Huang Naisi, Chen Jiajian, Xue Jingyan, Yu Baohua, Chen Yanqiong, Yang Wentao, Shao Zhimin, Wu Jiong
From the Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China (NH, JC, JX, ZS, JW); Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (BY, WY); Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (YC); Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China (NH, JC, JX, BY, YC, WY, ZS, JW); and Collaborative Innovation Center for Cancer Medicine, Guangdong, China (JW).
Medicine (Baltimore). 2015 Dec;94(49):e2298. doi: 10.1097/MD.0000000000002298.
Sclerosing adenosis (SA) is a less common histopathological lesion of the breast that can coexist with proliferative lesions as well as malignancies. We aimed to analyze the clinicopathological characteristics of SA and to investigate the radiological features of SA.Patients who underwent breast surgery at our institute from 2007 to 2013 were retrospectively reviewed. A total of 815 breasts (722 patients) were included in the final analysis. Synchronous bilateral SA was defined as the detection of another SA arising in the contralateral breast within 1 month after surgery for the initial breast lesion. Baseline characteristics, imaging records (ultrasonography, mammography, and magnetic resonance imaging [MRI]), and pathology were included in the analysis.The median age at diagnosis was 47 years old. The majority of patients had unilateral non-Bc-SA (457/722). Among 102 patients with bilateral SA, 78.4% were diagnosed synchronously. In total, 26 patients suffered from synchronous bilateral breast cancer. Upon final pathological investigation, 226 cases were SA involving breast cancer (Bc-SA), most (56.2%) of which were ductal carcinoma in situ (DCIS). In addition, lobular carcinoma in situ (LCIS) and diseases that involved LCIS also comprised up to 11.1% of cases. The majority of SA cases (405; 49.7%) had no obvious symptoms except for imaging changes in mammography or ultrasound. Compared with non-Bc-SA cases, Bc-SA cases were more likely to exhibit features of mass (32.8% vs. 28.6%) and architectural distortion (20.4% vs. 13.0%) on mammography. Ultrasonography, mammography, and MRI revealed unsatisfactory sensitivity and specificity to differentiate Bc-SA from non-Bc-SA. MRI exhibited the highest sensitivity and lowest specificity, whereas the specificity of mammography was as low as 50.0%.A tendency for synchronous bilaterality in both Bc-SA and non-Bc-SA was noted. DCIS was the most commonly observed malignancy involved in Bc-SA. Although most patients with SA were asymptomatic, the ability of imaging studies to accurately differentiate non-Bc-SA from Bc-SA remained unsatisfactory.
硬化性腺病（SA）是一种较少见的乳腺组织病理学病变，可与增殖性病变及恶性肿瘤共存。我们旨在分析SA的临床病理特征，并研究SA的影像学特征。对2007年至2013年在我院接受乳腺手术的患者进行回顾性研究。最终分析纳入了815例乳房（722例患者）。同步双侧SA定义为在首次乳腺病变手术后1个月内对侧乳房出现另一个SA。分析内容包括基线特征、影像学记录（超声、乳腺X线摄影和磁共振成像[MRI]）及病理。诊断时的中位年龄为47岁。大多数患者为单侧非乳腺癌相关SA（457/722）。在102例双侧SA患者中，78.4%为同步诊断。共有26例患者患有同步双侧乳腺癌。最终病理检查时，226例为SA合并乳腺癌（Bc-SA），其中大多数（56.2%）为导管原位癌（DCIS）。此外，小叶原位癌（LCIS）及涉及LCIS的疾病也占病例的11.1%。大多数SA病例（405例；49.7%）除乳腺X线摄影或超声检查的影像学改变外无明显症状。与非Bc-SA病例相比，Bc-SA病例在乳腺X线摄影上更易表现为肿块特征（32.8%对28.6%）和结构扭曲（20.4%对13.0%）。超声、乳腺X线摄影和MRI对区分Bc-SA和非Bc-SA的敏感性和特异性均不理想。MRI敏感性最高，特异性最低，而乳腺X线摄影的特异性低至50.0%。在Bc-SA和非Bc-SA中均观察到同步双侧性倾向。DCIS是Bc-SA中最常见的恶性肿瘤。虽然大多数SA患者无症状，但影像学检查准确区分非Bc-SA和Bc-SA的能力仍不理想。
