上海交通大学学报(医学版) ›› 2019, Vol. 39 ›› Issue (4): 398-.doi: 10.3969/j.issn.1674-8115.2019.04.012

• 论著·临床研究 • 上一篇    下一篇

乳腺癌 X线征象及其术后病理特征分析

孙晓寅,莊志刚,傅韵,成小林   

  1. 同济大学附属第一妇婴保健院乳腺外科,上海 201204
  • 出版日期:2019-04-28 发布日期:2019-05-23
  • 通讯作者: 莊志刚,电子信箱:zhuangzhigang@51mch.com。
  • 作者简介:孙晓寅(1986—),男,主治医师,硕士;电子信箱: dr_sunxy@163.com。
  • 基金资助:
    中央高校基本科研业务费专项资金(22120180402);上海市卫生和计划生育委员会面上项目( 201640084)

Analysis of X-ray signs and postoperative pathological features of breast cancer

SUN Xiao-yin, ZHUANG Zhi-gang, FU Yun, CHENG Xiao-lin   

  1. Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
  • Online:2019-04-28 Published:2019-05-23
  • Supported by:
    Fundamental Research Funds for the Central Universities, 22120180402; Funding of Shanghai Municipal Health and Family Planning Commission,201640084

摘要: 目的 ·探讨乳腺癌患者的钼靶 X线征象及其与术后病理特征的关系。方法 ·选取 2015年 8月至 2018年 8月同济大学附属第一妇婴保健院乳腺外科诊治的 300例经手术病理证实的原发性乳腺癌患者。入选患者在手术前均行乳腺钼靶 X线摄影检查。回顾性分析钼靶影像特征与病理类型之间的关系,进一步分析肿块影、钙化、毛刺征等特定影像学征象与重要病理特征的关系。结果 · 300例乳腺癌患者中 X线表现为肿块影者 251例(83.7%)。其中肿块影伴毛刺征 183例,肿块影合并钙化 190例。X线表现为钙化者 235例(78.3%),结构紊乱伴密度增高者 77例(25.7%),血管征阳性者 98例(32.7%)。浸润性导管癌患者的钼靶检查结果多表现为肿块影(95.1%),伴毛刺征( 82.3%)和钙化( 83.7%);浸润性小叶癌多表现为局部结构扭曲、紊乱( 88.2%);导管内癌多以钙化为主要征象(96.1%),可伴有肿块( 60.8%);小叶原位癌多表现为成簇细小钙化( 100.0%);单纯癌、髓样癌、黏液腺癌多表现为肿块影。肿块影 >5 cm患者雌激素受体( estrogen receptor,ER)和孕激素受体( progesterone receptor,PR)的阳性率较肿块影≤ 5 cm患者升高,但差异无统计学意义( P0.165,P0.317)。以钙化为征象者 ER、PR的阳性率分别为 54.5%和 60.8%,低于无钙化征象者( P0.027, P0.006)。而肿块边缘有毛刺征者 PR阳性率为 71.6%,高于无毛刺征者( P0.018),而在有 /无毛刺征者中 ER阳性率的差异无统计学意义( P0.321)。以单纯肿块影为征象的患者与肿块影合并钙化患者相比,淋巴结转移发生率更低( 29.5% vs 37.9%,P0.009),组织学分级更低( P0.043),而 ER阳性率( 70.5% vs 57.9%,P0.033)、PR阳性率( 73.8% vs 65.3%,P0.014)更高。结论 ·不同病理类型的乳腺癌表现出不同的 X线征象。 X线征象与乳腺癌免疫组织化学指标 ER、PR等的表达存在一定关联。单纯肿块影的 X线征象提示乳腺癌预后较好。

关键词: 乳腺癌, 钼靶 X线, 病理学特征, 免疫组织化学指标

Abstract: Objective · To investigate the relationship between the mammographic signs and the pathological features in breast cancer. Methods · August 2015 to August 2018, 300 patients with primary breast cancer confirmedoperation and pathology in Shanghai First Maternity and Infant Hospital, Tongji University were selected. All patients had mammography before operation. The relation between characteristics of molybdenum target imaging and pathological types were retrospectively analyzed. The correlation between specific imaging signs such as lump, calcification, spiculation sign and important pathological features were further analyzed. Results · Among 300 cases of breast cancer, 251 cases (83.7%) had lumps, of which 183 cases had spiculation sign, and 190 cases had calcification. Besides, 235 cases (78.3%) had calcification; 77 cases (25.7%) had structural disorder with diffdensity; 98 cases (32.7%) had positive signs of vascular symptoms. Lump (95.1%), spiculation sign (82.3%) and calcification (83.7%) were mostly observed in invasive ductal carcinoma. Structural disorder (88.2%) was mostly observed in invasive lobular carcinoma. Calcification (96.1%) and lump (60.8%) were mostly observed in intraductal carcinoma. Calcification (100.0%) was mostly observed in lobular carcinoma in situ. Lump was mostly observed in simple carcinoma, medullary carcinoma and mucinous adenocarcinoma. The positive rates of estrogen receptor (ER) and progesterone receptor (PR) were higher in patients with tumor lump >5 cm than those with tumor lump ≤ 5 cm, but there were no significant differences (P0.165, P0.317). The positive rate of ER was 54.5% and the positive rate of PR was 60.8% in patients with calcification, which were lower than those without calcification (P0.027, P0.006). The positive rate of PR in patients with spiculation sign was 71.6%, which was higher than those without spiculation sign (P0.018). But there was no significant difference in the of ER in patients with or without spiculation sign (P0.321). Patients with lumps alone had a lower incidence of lymph node metastasis (29.5% vs 37.9%, P0.009), and lower histological grade (P0.043), in comparison with patients with lumps and calcification. But they had higher ER positive rate (70.5% vs 57.9%, P0.033) and PR positive rate (73.8% vs 65.3%, P0.014). Conclusion · Breast cancer patients with different pathological types show different signs of mammography which may have certain associations with the of immunohistochemical indicators such as ER and PR. Simple lump shadows in mammography may be a predictor in the good prognosis of breast cancer. [Key words]breast cancer; molybdenum target X-ray; pathological feature; immunohistochemical indicator

Key words: breast cancer, molybdenum target X-ray, pathological feature, immunohistochemical indicator

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