结节肿块型乳腺导管内乳头状瘤的MRI表现及与乳腺小浸润性导管癌的鉴别诊断_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王齐艳 , 蒲杨梅 ,  康敏 , 马淑珍 , 邹雪瑾

四川省妇幼保健院放射科（成都 610041）;

Corresponding author：

康敏, Email: 1073297610@qq.com

Keywords：

乳腺导管内乳头状瘤; 乳腺浸润性导管癌; 磁共振成像

DOI：

10.7507/1007-9424.202112016

Video：

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目的分析结节肿块型乳腺导管内乳头状瘤（intraductal papilloma，IDP）磁共振成像（magnetic resonance imaging，MRI）的影像学表现，加深对IDP的MRI特征的认识，并探讨其与直径小于2 cm的乳腺浸润性导管癌（invasive ductal carcinoma，IDC）的鉴别诊断特征。方法回顾性分析2018年1月至2021年6月期间在四川省妇幼保健院经手术后病理学检查证实的28例乳腺结节肿块型IDP和34例直径小于2 cm的IDC的MRI表现，包括病灶大小、形态、边缘、是否有毛刺征、病灶周围有无扩张导管、病灶的最大径是否沿乳腺导管方向走行、病灶是否距乳头4 cm以内、平扫T2WI信号、表观扩散系数（apparent diffusion coefficient，ADC）值、动态增强时间-信号强度曲线（time-signal intensity curve，TIC）类型、早期强化率以及增强扫描病灶内部强化方式演变特征。结果 2组比较，肿瘤直径（P<0.001）、形态（P<0.001）、边缘（P<0.001）、病灶周围有无扩张导管（P<0.001）、病灶最大径是否沿乳腺导管方向走行（P<0.001）、病灶是否距乳头4 cm以内（P=0.009）、ADC值（P=0.001）、TIC曲线类型（P<0.001）、早期强化率（P<0.001）以及增强扫描病灶内部强化方式演变特征（P=0.010）的差异均具有统计学意义。12 例（35.3%）IDC 边缘出现毛刺征，而IDP无上述表现。8 例（23.5%）IDC 在早期及延迟期强化中均表现为边缘强化，而IDP组仅1 例在早期及延迟期表现为小环状强化，且病灶前方可见扩张导管影。9例（32.1%）IDP病灶周围有导管扩张，而IDC无此征象。结论结节肿块型IDP与小IDC的MRI影像表现具有一定相似性，但两者病灶边缘、与导管的关系（有无相关导管扩张、是否位于乳头附近、病灶最大径是否沿导管方向走行）、早期强化率以及增强扫描病灶强化方式演变特征存在差异，对两者的鉴别诊断具有重要意义。TIC曲线以及ADC值不能单独作为IDP与IDC的鉴别征象。

Citation： 王齐艳, 蒲杨梅, 康敏, 马淑珍, 邹雪瑾. 结节肿块型乳腺导管内乳头状瘤的MRI表现及与乳腺小浸润性导管癌的鉴别诊断. 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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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.	郭宝琴, 李华, 陈轶, 等. MRI对乳腺导管内乳头状瘤的早期诊断价值. 实用放射学杂志, 2016, 32(1): 1541-1542.
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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.
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14.	周研. 结节肿块型乳腺导管内乳头状瘤的MRI表现及与乳腺浸润性导管癌的鉴别诊断. 检验医学与临床, 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.	Krämer SC, Rieber A, Görich 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.	刘超, 张淑平, 刘佩芳, 等. 乳腺导管乳头状瘤的MR特征. 中华放射学杂志, 2011, 45(5): 449-453.
18.	彭腾飞, 罗娅红. 乳腺浸润性导管癌MRI特征及与预后因子相关性研究. 放射学实践, 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.	叶芳, 曾蒙苏, 严福华, 等. 乳腺病灶不同强化形态及大小的MR扩散加权成像研究和参数选择. 中华放射学杂志, 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.	路红, 刘佩芳, 叶兆祥, 等. 扩散加权成像中不同扩散敏感系数对乳腺病变的诊断价值. 临床放射学杂志, 2010, 29(7): 892-896.

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. 龚西騟, 丁华野. 乳腺病理学. 北京: 人民卫生出版社, 2009: 273-282.
6. 王聪聪, 林青, 崔春晓, 等. 乳腺导管内乳头状瘤—影像学技术的选择. 肿瘤影像学, 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. 郭宝琴, 李华, 陈轶, 等. MRI对乳腺导管内乳头状瘤的早期诊断价值. 实用放射学杂志, 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. 结节肿块型乳腺导管内乳头状瘤的MRI表现及与乳腺浸润性导管癌的鉴别诊断. 检验医学与临床, 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. Krämer SC, Rieber A, Görich 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. 刘超, 张淑平, 刘佩芳, 等. 乳腺导管乳头状瘤的MR特征. 中华放射学杂志, 2011, 45(5): 449-453.
18. 彭腾飞, 罗娅红. 乳腺浸润性导管癌MRI特征及与预后因子相关性研究. 放射学实践, 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. 叶芳, 曾蒙苏, 严福华, 等. 乳腺病灶不同强化形态及大小的MR扩散加权成像研究和参数选择. 中华放射学杂志, 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. 路红, 刘佩芳, 叶兆祥, 等. 扩散加权成像中不同扩散敏感系数对乳腺病变的诊断价值. 临床放射学杂志, 2010, 29(7): 892-896.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

结节肿块型乳腺导管内乳头状瘤的MRI表现及与乳腺小浸润性导管癌的鉴别诊断

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