乳腺癌的影像學(xué)診斷

乳腺癌的影像學(xué)診斷第1頁/共28頁P(yáng)athologicaltype2.Highlydifferentiatedbreastcancer:分化高的乳腺癌

1)adenocarcinoma腺癌2)ductalcarcinoma(alsoknownastubecancer)導(dǎo)管癌(亦稱管內(nèi)癌)3)papillarycarcinoma(alsoknownaspapillaryadenocarcinoma)導(dǎo)管癌(亦稱管內(nèi)癌)4)eczema-likecancer(alsoknownasPaget'snippledisease)濕疹樣癌(亦稱Paget氏乳頭病)

第2頁/共28頁ClinicalmanifestationsBreastlumps乳房腫塊Nippledischarge乳頭溢液Changesinthebreastskinandcontour乳房皮膚及輪廓改變

第3頁/共28頁InspectionmethodsUltrasoundMammography鉬靶X線

MRINearinfraredscanning近紅外線掃描

Positronemissiontomography(PET)EnhancedCT第4頁/共28頁UltrasoundSolidhypoecho低回聲Withoutcapsule無包膜Borderclearance邊界清Heterogeneous不均勻internalechoStrongechocanbeseenclusteredcalcifications鈣化第5頁/共28頁mammographySeetheupperouterquadrantmassinshallowleaf淺分葉腫塊影LessclearboundarySeeclustersofcalcification其內(nèi)見成簇鈣化第6頁/共28頁"MRIshouldnolongerberegardedasanadjuncttomammographybutasadistinctbreastcancerinitsearlieststage."

“MRI不再是鉬靶X線的輔助方法，而是作為乳腺癌早期診斷的獨(dú)立檢查方法。”第7頁/共28頁MRIFeatures（breastcancer）T1WIlowsignalT2WIIncreasedsignal

第8頁/共28頁MRIFeaturesIrregular不規(guī)則massLobulated分葉狀edgesBlur模糊,rough毛糙Crab-likegrowth呈蟹足樣生長Ill-defined,第9頁/共28頁MRIFeaturesLiquefactionnecrosis液化壞死seeninthelargerlesions第10頁/共28頁MRIFeaturesQuicksignificantly明顯enhancedRapidclearance廓清Aroundthebeginningofthespreadofthediseasecenters向心性強(qiáng)化Liquefactionnecrosisandbleeding液化壞死及出血hasalwaysbeenpartofnoenhancement第11頁/共28頁Time-intensitycurves（TIC）TypeClearancetype

type持續(xù)型平臺型廓清型第12頁/共28頁Time-intensitycurves（TIC）Mostofthebenignlesionsshowed"persistent"持續(xù)型toenhanceMostmalignantlesionsshowed"clearance-type"廓清型enhanced"Platform-type"平臺型canbebenignlesions,butalsoformalignantlesions.第13頁/共28頁

DiagnosisofbreastcancerBI-RADSclassification分級

Level0:assessed評估isnotcomplete,tofurtherassesstheneedforotherimagingLevel1:noabnormalfindings無異常發(fā)現(xiàn)

Level2:Benignfound良性發(fā)現(xiàn)-routinefollow-upLevel3:Possiblepositivefindings可能良性發(fā)現(xiàn)-short-termfollow-upLevel4:Low-Moderatesuspiciousmalignant低-中度可疑惡性-considerbiopsyLevel5:highlysuspectedmalignancy高度懷疑惡性-Level6:malignantlesionsbiopsyconfirm已活檢證實(shí)的惡性病變

第14頁/共28頁Differential鑒別Diagnosis1Breastfibroadenoma：纖維腺瘤

Oftenoccursinyoungfemale，Massoftensmooth光滑edge，Similardensityandglands腺體，Coarsecalcificationwithinthevisible，Strengtheneven,slow,waseccentric.

第15頁/共28頁DifferentialDiagnosis2Hyperplasia增生

：Localglandincreased,edgesblur模糊Enhancedwithaslow,progressive漸進(jìn)性enhancement，Inthelateenhancement,lesiondegreeofenhancementincreasingtrend

第16頁/共28頁DifferentialDiagnosis3Breastcyst囊腫：appearassignificantlongT1andlongT2singalintensity第17頁/共28頁P(yáng)hotoReview

纖維腺瘤1a）showlowT1WIsignalmassattheleftbreast1b）showhighT2WIsignalmass,edgeclear第18頁/共28頁P(yáng)hotoReview

纖維腺瘤2a）T2WImasssignalwasslightlylower2b）Enhancedscanmasslesioninthebreastdeep,sharpedgesandstrengthenamoreeven第19頁/共28頁P(yáng)hotoReview纖維腺瘤3a）Enhancedmassintherightbreastshowedamorehomogeneous均勻enhancement3b）CurveforthelesiontypeⅠⅡtypecurveforthenormalglands第20頁/共28頁P(yáng)hotoReview浸潤性導(dǎo)管癌4a）Masswithintheleftbreastwassignificantly明顯enhanced4b）DynamicenhancementcurvesofthetypeⅢ(clearancetype)第21頁/共28頁P(yáng)hotoReview浸潤性導(dǎo)管癌5a）X-rayimageRightbreastnearthechestwallseethemass5b）Significantlyenhancedlesions,irregular不規(guī)則margin第22頁/共28頁P(yáng)hotoReview浸潤性導(dǎo)管癌6a）X-rayimageLargecalcifiedlesionsinthebreast6b）Theouterupperquadrantlesionswithinthechipheterogeneous不均勻enhancement第23頁/共28頁P(yáng)hotoReview乳腺囊腫第24頁/共28頁P(yáng)hotoReview乳腺增生第25頁/共28頁Summary

Middle-agedwomenwithmultiple多發(fā)

Wasinfiltrating浸潤thesurroundingtissueinvasiona