結節腫塊型乳腺導管內乳頭狀瘤的MRI表現及與乳腺小浸潤性導管癌的鑒別診斷_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王齊艷 , 蒲楊梅 ,  康敏 , 馬淑珍 , 鄒雪瑾

四川省婦幼保健院放射科（成都 610041）;

Corresponding?author：

康敏, Email: 1073297610@qq.com

Keywords：

乳腺導管內乳頭狀瘤; 乳腺浸潤性導管癌; 磁共振成像

DOI：

10.7507/1007-9424.202112016

Video：

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目的分析結節腫塊型乳腺導管內乳頭狀瘤（intraductal papilloma，IDP）磁共振成像（magnetic resonance imaging，MRI）的影像學表現，加深對IDP的MRI特征的認識，并探討其與直徑小于2 cm的乳腺浸潤性導管癌（invasive ductal carcinoma，IDC）的鑒別診斷特征。方法回顧性分析2018年1月至2021年6月期間在四川省婦幼保健院經手術后病理學檢查證實的28例乳腺結節腫塊型IDP和34例直徑小于2 cm的IDC的MRI表現，包括病灶大小、形態、邊緣、是否有毛刺征、病灶周圍有無擴張導管、病灶的最大徑是否沿乳腺導管方向走行、病灶是否距乳頭4 cm以內、平掃T2WI信號、表觀擴散系數（apparent diffusion coefficient，ADC）值、動態增強時間-信號強度曲線（time-signal intensity curve，TIC）類型、早期強化率以及增強掃描病灶內部強化方式演變特征。結果 2組比較，腫瘤直徑（P<0.001）、形態（P<0.001）、邊緣（P<0.001）、病灶周圍有無擴張導管（P<0.001）、病灶最大徑是否沿乳腺導管方向走行（P<0.001）、病灶是否距乳頭4 cm以內（P=0.009）、ADC值（P=0.001）、TIC曲線類型（P<0.001）、早期強化率（P<0.001）以及增強掃描病灶內部強化方式演變特征（P=0.010）的差異均具有統計學意義。12 例（35.3%）IDC 邊緣出現毛刺征，而IDP無上述表現。8 例（23.5%）IDC 在早期及延遲期強化中均表現為邊緣強化，而IDP組僅1 例在早期及延遲期表現為小環狀強化，且病灶前方可見擴張導管影。9例（32.1%）IDP病灶周圍有導管擴張，而IDC無此征象。結論結節腫塊型IDP與小IDC的MRI影像表現具有一定相似性，但兩者病灶邊緣、與導管的關系（有無相關導管擴張、是否位于乳頭附近、病灶最大徑是否沿導管方向走行）、早期強化率以及增強掃描病灶強化方式演變特征存在差異，對兩者的鑒別診斷具有重要意義。TIC曲線以及ADC值不能單獨作為IDP與IDC的鑒別征象。

Citation： 王齊艷, 蒲楊梅, 康敏, 馬淑珍, 鄒雪瑾. 結節腫塊型乳腺導管內乳頭狀瘤的MRI表現及與乳腺小浸潤性導管癌的鑒別診斷. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 1067-1072. doi: 10.7507/1007-9424.202112016 Copy

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1. Ni YB, Tse GM. Pathological criteria and practical issues in papillary lesions of the breast—a review. Histopathology, 2016, 68(1): 22-32.
2. Brookes MJ, Bourke AG. Radiological appearances of papillary breast lesions. Clin Radiol, 2008, 63(11): 1265-1273.
3. Ballesio L, Maggi C, Savelli S, et al. Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol Med, 2008, 113(2): 249-264.
4. D’Orsi CJ, Sickles EA, Mendelson EB, et al. ACR BI-RADS atlas, breast imaging reporting and data system. Reston, VA: American College of Radiology, 2013: 312-358.
5. 龔西騟, 丁華野. 乳腺病理學. 北京: 人民衛生出版社, 2009: 273-282.
6. 王聰聰, 林青, 崔春曉, 等. 乳腺導管內乳頭狀瘤—影像學技術的選擇. 腫瘤影像學, 2020, 29(2): 121-126.
7. Lam WW, Chu WC, Tang AP, et al. Role of radiologic features in the management of papillary lesions of the breast. AJR Am J Roentgenol, 2006, 186(5): 1322-1327.
8. 郭寶琴, 李華, 陳軼, 等. MRI對乳腺導管內乳頭狀瘤的早期診斷價值. 實用放射學雜志, 2016, 32(1): 1541-1542.
9. Wang W, Ding JH, Yang WT, et al. MRI characteristics of intraductal papilloma. Acta Radiol, 2015, 56(3): 276-283.
10. Iglesias A, Arias M, Santiago P, et al. Benign breast lesions that simulate malignancy: magnetic resonance imaging with radiologic-pathologic correlation. Curr Probl Diagn Radiol, 2007, 36(2): 66-82.
11. Kurz KD, Roy S, Saleh A, et al. MRI features of intraductal papilloma of the breast: sheep in wolf's clothing? Acta Radiol, 2011, 52(3): 264-272.
12. Tominaga J, Hama H, Kimura N, et al. Magnetic resonance imaging of intraductal papillomas of the breast. J Comput Assist Tomogr, 2011, 35(1): 153-157.
13. Zhu Y, Zhang SP, Liu PF, et al. Solitary intraductal papillomas of the breast: MRI features and differentiation from small invasive ductal carcinomas. AJR Am J Roentgenol, 2012, 199(4): 936-942.
14. 周研. 結節腫塊型乳腺導管內乳頭狀瘤的MRI表現及與乳腺浸潤性導管癌的鑒別診斷. 檢驗醫學與臨床, 2020, 17(16): 2332-2336.
15. Hirose M, Otsuki N, Hayano D, et al. Multi-volume fusion imaging of MR ductography and MR mammography for patients with nipple discharge. Magn Reson Med Sci, 2006, 5(2): 105-112.
16. Kr?mer SC, Rieber A, G?rich J, et al. Diagnosis of papillomas of the breast: value of magnetic resonance mammography in comparison with galactography. Eur Radiol, 2000, 10(11): 1733-1736.
17. 劉超, 張淑平, 劉佩芳, 等. 乳腺導管乳頭狀瘤的MR特征. 中華放射學雜志, 2011, 45(5): 449-453.
18. 彭騰飛, 羅婭紅. 乳腺浸潤性導管癌MRI特征及與預后因子相關性研究. 放射學實踐, 2017, 32(6): 578-581.
19. Yabuuchi H, Matsuo Y, Okafuji T, et al. Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. J Magn Reson Imaging, 2008, 28(5): 1157-1165.
20. Daniel BL, Gardner RW, Birdwell RL, et al. Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging, 2003, 21(8): 887-892.
21. Matsubayashi R, Matsuo Y, Edakuni G, et al. Breast masses with peripheral rim enhancement on dynamic contrast-enhanced MR images: correlation of MR findings with histologic features and expression of growth factors. Radiology, 2000, 217(3): 841-848.
22. 葉芳, 曾蒙蘇, 嚴福華, 等. 乳腺病灶不同強化形態及大小的MR擴散加權成像研究和參數選擇. 中華放射學雜志, 2010, 44(5): 459-464.
23. Zhang L, Tang M, Min Z, et al. Accuracy of combined dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging for breast cancer detection: a meta-analysis. Acta Radiol, 2016, 57(6): 651-660.
24. Chen X, Li WL, Zhang YL, et al. Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions. BMC Cancer, 2010, 10: 693. doi: 10.1186/1471-2407-10-693.
25. 路紅, 劉佩芳, 葉兆祥, 等. 擴散加權成像中不同擴散敏感系數對乳腺病變的診斷價值. 臨床放射學雜志, 2010, 29(7): 892-896.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

結節腫塊型乳腺導管內乳頭狀瘤的MRI表現及與乳腺小浸潤性導管癌的鑒別診斷

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