Comparative analysis of intraductal spread of breast cancer between helical computed tomography and magnetic resonance imaging.

背景资料。为了避免保乳手术中的局部失败，手术清除所有细胞是很重要的。不同的成像方式已经被应用于预测肿瘤的扩展。我们已经报道，当与组织学测量精确评估时，三维磁共振成像(MRI)在测量肿瘤范围方面比乳房X线片和超声检查更准确。方法：对52例乳腺癌患者行螺旋CT和MRI检查，并在术前用软件进行三维重建，比较螺旋CT和3D-MRI对乳腺癌侵犯范围和多中心的诊断价值。对手术标本进行5 mm厚的连续切片，并进行病理标测。结果：1)17例高级别(>2 cm)乳腺导管内扩散癌(ISC)患者经手术病理证实，ISC分级高于2 cm。17例中11例CT和MRI均能检出高级别ISC，而5例两者均不能检出高级别ISC。2)MRI检出高级别ISC的敏感性(71%)高于CT(65%)。3)CT诊断多中心病变的特异度高于MRI(93%比80%)。4)对于导管内成分粉刺样型、组织学分级较高(III级)的肿瘤，CT和MRI均能较准确地判断肿瘤的侵犯范围。结论三维CT倾向于低估，而3D-MRI倾向于高估。导管内成分的亚型和组织学分级与高血运的癌扩展测量的准确性有关

BACKGROUND. Surgical clearance of all the cells is important to avoid local failure in breast conserving surgery. Various imaging modalities have been applied to predict the carcinoma extension. We have reported that 3-D magnetic resonance imaging (MRI) is more accurate than mammography and ultrasonography in measuring the extent of tumor when precisely assessed with histological measurements. This study was initiated to compare the utility of helical computed tomography (CT) and 3-D MRI in detecting the extension and multicentricity of breast cancer.METHODS. Fifty-two patients with primary breast cancer were subjected to helical CT and MRI, subsequently reconstructed three dimensionally using software before operation. Surgical specimens were subjected to serial slices 5mm thick and mapped pathologically. The sensitivity, specificity and accuracy were investigated for detecting intraductal spread of carcinoma (ISC) and multicentricity of small foci of breast cancer.RESULTS. 1) Seventeen cases with high grade ISC (over 2cm) were observed pathologically. Both CT and MRI were useful for detecting high grade ISC in 11 of 17 cases, whereas neither of them were available in 5 of 17 cases. 2) The sensitivity of MRI for detecting high grade ISC was higher than CT (71% vs 65%). 3) The specificity of CT for detecting multicentricity was higher than MRI (93% VS 80%). 4) Both CT and MRI were more accurate in measuring carcinoma extension when tumor with comedo type of intraductal component and high histological grade (grade III).CONCLUSIONS. The results suggested that 3-D CT tends to underestimate, whereas 3-D MRI is likely to overestimate. Subtype of intraductal component and histological grade were associated with accuracy of measuring carciooma extension due to high vascularity