Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Clin Radiol. 2010 Mar;65(3):181-4. doi: 10.1016/j.crad.2009.05.017. Epub 2010 Jan 18.
To assess the radiological features of calcific ductal carcinoma in situ (DCIS) in a large, multicentre dataset according to grade and size, and to investigate the possibility that DCIS has different mammographic features when small.
The dataset consisted of all Sloane Project DCIS cases where calcification was present mammographically and histological grade and size were available. The radiology data form classifies calcific DCIS as casting/linear, granular/irregular, or punctate. The pathology dataset includes cytonuclear grade and microscopic tumour size. Correlations were sought between the radiological findings and DCIS grade and size. The significance of differences was assessed using the chi-square test and chi-square test for trend.
One thousand, seven hundred and eighty-three cases were included in the study. Of these, 1128, 485, and 170 had high, intermediate, and low-grade DCIS, respectively. Casting calcification was more frequently seen the higher the grade of DCIS, occurring in 58% of high grade, 38% of intermediate grade, and 26% of low-grade cases, respectively (p<0.001). Casting calcification was also increasingly common with increasing lesion size, irrespective of the histological grade (p<0.001). Thus casting calcifications in small (<10mm) high-grade DCIS lesions were seen with a similar frequency (50%) to those in moderate-sized (21-30 mm) intermediate-grade lesions (48%), and to those in large (>30 mm) low-grade lesions (46%).
Lesion size has a strong influence on the radiological features of calcific DCIS; small, high-grade lesions often show no casting calcifications, whereas casting calcifications are seen in nearly half of large, low-grade lesions. As small clusters of punctate or granular calcifications may represent high-grade DCIS, an aggressive clinical approach to the diagnosis of such lesions is recommended as the adequate treatment of high-grade DCIS will prevent the occurrence of potentially life-threatening high-grade invasive disease.
根据分级和大小，评估大型多中心数据集中小叶原位导管癌（DCIS）的放射学特征，并研究当 DCIS 较小时是否具有不同的乳房 X 线照相特征的可能性。
数据集由所有 Sloane 项目 DCIS 病例组成，这些病例在乳房 X 线照相中存在钙化，并且可获得组织学分级和大小。放射学数据表单将钙化 DCIS 分类为铸型/线性、颗粒/不规则或点状。病理数据集包括细胞核分级和显微镜下肿瘤大小。研究了放射学发现与 DCIS 分级和大小之间的相关性。使用卡方检验和卡方趋势检验评估差异的显著性。
研究纳入了 1783 例病例。其中，1128、485 和 170 例分别为高级、中级和低级 DCIS。高级 DCIS 中更常见铸型钙化，分别占 58%、38%和 26%（p<0.001）。无论组织学分级如何，随着病变大小的增加，铸型钙化也越来越常见（p<0.001）。因此，在大小较小（<10mm）的高级 DCIS 病变中，铸型钙化的出现频率与在中等大小（21-30mm）的中级病变（48%）和在较大（>30mm）的低级病变（46%）相似。
病变大小对钙化 DCIS 的放射学特征有很大影响；小的高级病变通常没有铸型钙化，而近一半的大的低级病变则有铸型钙化。由于小簇点状或颗粒状钙化可能代表高级 DCIS，因此建议对这些病变进行积极的临床诊断方法，因为高级 DCIS 的充分治疗可预防潜在危及生命的高级浸润性疾病的发生。
