。方法以术后组织病理学诊断为标准,对34例乳腺Paget病的临床资料、超声表现进行分析,总结乳腺Paget病的临床表现和超声声像图特征。结果 34例患者中,单一Paget病7例,合并浸润性导管癌16例,合并导管原位癌7例,同时合并浸润性导管癌和导管内癌3例,合并其他病理类型癌1例;有Paget病典型临床表现的24例,无Paget病典型临床表现的10例。24例有Paget病典型临床表现的患者中,超声提示乳头或乳晕区回声异常11例,乳腺肿物14例,微钙化14例;10例无Paget病典型临床表现的患者中,超声提示乳头或乳晕区回声异常3例,乳腺肿物9例,微钙化6例。14例超声提示乳头或乳晕区回声异常的患者中,彩色多普勒超声均提示乳头局部血流丰富。结论乳腺Paget病主要表现为乳头或乳晕区皮肤的改变,高频超声可敏感识别乳头及乳晕区回声异常。对于超声发现的乳腺病灶,应对其乳头及乳晕区进行仔细扫查,避免Paget病漏诊。
Objective To summarize the clinical and sonographic features of mammary Paget's disease(MPD). Methods Totally 34 female patients with pathologically confirmed MPD were retrospectively recruited. According to diagnosis,the clinical data and sonographic findings were reviewed and analyzed. Results Among these 34 patients,7 patients had single MPD; in the remaining 27 patients,16 were accompanied by invasive ductal carcinoma(IDC),7 by ductal carcinoma in situ(DCIS),3 by both IDC and DCIS,and 1 by other pathologic types of carcinoma. Twenty-four patients presented with typical clinical features of MPD,whereas 10 patients had no typical features of MPD. Among the 24 patients with typical clinical features,ultrasound examinations showed that 11 had echoic abnormality in nipple-areolar complex,14 had lesions of breast,and 14 had microcalcifications. Among the 10 patients without typical clinical features,ultrasound examinations revealed echoic abnormality in nipple-areolar complex in 3 cases,breast lesions in 9 cases,and microcalcifications in 6cases. Among the 14 patients with echoic abnormality in nipple-areolar complex,all of them presented as rich blood flow in nipple detected by color Doppler ultrasonography. Conclusions The main clinical feature of MPD is abnormalities in nipple-areolar complex. Sonography can recognize the echoic abnormalities of nipple and le-sions of breast. Sonographer should be careful of the nipple-areolar complex when mass is found in breast.
Objective To summarize the clinical and sonographic features of mammary Paget's disease(MPD). Methods Totally 34 female patients with pathologically confirmed MPD were retrospectively recruited. According to diagnosis,the clinical data and sonographic findings were reviewed and analyzed. Results Among these 34 patients,7 patients had single MPD; in the remaining 27 patients,16 were accompanied by invasive ductal carcinoma(IDC),7 by ductal carcinoma in situ(DCIS),3 by both IDC and DCIS,and 1 by other pathologic types of carcinoma. Twenty-four patients presented with typical clinical features of MPD,whereas 10 patients had no typical features of MPD. Among the 24 patients with typical clinical features,ultrasound examinations showed that 11 had echoic abnormality in nipple-areolar complex,14 had lesions of breast,and 14 had microcalcifications. Among the 10 patients without typical clinical features,ultrasound examinations revealed echoic abnormality in nipple-areolar complex in 3 cases,breast lesions in 9 cases,and microcalcifications in 6cases. Among the 14 patients with echoic abnormality in nipple-areolar complex,all of them presented as rich blood flow in nipple detected by color Doppler ultrasonography. Conclusions The main clinical feature of MPD is abnormalities in nipple-areolar complex. Sonography can recognize the echoic abnormalities of nipple and le-sions of breast. Sonographer should be careful of the nipple-areolar complex when mass is found in breast.
引文
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[15]Nagashima T,Hashimoto H,Oshida K,et al.Ultrasound demonstration of mammographically detected microcalcfications in patients with ductal carcinoma in situ of the breast[J].Breast Cancer,2005,12(3):216-220.
[16]詹小林,严昆,关瑞宏,等.彩色多普勒超声诊断乳腺Paget病的价值及分析[J].中国超声医学杂志,2015,31(8):755-757.
[2]Fu W,Mittel VK,Young SC.Paget disease of the breast:analysis of 41 patients[J].Am J Clin Oncol,2001,24(4):397-400.
[3]Lopes Filho LL,Lopes IM,Lopes LR,et al.Mammary and extramammary Paget’s disease[J].An Bras Dermatol,2015,90(2):225-231.
[4]Günhan-Bilgen I,Oktay A.Paget’s disease of the breast:clinical,mammographic,sonographic and pathologic findings in 52 cases[J].Eur J Radiol,2006,60(2):256-263.
[5]Zheng S,Song QK,Zhao L,et al.Characteristics of mammary Paget’s disease in China:a national-wide multicenter retrospective study during 1999-2008[J].Asian Pac J Cancer Prev,2012,13(5):1887-1893.
[6]Sakorafas GH,Blanchard K,Sarr MG,et al.Paget’s disease of the breast[J].Cancer Treat Rev,2001,27(1):9-18.
[7]Ward KA,Burton JL.Dermatological diseases of the breast in young women[J].Clin Dermatol,1997,15(1):45-52.
[8]Lagios MD,Westdahl PR,Rose MR,et al.Paget’s disease of the nipple.Alternative management in cases without or with minimal extent of underlying breast carcinoma[J].Cancer,1984,54(3):545-551.
[9]Lim HS,Jeong SJ,Lee JS,et al.Paget disease of the breast:mammographic,US,and MR imaging findings with pathologic correlation[J].Radiographics,2011,31(7):1973-1987.
[10]Ashikari R,Park K,Huvos AG,et al.Paget’s disease of the nipple[J].Cancer,1970,26(3):680-685.
[11]Kothari AS,Beechey-Newman N,Hamed H,et al.Paget disease of the nipple:a multifocal manifestation of higher-risk disease[J].Cancer,2002,95(1):1-7.
[12]Ceccherini AF,Evans AJ,Pinder SE,et al.Is ipsilateral mammography worthwhile in Paget’s disease of the breast[J].Clin Radiol,1996,51(1):35-38.
[13]Tohno E,Cosgrove DO,Sloane JP.Ultrasound diagnosis of breast disease[M].London:Churchill Livingstone,1994:76-178.
[14]Da Costa D,Taddese A,Cure ML,et al.Common and unusual diseases of the nipple-areolar complex[J].Radiographics,2007,27(Suppl 1):S65-S77.
[15]Nagashima T,Hashimoto H,Oshida K,et al.Ultrasound demonstration of mammographically detected microcalcfications in patients with ductal carcinoma in situ of the breast[J].Breast Cancer,2005,12(3):216-220.
[16]詹小林,严昆,关瑞宏,等.彩色多普勒超声诊断乳腺Paget病的价值及分析[J].中国超声医学杂志,2015,31(8):755-757.