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目的探讨乳腺肿块型浸润性导管癌的MRI动态增强扫描(DCEMRI)征象与其WHO病理分级的关系。方法回顾性分析四川大学华西医院2012年6月至2013年12月期间92例经手术或活检病理证实为肿块型浸润性导管癌的DCEMRI征象,并分析其与WHO病理分级的关系。结果 92例乳腺肿块型浸润性导管癌患者中肿瘤长径≤2 cm者29例(31.52%),2~5 cm者53例(57.61%),≥5 cm者10例(10.87%);病灶形态为圆形者3例(3.26%),卵圆形者7例(7.61%),分叶形者33例(35.87%),不规则形者49例(53.26%)。病灶边缘光整者11例(11.96%),不规则者47例(51.09%),毛刺状者34例(36.96%)。病灶早期均匀强化者15例(16.30%),不均匀强化者40例(43.48%),环形强化者37例(40.22%)。WHO病理分级:1级者5例(5.43%),2级者30例(32.61%),3级者57例(61.96%)。经统计分析,肿瘤大小、病灶形态及病灶早期强化特点与WHO病理分级有关(P=0.012,P=0.004,P=0.000),即病灶长径越大,WHO病理分级越高;圆形和卵圆形肿块的WHO病理分级相对较低,分叶状和不规则形肿块的WHO病理分级高;不均匀强化及环状强化的WHO病理分级高,均匀强化的WHO病理分级较低。病灶边缘形态与WHO病理分级无关(P>0.05)。结论乳腺肿块型浸润性导管癌DCEMRI特征与WHO分级有一定关系,可根据MRI征象对病灶的生物学行为和预后进行评估。
Objective To investigate the relationship between the appearance of DCEMRI and the pathological grading of breast in breast tumor of invasive ductal carcinoma. Methods A retrospective analysis of 92 patients with histologically confirmed invasive ductal carcinoma in China from June 2012 to December 2013 at West China Hospital of Sichuan University was performed. The relationship between DCEMRI and WHO pathological grade was analyzed. Results Totally 92 patients (31.52%) with tumor diameter> 2 cm, 53 patients (57.61%) at 2 ~ 5 cm and 10 patients (10.87%) ≥ 5 cm in 92 cases of breast tumor with invasive ductal carcinoma. There were 3 cases (3.26%) with circular shape, 7 cases with oval shape (7.61%), 33 cases with lobulated shape (35.87%) and 49 cases with irregular shape (53.26%). Eleven patients (11.96%) had margins of margins, 47 (51.09%) were irregular and 34 (36.96%) had burr. There were 15 cases (16.30%) with early uniform enhancement, 40 cases (43.48%) with uneven enhancement and 37 cases (40.22%) with circular enhancement. WHO grade of pathology: grade 1 in 5 cases (5.43%), grade 2 in 30 cases (32.61%), grade 3 in 57 cases (61.96%). According to the statistical analysis, the size of the tumor, the shape of the lesion and the early enhancement of the lesion were related to the WHO pathological grade (P = 0.012, P = 0.004, P = 0.000). The longer the diameter of the lesion, the higher the WHO pathological grade. The WHO classification of round lumps is relatively low, and the WHO classification of lobulated and irregular lumps is high. The WHO classification of high and uniform livers of uneven livers and ring livers has a lower histopathological grade. The edge of the lesion has nothing to do with the WHO pathological grade (P> 0.05). Conclusion The characteristics of DCEMRI in breast tumor with invasive ductal carcinoma are related to WHO classification. The biological behavior and prognosis of the lesions can be evaluated according to MRI findings.