乳腺X 线摄影癌周透亮带的影像特征及其病理基础与价值

目的:研究乳腺X线摄影癌周透亮带影像学特征,分析其病理基础及临床意义。方法:回顾性分析2010年6月-2011年10月期间我院经手术病理证实为乳腺癌患者196例,筛选出术前进行过乳腺X线摄影检查并且图像上癌周出现透亮带征象的患者共47例51个病灶,测量肿块直径、癌周透亮带宽度等,与病理大体标本切面和镜下切片进行对比研究分析。结果:双乳病灶多分布于外上象限(19/51),临床触诊病灶大小平均值约35.45±1.25 mm。乳腺X摄影观察病灶均为肿块样,影像测量病灶大小平均值约20.49±1.18 mm,与临床触诊大小之间的差别具有统计学意义(t=2.85,P<0.01);肿块周围可观察到宽窄不均透亮带,平均宽度约15.07±0.86 mm,乳腺癌癌周透亮带宽度与肿块大小之间没有显著相关性(r=0.188,P=0.186)。病理大体标本观察病灶周围包绕一圈连续的黄色脂肪组织;HE染色镜下切片观察瘤灶周围为一圈成熟脂肪细胞,局部被瘤灶边缘增生的致密结缔组织为主的毛刺分割,脂肪组织中散在分布炎性细胞,部分区域见灶状癌细胞团浸润。结论:乳腺X线摄影癌周透亮带病理基础为伴随瘤周间质反应的富含脂肪的组织层,此征象对乳腺癌的诊断、以及临床评估肿瘤浸润范围具有一定意义。

Pathology Basis and Clinical Value of Radiolucent Zone Around Breast Cancer on Mammography

Objective: To investigate the characteristic of radiolucent zone around breast cancer on mammography,and emplor its pathology basis and clinical value.Methods: The study retrospectively reviewed 196 breast cancer patients in our clinical unit performed from June 2010 to October 2011.Then futher options included 47 patients with 51 lesions for they had taken mammography examinations before surgery and there were radiolucent zones appeared around breast cancer lesions in image.The tumor diameter and radiolucent zone width were observed and the histopathologic basis was analysed.Results: The breast lesions mostly located in superior-external field(19/51).The average tumor diameter in clinical palpation was 35.45±1.25mm while in mammography was 20.49±1.18mm,and the dif-ference between them showed statistical significance(t=2.85,P<0.01).The average radiolucent zone width was 15.07±0.86mm,while there was no positive correlation between the radiolucent zone width and average diameter(P=0.189).Under macroscopie observation,around breast cancer leision was a circle of yellow fatty tissue,and tightly contacted to the edge of the cancerous tissue.Under light mi-croscope,the zone was mainly composed of fatty tissue and seattered clumps of cancerous tissue,fibrous tissue,and inflammatory cells.Conclusion: The radiolucent zone showed in hispathologis was stromal reaction around tumor with most of the composition is fat.This sign in mammography plays an important role in differential diagnosis of benign and malignent lesions,and also has a certain significance for evaluation of clinical tumor infiltration range.