Scoggins Marion E, Fox Patricia S, Kuerer Henry M, Rauch Gaiane M, Benveniste Ana P, Park Young Mi, Lari Sara A, Krishnamurthy Savitri, Yang Wei T
1 Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030.
AJR Am J Roentgenol. 2015 Apr;204(4):878-88. doi: 10.2214/AJR.13.12221.
The objective of our study was to compare the sonographic features of pure ductal carcinoma in situ (DCIS) lesions with the initial clinical presentation and histopathologic findings.
The images and records of 691 patients with pure DCIS who underwent preoperative mammography and whole-breast sonography as part of staging workup in a single institution from January 1, 1996, through July 31, 2009, were reviewed. The BI-RADS sonography lexicon was used when reviewing the sonographic studies. Histopathologic features recorded included estrogen receptor (ER) status, nuclear grade, and presence or absence of comedonecrosis. Statistical comparisons were made using the Student t test, chi-square test, Fisher exact test, Kruskal-Wallis or Wilcoxon rank sum test, multiple logistic regression analysis, and Pearson correlation coefficient.
A total of 304 (44%) tumors were visible on mammography and sonography; 315 (46%), on mammography only; 58 (8%), on sonography only; and 14 (2%), on neither mammography nor sonography. The most common sonographic appearance of DCIS was an irregular hypoechoic mass with indistinct margins and normal posterior features that was indistinguishable from invasive carcinoma. Patients with symptomatic high-nuclear-grade DCIS, dense breasts, and comedonecrosis were younger and had larger tumors on sonography than asymptomatic women with nondense breasts and low-nuclear-grade and noncomedo DCIS. Women with ER-negative DCIS were older and had larger tumors on sonography than women with ER-positive DCIS. ER-negative tumors were more frequently visible on sonography than ER-positive tumors (p=0.007). High-grade DCIS (p<0.0001) and comedo DCIS (p<0.0001) presented more frequently as microcalcifications, architectural distortion, and ductal changes on sonography than low-grade DCIS or noncomedo DCIS.
Of the 691 pure DCIS lesions, 362 (52%) were visible on sonography and presented most commonly as a mass. Lesion visibility of DCIS on sonography was not related to nuclear grade or the presence of comedonecrosis.
我们研究的目的是比较纯导管原位癌（DCIS）病变的超声特征与初始临床表现及组织病理学结果。
回顾了1996年1月1日至2009年7月31日期间在单一机构接受术前乳腺X线摄影和全乳超声检查作为分期检查一部分的691例纯DCIS患者的图像和记录。在回顾超声检查时使用了BI-RADS超声术语词典。记录的组织病理学特征包括雌激素受体（ER）状态、核分级以及是否存在粉刺样坏死。使用Student t检验、卡方检验、Fisher精确检验、Kruskal-Wallis或Wilcoxon秩和检验、多元逻辑回归分析以及Pearson相关系数进行统计学比较。
共有304例（44%）肿瘤在乳腺X线摄影和超声检查中可见；315例（46%）仅在乳腺X线摄影中可见；58例（8%）仅在超声检查中可见；14例（2%）在乳腺X线摄影和超声检查中均不可见。DCIS最常见的超声表现是边界不清、后方特征正常的不规则低回声肿块，与浸润性癌难以区分。有症状的高核分级DCIS、乳腺致密以及有粉刺样坏死的患者比无症状乳腺不致密、低核分级且无粉刺样DCIS的女性更年轻，超声检查显示肿瘤更大。ER阴性DCIS的女性比ER阳性DCIS的女性年龄更大，超声检查显示肿瘤更大。ER阴性肿瘤在超声检查中比ER阳性肿瘤更常可见（p = 0.007）。与低分级DCIS或无粉刺样DCIS相比，高分级DCIS（p < 0.0001）和粉刺样DCIS（p < 0.0001）在超声检查中更常表现为微钙化、结构扭曲和导管改变。
在691例纯DCIS病变中，362例（52%）在超声检查中可见，最常见表现为肿块。DCIS在超声检查中的病变可见性与核分级或粉刺样坏死的存在无关。
