乳腺癌的影像学诊断

乳腺癌的影像学诊断第1页/共28页Pathologicaltype2.Highlydifferentiatedbreastcancer:分化高的乳腺癌

1)adenocarcinoma腺癌2)ductalcarcinoma(alsoknownastubecancer)导管癌(亦称管内癌)3)papillarycarcinoma(alsoknownaspapillaryadenocarcinoma)导管癌(亦称管内癌)4)eczema-likecancer(alsoknownasPaget'snippledisease)湿疹样癌(亦称Paget氏乳头病)

第2页/共28页ClinicalmanifestationsBreastlumps乳房肿块Nippledischarge乳头溢液Changesinthebreastskinandcontour乳房皮肤及轮廓改变

第3页/共28页InspectionmethodsUltrasoundMammography钼靶X线

MRINearinfraredscanning近红外线扫描

Positronemissiontomography(PET)EnhancedCT第4页/共28页UltrasoundSolidhypoecho低回声Withoutcapsule无包膜Borderclearance边界清Heterogeneous不均匀internalechoStrongechocanbeseenclusteredcalcifications钙化第5页/共28页mammographySeetheupperouterquadrantmassinshallowleaf浅分叶肿块影LessclearboundarySeeclustersofcalcification其内见成簇钙化第6页/共28页"MRIshouldnolongerberegardedasanadjuncttomammographybutasadistinctbreastcancerinitsearlieststage."

“MRI不再是钼靶X线的辅助方法，而是作为乳腺癌早期诊断的独立检查方法。”第7页/共28页MRIFeatures（breastcancer）T1WIlowsignalT2WIIncreasedsignal

第8页/共28页MRIFeaturesIrregular不规则massLobulated分叶状edgesBlur模糊,rough毛糙Crab-likegrowth呈蟹足样生长Ill-defined,第9页/共28页MRIFeaturesLiquefactionnecrosis液化坏死seeninthelargerlesions第10页/共28页MRIFeaturesQuicksignificantly明显enhancedRapidclearance廓清Aroundthebeginningofthespreadofthediseasecenters向心性强化Liquefactionnecrosisandbleeding液化坏死及出血hasalwaysbeenpartofnoenhancement第11页/共28页Time-intensitycurves（TIC）TypeClearancetype

type持续型平台型廓清型第12页/共28页Time-intensitycurves（TIC）Mostofthebenignlesionsshowed"persistent"持续型toenhanceMostmalignantlesionsshowed"clearance-type"廓清型enhanced"Platform-type"平台型canbebenignlesions,butalsoformalignantlesions.第13页/共28页

DiagnosisofbreastcancerBI-RADSclassification分级

Level0:assessed评估isnotcomplete,tofurtherassesstheneedforotherimagingLevel1:noabnormalfindings无异常发现

Level2:Benignfound良性发现-routinefollow-upLevel3:Possiblepositivefindings可能良性发现-short-termfollow-upLevel4:Low-Moderatesuspiciousmalignant低-中度可疑恶性-considerbiopsyLevel5:highlysuspectedmalignancy高度怀疑恶性-Level6:malignantlesionsbiopsyconfirm已活检证实的恶性病变

第14页/共28页Differential鉴别Diagnosis1Breastfibroadenoma：纤维腺瘤

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

第15页/共28页DifferentialDiagnosis2Hyperplasia增生

：Localglandincreased,edgesblur模糊Enhancedwithaslow,progressive渐进性enhancement，Inthelateenhancement,lesiondegreeofenhancementincreasingtrend

第16页/共28页DifferentialDiagnosis3Breastcyst囊肿：appearassignificantlongT1andlongT2singalintensity第17页/共28页PhotoReview

纤维腺瘤1a）showlowT1WIsignalmassattheleftbreast1b）showhighT2WIsignalmass,edgeclear第18页/共28页PhotoReview

纤维腺瘤2a）T2WImasssignalwasslightlylower2b）Enhancedscanmasslesioninthebreastdeep,sharpedgesandstrengthenamoreeven第19页/共28页PhotoReview纤维腺瘤3a）Enhancedmassintherightbreastshowedamorehomogeneous均匀enhancement3b）CurveforthelesiontypeⅠⅡtypecurveforthenormalglands第20页/共28页PhotoReview浸润性导管癌4a）Masswithintheleftbreastwassignificantly明显enhanced4b）DynamicenhancementcurvesofthetypeⅢ(clearancetype)第21页/共28页PhotoReview浸润性导管癌5a）X-rayimageRightbreastnearthechestwallseethemass5b）Significantlyenhancedlesions,irregular不规则margin第22页/共28页PhotoReview浸润性导管癌6a）X-rayimageLargecalcifiedlesionsinthebreast6b）Theouterupperquadrantlesionswithinthechipheterogeneous不均匀enhancement第23页/共28页PhotoReview乳腺囊肿第24页/共28页PhotoReview乳腺增生第25页/共28页Summary

Middle-agedwomenwithmultiple多发

Wasinfiltrating浸润thesurroundingtissueinvasiona