乳腺导管原位癌的超声评估。
Ultrasound evaluation of ductal carcinoma in situ of the breast.
机构信息
DETO, Department of Emergency and Organ Transplantations, Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy.
DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy.
出版信息
J Ultrasound. 2022 Mar;25(1):41-45. doi: 10.1007/s40477-020-00551-x. Epub 2021 Jan 6.
PURPOSE
To assess the role of ultrasound (US) in detecting and characterizing ductal carcinoma in situ (DCIS) of the breast and to investigate the correlation between ultrasonographic and biological features of DCIS.
METHODS
In total, 171 patients (mean age 44; range 39-62) with 178 lesions were retrospectively evaluated by two independent radiologists searching for US mass or non-mass lesions. Immunohistochemistry analysis was performed to determine estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. The US detection rate and pattern distribution among the lesion types were evaluated. The χ test was used to evaluate the correlation between the US findings and the biological factors. Statistical significance was indicated by p values < 0.05. Inter-observer agreement was calculated by Kohen's k test.
RESULTS
US detected 35% (63/178) of all lesions. Fifty-two (83%) lesions were classified as mass lesions, and 11 (17%) as non-mass lesions (p < 0.0001). Among the mass lesions, the most common shape was irregular (79%; p < 0.0001), with 45 (87%) lesions having indistinct margins. Hypoechogenicity was the most common echo pattern (49 cases, 94%; p < 0.0001). Microcalcifications were found in 23 cases (37%; p = 0.004) and were associated with mass lesions in 15 cases (65%) and with non-mass lesions in 8 cases (35%) (p = 0.21). An almost perfect inter-observer agreement (k = 0.87) was obtained between the two radiologists. A significant ER expression was found in mass lesions (83%; p < 0.0001), with no significant PR (p = 0.89) or HER2 expression (p = 0.81). Among the lesions with microcalcifications, only 7 out of 23 cases (30%) were positive for HER2 (p = 0.09).
CONCLUSION
DCIS represents a heterogeneous pathological process with variable US appearance (mass-like, non-mass-like, or occult). The most common US finding is represented by mass-type, hypoechogenic lesions with indistinct margins. A significant ER expression exists among mass-type lesions, while microcalcifications seem not to be associated with HER2 expression.
目的
评估超声（US）在检测和描述乳腺导管原位癌（DCIS）中的作用，并研究 DCIS 的超声和生物学特征之间的相关性。
方法
回顾性分析了 171 例（平均年龄 44 岁；范围 39-62 岁）178 个病灶的患者，由两名独立的放射科医生通过超声检查寻找肿块或非肿块病变。通过免疫组织化学分析来确定雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体 2（HER2）的表达。评估了病变类型中 US 检测率和模式分布。使用 χ 检验评估 US 结果与生物学因素之间的相关性。p 值<0.05 表示有统计学意义。采用 Kohen 的 k 检验评估观察者间的一致性。
结果
US 检测到 178 个病灶中的 35%（63 个）。52 个（83%）病灶为肿块病变，11 个（17%）为非肿块病变（p<0.0001）。在肿块病变中，最常见的形状为不规则（79%；p<0.0001），其中 45 个（87%）病灶边界不清。低回声是最常见的回声模式（49 例，94%；p<0.0001）。23 例（37%）发现微钙化（p=0.004），其中 15 例（65%）与肿块病变有关，8 例（35%）与非肿块病变有关（p=0.21）。两名放射科医生之间的观察者间一致性几乎为完美（k=0.87）。在肿块病变中发现 ER 表达显著（83%；p<0.0001），而 PR（p=0.89）或 HER2 表达无显著差异（p=0.81）。在有微钙化的病变中，只有 23 例中的 7 例（30%）HER2 阳性（p=0.09）。
结论
DCIS 是一种具有不同超声表现（肿块样、非肿块样或隐匿性）的异质性病理过程。最常见的 US 表现为肿块型、低回声、边界不清的病变。肿块型病变中存在显著的 ER 表达，而微钙化似乎与 HER2 表达无关。
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