Porter Alan J, Evans Elizabeth B, Foxcroft Loani M, Simpson Peter T, Lakhani Sunil R
Wesley Breast Clinic, Wesley Hospital, Australia.
J Med Imaging Radiat Oncol. 2014 Feb;58(1):1-10. doi: 10.1111/1754-9485.12080. Epub 2013 Jun 5.
Invasive lobular cancer (ILC) is an important contributor to false negative mammography. This study aims to assess the value of digital mammography and to identify imaging features that could assist the radiologist to suggest the diagnosis of ILC prior to biopsy.
Three hundred sixty-one cases of pure ILC diagnosed at the Wesley Breast Clinic during the period 1995-2010 were reviewed by one of the authors (AP). Radiological features were categorized, and clinical features and needle sampling results were recorded.
Mammography was negative in 29.9% of ILCs. The commonest positive finding was a localized spiculated mass (41.8%). Thirty-four point nine per cent of lesions were visible in only one view, usually cranio-caudal. Calcification was not a feature of ILC. The use of digital mammography in 30% of cases did not decrease the false negative rate for ILC. Breast ultrasound (BUS) showed an abnormality in 97.8%, most commonly a localized irregular hypoechoic mass with shadowing.
Digital mammography does not reduce false negative mammography in ILC. The poor visibility of ILCs may be partly related to their low density (mass/unit volume). ILCs may sometimes be poor attenuators of X-rays but excellent attenuators of ultrasound, causing marked acoustic shadowing. Bilateral whole BUS has a very low false negative rate in experienced hands and is mandatory in symptomatic women. The combination of poor visibility on mammography with high visibility on ultrasound, as well as certain characteristic ultrasound appearances of ILC, may enable the radiologist to suggest ILC as a diagnostic possibility, prior to biopsy.
浸润性小叶癌（ILC）是乳腺钼靶检查假阴性的重要原因。本研究旨在评估数字乳腺钼靶的价值，并识别有助于放射科医生在活检前提示ILC诊断的影像学特征。
由作者之一（AP）回顾了1995年至2010年期间在卫斯理乳腺诊所诊断的361例纯ILC病例。对放射学特征进行分类，并记录临床特征和针吸活检结果。
29.9%的ILC病例乳腺钼靶检查为阴性。最常见的阳性发现是局限性毛刺状肿块（41.8%）。34.9%的病变仅在一个投照位可见，通常是头尾位。钙化不是ILC的特征。30%的病例使用数字乳腺钼靶并未降低ILC的假阴性率。乳腺超声（BUS）显示97.8%的病例有异常，最常见的是局限性不规则低回声肿块伴声影。
数字乳腺钼靶不能降低ILC的乳腺钼靶检查假阴性率。ILC的可见性差可能部分与其低密度（质量/单位体积）有关。ILC有时可能是X射线的弱衰减器，但却是超声的强衰减器，导致明显的声影。在经验丰富的医生手中，双侧全乳腺超声的假阴性率非常低，对有症状的女性来说是必需的。乳腺钼靶可见性差与超声可见性高以及ILC某些特征性超声表现相结合，可能使放射科医生在活检前提示ILC作为一种诊断可能性。
