2023 年第 5 期 第 18 卷

乳腺导管原位癌超声及病理学特征对比分析

Comparative analysis of ultrasonographic and pathological features of ductal carcinoma in situ of the breast

作者：汤丽丽1张纯1曾燕荣2

英文作者：Tang Lili1 Zhang Chun1 Zeng Yanrong2

单位：1首都医科大学附属北京安贞医院介入超声科，北京100029；2首都医科大学附属北京潞河医院超声科，北京101100

英文单位：1Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Ultrasound Beijing Luhe Hospital Capital Medical University Beijing 101100 China

关键词：乳腺导管原位癌；超声特征；病理特征

英文关键词：Ductalcarcinomainsituofthebreast;Ultrasoniccharacteristics;Pathologicalcharacteristics

• 摘要：

• 目的 对比分析不同类型乳腺导管原位癌（DCIS）病灶的超声及病理学特征，以期提高超声对乳腺DCIS早期诊断能力。方法 收集2015年10月至2021年12月在首都医科大学附属北京潞河医院手术且术后病理学检查证实为单纯性乳腺DCIS的50例患者的临床资料进行回顾性分析。共涉及52个病灶，根据病灶超声影像图特征分为肿块型与非肿块型，按照病灶内部有无钙化分为钙化组与非钙化组。依据病理组织学特征将组织学分级分为高级别和低中级别；依照雌激素受体、孕激素受体、人类表皮生长因子受体2（HER-2）及细胞增殖抗原标记指数免疫组织化学分析结果分为Luminal A型、Luminal B型、HER-2阳性型和三阴性型。比较肿块型与非肿块型、钙化组与非钙化组乳腺DCIS患者的病理组织学分级及病理分子分型间的差异。结果  52个乳腺DCIS患者病灶中，肿块型33个（63.5%）、非肿块型19个（36.5%），钙化30个（57.7%）、非钙化22个（42.3%）。在众多超声特征中，肿块型病灶钙化比例低于、边缘光整比例高于非肿块型病灶［42.4%（14/33）比84.2%（16/19）、30.3%（10/33）比0（0/19）］，差异均有统计学意义（均P<0.05）。52个病灶的病理组织学分级低中级别为24个（46.2%）、高级别为28个（53.8%）；分子分型中Luminal A型16个（30.8%）、Luminal B型24个（46.2%）、HER-2阳性型10个（19.2%）、三阴性型2个（3.8%）。钙化组与非钙化组的病理组织学分级、病理分子分型差异均有统计学意义（均P<0.05）。结论   乳腺DCIS病灶超声及病理特征表现多样。充分掌握乳腺DCIS病灶超声与病理学特征的关系，有助于提高超声对乳腺DCIS早期诊断能力。

• Objective  To compare and analyze the ultrasonographic and pathological characteristics of different types of ductal carcinoma in situ(DCIS) of the breast lesions, in order to improve the early diagnostic ability of ultrasound in DCIS of the breast. Methods From October 2015 to December 2021, the clinical data of 50 patients who underwent surgery at Beijing Luhe Hospital, Capital Medical University and were confirmed as simple DCIS of the breast by postoperative pathological examination were retrospectively analyzed. A total of 52 lesions were involved, and they were divided into mass type and non-mass type according to the characteristics of ultrasound image of the lesions, and were divided into calcification group and non-calcification group according to whether there was calcification in the lesions. The pathological tissue grading was divided into high grade and low middle grade according to the histopathological characteristics, and they were divided into Luminal A type, Luminal B type, human epidermal growth factor receptor 2(HER-2) positive type and triple negative type according to the immunohistochemical results of estrogen receptor, progesterone receptor, HER-2 and cell proliferation antigen labeling index. The differences of pathological tissue grading and pathological molecular typing between DCIS of the breast patients of mass type and non-mass type, calcification group and non-calcification group were compared. ResultsAmong 52 DCIS of the breast lesions, 33(63.5%) were mass type, 19(36.5%) were non-mass type, 30(57.7%) were calcified, and 22(42.3%) were non-calcified. Among many ultrasound characteristics, the proportion of calcification in the mass type lesions was lower than that in the non-mass type lesions, and the proportion of edge smoothness in the mass type lesions was higher than that in the non-mass type lesions［42.4%(14/33) vs 84.2%(16/19), 30.3%(10/33) vs 0(0/19)］(all P<0.05). The histopathological grading of 52 lesions was 24(46.2%) in low and middle grades and 28(53.8%) in high grades; in molecular typing, there were 16(30.8%) Luminal A, 24(46.2%) Luminal B, 10(19.2%) HER-2 positive and 2(3.8%) triple negative. There were statistically significant differences in histopathological grading and pathological molecular typing between calcification group and non-calcification group(both P<0.05). Conclusions The ultrasound and pathological characteristics of DCIS of the breast lesions are varied. Understanding the relationship between ultrasound and pathological characteristics of DCIS of the breast lesions is helpful to improve the ability of ultrasound in early diagnosis of DCIS of the breast.