CAJ | 학술논문

目的分析囊实性乳腺癌的影像学特征及临床病理学特点.方法回顾经病理证实的26例囊实性乳腺癌的磁共振成像(MRI)及超声等影像学表现,对照术后病理及临床表现进行相关性分析.结果临床表现:鳞状细胞癌高龄者居多(平均70.1岁),囊内乳头状癌(平均67.7岁)、黏液癌相对较低(平均55.1岁)；鳞状细胞癌生长迅速,囊内乳头状癌及黏液癌相对比较迟缓；鳞状细胞癌多发生在乳头周围(4/5),囊内乳头状癌及黏液癌与其他乳腺癌相似,多发生在乳腺外上象限.鳞状细胞癌肿瘤直径平均值最大(49.6 mm),囊内乳头状癌(35.2 mm)、黏液癌(25.1 mm)次之；鳞状细胞癌较黏液癌及囊内乳头状癌恶性程度高,且易发生淋巴结转移和皮肤浸润；黏液癌及囊内乳头状癌术前穿刺确定诊断的成功率较低,鳞状细胞癌较高.MRI共同点:肿块多为圆形或分叶状,T1WI呈现等-稍高信号,T2WI上显示高信号,增强后均呈环状强化；MRI不同点:黏液癌和鳞状细胞癌边缘粗糙,囊内乳头状癌边缘光整；鳞状细胞癌的囊壁较厚,且不均匀,囊肿内癌的囊内可见乳头状软组织影,增强后均表现为明显强化,黏液癌囊壁均匀,不伴有乳头状成分.超声:较其他乳腺浸润癌囊实性乳腺癌肿瘤内部回声较低,且伴后方回声增强,大部分黏液癌同时有侧方阴影,鳞状细胞癌血流丰富,黏液癌及囊内乳头状癌血流供应较少.结论囊实性乳腺癌的组织学类型多样,MRI及超声表现具有一定特征性,结合术前穿刺活检及临床表现,能够推测组织学类型及病变范围,对手术方式的选择及指导治疗有着重要的作用.
목적 분석낭실성유선암적영상학특정급림상병이학특점.방법 회고경병리증실적26례낭실성유선암적자공진성상(MRI)급초성등영상학표현,대조술후병리급림상표현진행상관성분석.결과 림상표현:린상세포암고령자거다(평균70.1세),낭내유두상암(평균67.7세)、점액암상대교저(평균55.1세)；린상세포암생장신속,낭내유두상암급점액암상대비교지완；린상세포암다발생재유두주위(4/5),낭내유두상암급점액암여기타유선암상사,다발생재유선외상상한.린상세포암종류직경평균치최대(49.6 mm),낭내유두상암(35.2 mm)、점액암(25.1 mm)차지；린상세포암교점액암급낭내유두상암악성정도고,차역발생림파결전이화피부침윤；점액암급낭내유두상암술전천자학정진단적성공솔교저,린상세포암교고.MRI공동점:종괴다위원형혹분협상,T1WI정현등-초고신호,T2WI상현시고신호,증강후균정배상강화；MRI불동점:점액암화린상세포암변연조조,낭내유두상암변연광정；린상세포암적낭벽교후,차불균균,낭종내암적낭내가견유두상연조직영,증강후균표현위명현강화,점액암낭벽균균,불반유유두상성분.초성:교기타유선침윤암낭실성유선암종류내부회성교저,차반후방회성증강,대부분점액암동시유측방음영,린상세포암혈류봉부,점액암급낭내유두상암혈류공응교소.결론 낭실성유선암적조직학류형다양,MRI급초성표현구유일정특정성,결합술전천자활검급림상표현,능구추측조직학류형급병변범위,대수술방식적선택급지도치료유착중요적작용.
Objective To analyze imageology appearance and clinical characteristics of the cystic and solid breast carcinoma.Methods Features of MRI and B-type ultrasonic inspection of 26 patients with the cystic and solid breast carcinoma pathologically confirmed (15 patients with mucinous carcinoma,6 patients with intracystic papillary carcinoma,5 patients with squamous cell carcinoma of the breast) were retrospectively reviewed.Results In terms of clinical appearance,the incidence of the squamous cell breast carcinoma with an average age of 70.1 years old was larger than in youth,while mucinous carcinoma with an average age of 67.7 years old and intracystic carcinoma of breast with an average age of 55.1 years old were contrary.The squamous cell breast carcinoma developed more quickly than mucinous carcinoma and intracystic carcinoma of breast.The squamous cell breast carcinoma often occurred around mammilla (4/5),while the mucinous carcinoma and intracystic papillary carcinoma often occurred upper outer quadrant of breast,which was similar with other breast cancer.The average size of 49.6 mm in the squamous cell breast carcinoma was largest than the average size of 25.1 mm in mucinous carcinoma and the average size of 35.2 mm in intracystic papillary carcinoma.The malignant degree of squamous cell breast carcinoma was higher than mucinous carcinoma and intracystic papillary carcinoma,which intended to occur lymph node metastasis and skin infiltration.The diagnosis probability of mucinous carcinoma was smaller than intracystic papillary carcinoma through preoperative puncture,while squamous cell breast carcinoma was larger.On the MRI imageology appearance,both types of breast cancer had the same shape of rotundity or lobulated.The tumors were low signal on T1WI and partially high signal on T2WI,which were circular enhancement after enhancement.However,the edge of mucinous carcinoma and squamous cell breast carcinoma was rougher than intracystic papillary carcinoma compared with squamous cell breast carcinoma.The bursa wall of mucinous carcinoma was more uniformity,while papillary soft tissue image can be found in intracystic papillary carcinoma,which was enhanced significantly after enhancement.In terms of ultrasonic sound (US),there were low echo signal and high echo signal on the back of tumor compared with other breast tumor.There were shadow beside mucinous carcinoma.Squamous cell breast carcinoma was rich in blood supply,while mucinous carcinoma and intracystic papillary carcinoma were opposite.Conclusion Histological type of cystic and solid breast carcinoma is complex,but the appearances of MRI and US have some characteristics.Histological type and the range of disease could be guessed through the combination of preoperative puncture and clinical appearance,which plays an important role in operation mode and treatment guidance.