Recanatini L, Renoldi L, Sfondrini M S, Di Nubila B, Marzano L, Campoleoni M, Landini A
Servizio di Radiodiagnostica e di Radioterapia, Clinica Mangiagalli, Milano.
Radiol Med. 1998 Jan-Feb;95(1-2):32-7.
The differential diagnosis of malignancy in small foci of microcalcifications or in extremely small nodes can be difficult. We carried out a retrospective analysis of integrated mammographic and US results, correlated with histologic data, to assess the limitations of each method and to optimize and benign/malignant ratio.
Our series consisted of 485 nonpalpable breast lesions submitted to histologic examination after vegetable charcoal marking. We gave each lesion an 0-5 score according to the degree of diagnostic doubt/suspicion after mammography and US, which results were correlated with histologic data to assess the carcinoma frequency in the various groups identified.
The analysis of mammographic and US images showed that the most frequent mammographic alteration in the lesions submitted to biopsy was an isolated cluster of microcalcifications (40.99%): of these, 36.86% were neoplastic. The nodules submitted to biopsy, which were 29.81% of the total, showed a cancer rate (36.80%) very similar to that of the microcalcifications. The carcinoma rate rose to 37.93% when the microcalcifications were associated with nodes. The highest carcinoma rates, i.e., 52.94% and 66.66%, respectively, were found in parenchymal distortions, either isolated or associated with microcalcifications, which however were only 7.03% and 3.10%, respectively, of the total number of cases.
Our study showed that: 1) a highly suspicious US result must be seriously considered when a negative mammography has poor intrinsic contrast; 2) a highly suspicious US image with a little suspicious good contrast mammography requires further confirmation before surgery is planned; 3) when the mammographic finding is mid-to-highly suspicious, further investigations are needed even if US is negative. To conclude, even though the histologic examination of nonpalpable breast lesions involves performing a biopsy, we believe this is acceptable when performed on an outpatient basis, under local anesthesia and removing a limited amount of tissue only. The benign/malignant ratio ranges 2 to 1.5: if it is further reduced (below 1.5), there will be the risk of missing some early neoplastic lesions.
微钙化小病灶或极小淋巴结中恶性肿瘤的鉴别诊断可能具有挑战性。我们对乳腺钼靶和超声检查结果进行了回顾性分析，并与组织学数据相关联，以评估每种方法的局限性，并优化良恶性比例。
我们的研究系列包括485例不可触及的乳腺病变，这些病变在经植物炭标记后接受了组织学检查。根据乳腺钼靶和超声检查后诊断怀疑/怀疑程度，我们给每个病变一个0 - 5分，将这些结果与组织学数据相关联，以评估所确定的各个组中的癌发生率。
乳腺钼靶和超声图像分析表明，接受活检的病变中最常见的乳腺钼靶改变是孤立的微钙化簇（40.99%）：其中，36.86%为肿瘤性病变。接受活检的结节占总数的29.81%，其癌症发生率（36.80%）与微钙化的发生率非常相似。当微钙化与淋巴结相关时，癌发生率升至37.93%。在实质扭曲中发现了最高的癌发生率，分别为52.94%和66.66%，实质扭曲可为孤立性或与微钙化相关，但分别仅占病例总数的7.03%和3.10%。
我们的研究表明：1）当乳腺钼靶检查结果为阴性且内在对比度较差时，必须认真考虑超声检查结果高度可疑的情况；2）超声图像高度可疑而乳腺钼靶检查结果可疑程度较低且对比度良好时，在计划手术前需要进一步确认；3）当乳腺钼靶检查结果为中度至高度可疑时，即使超声检查结果为阴性也需要进一步检查。总之，尽管对不可触及的乳腺病变进行组织学检查需要进行活检，但我们认为在门诊局部麻醉下仅切除有限量组织的情况下，这是可以接受的。良恶性比例范围为2至1.5：如果进一步降低（低于1.5），则存在漏诊一些早期肿瘤性病变的风险。
