青年女性乳腺癌特征及影像检查手段效能评价

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摘要目的：回顾性分析经病理证实的青年（≤35岁）乳腺癌患者的临床、病理及影像资料，分析其表现特点，评价目前各种影像检查对乳腺癌的诊断价值。方法：收集2011年1月—2014年12月我院经病理证实的35岁以下青年女性乳腺癌174例，共180个恶性病灶，平均年龄31.6岁，174例患者中89例行乳腺X线摄影检查，174例均行乳腺超声检查，21例行乳腺动态增强磁共振检查。回顾性分析其临床首发症状、乳腺癌的病理类型、免疫组化结果、淋巴结转移率、乳腺影像检查表现特点及乳腺影像报告数据系统（BI-RADS）的分类，对比性分析各项检查的敏感度、特异度及其联合诊断率。结果：青年乳腺癌的临床症状以无意间或体检发现乳腺肿块为主（94/174，54.0%），病理类型以浸润性导管癌为主（148/180，82.2%），且以高级别（Ⅱ、Ⅲ级）为主（118/148，79.7%及20/148，13.5%）；腋窝淋巴结转移阳性率高（55/140，39.3%），免疫组化结果中激素受体表达水平较低，雌激素受体（ER）阴性（63/174，36.2%），孕激素受体（PR）阴性（58/174，33.3%）；免疫组化类型以Luminal A型为主（82/140，58.6%）。X线表现以肿块（伴钙化）为主（52/78，66.7%），肿块以高密度、不规则形、边缘模糊为主要表现特征。3种主要的检查手段中乳腺超声的敏感度和特异度分别为100%和97.1%，乳腺X线为96.6%和87.6%，乳腺动态增强磁共振的敏感度及特异度均为100%。结论：青年乳腺癌以无自觉症状的乳腺肿块为主要临床表现，病理类型以高级别（Ⅱ、Ⅲ级）的浸润性导管癌为主，淋巴结转移率较高，ER、PR表达阴性率高，免疫组化类型以Luminal A型为主。X线主要表现为不规则形、边缘模糊的高密度肿块（伴钙化），乳腺超声检查的敏感度和特异度相对较高，可作为青年乳腺癌的主要筛查手段，当怀疑恶性病变时，应联合两种及以上的影像检查手段，以提高病变诊断的特异度，减少不必要的活检及手术。

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	刘丹青1
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	韩露2
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关键词 ：乳腺肿瘤, 乳腺X线摄影术, 超声检查, 多普勒, 彩色, 磁共振成像

Abstract：Objective: This is a retrospective study which analyzed the clinical, pathological and radiological information of young women with pathological confirmed breast cancer(≤35 years) in the past four years in our hospital to evaluate the diagnostic value of various imaging methods. Methods: Retrospective analyzed 174 patients(under 35 years old) with 180 pathological confirmed breast cancer lesions in our hospital from January 2011 to December 2014(the average age was 31.6). All patients underwent ultrasound, and 89/174 patients underwent pre-operation mammography, and 21/174 underwent dynamic contrast-enhanced MRI. The status of first clinical symptoms, pathological type, immunohistochemically result, lymph node metastasis, breast imaging performance characteristics, the classification of Breast Imaging Reporting Data System were analyzed. Results: The majority clinical symptom of breast cancer in young women is breast masses which were found occasionally or by health examination(94/174, 54.0%). The main histological type is invasive ductal carcinoma(148/180, 82.2%), and Ⅱ/Ⅲ grade carcinoma accounted for majority of invasive ductal carcinoma(118/148, 79.7% and 20/148, 13.5%). Axillary lymph node-positive rate is high(55/140, 39.3%). Immunohistochemical results showed that the expression level of hormone receptor is low, 36.2% of breast cancer expressed estrogen receptor negative(63/174), 33.3% of breast cancer expressed progesterone receptor negative(58/174); 58.6% of breast cancers was Luminal A type(82/140). Mammography findings maily performed as mass (or with calcification)(52/78, 66.7%), with high density, irregular, blurred edges. The sensitivity and specificity of the breast ultrasound are 100% and 97.1%, respectively and of mammography are 96.6% and 87.6%, respectively, and of dynamic contrast-enhanced breast MRI are both 100%. Conclusions: Breast cancer in young women usually showed breast masses with no symptoms as the main clinical manifestation. The main pathologic type is high-level(Ⅱ, Ⅲ grade) invasive ductal carcinoma, with high lymph node metastasis rate, high ER, PR negative rate, and majority immunohistochemistry type of breast cancer is Luminal A type. The main characteristics of breast cancer mammography images are irregular shape, blurred edge and high density mass(with calcification). The sensitivity and specificity of breast ultrasound is relatively high, which should be taken as the main screening tool for breast cancer in young women. When faced with suspected malignant lesions, joint applying two or more imaging approaches could improve the specificity of diagnosis and avoid unnecessary biopsies and surgery.

Key words： Breast neoplasms Mammography Ultrasonography, Doppler, color Magnetic resonance imaging

收稿日期: 2016-08-04

PACS:	Ｒ737.9
	Ｒ445.1
	Ｒ445.2

通讯作者: 张伟，中国医科大学附属盛京医院放射科，110004。E-mail：zhangw1@sj-hospital.org

作者简介: 刘丹青（1989-），女，河南焦作人，在读硕士研究生。E-mail：814358495@qq.com

引用本文:

刘丹青1，张伟1，王慧颖1，韩露2，吕冬君1. 青年女性乳腺癌特征及影像检查手段效能评价[J]. 中国临床医学影像杂志, 2017, 28(5): 331-336.
LIU Dan-qing1, ZHANG Wei1, WANG Hui-ying1, HAN Lu2, LV Dong-jun1. The features of breast cancer in young women and the diagnostic efficacy of imaging means. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(5): 331-336.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I5/331

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