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文献速递乳腺乳腺X线

对比增强乳腺X线摄影评估乳腺导管原位癌及与病理分级对照

Preoperative contrast enhanced mammography evaluation of breast ductal carcinoma in situ and comparative analysis with pathological grading.
PubMed 文献 · Clin Radiol · 2026-05-22

本研究为单中心回顾性研究，纳入190例纯导管原位癌患者共196个病灶，术前两周内行对比增强乳腺X线摄影。结果显示CEM对导管原位癌的敏感度为89.3%，显著高于单纯低能图像的72.4%。不同核分级导管原位癌在CEM上的钙化、大小及强化显著度方面表现不同。

要点

  • CEM对导管原位癌敏感度显著高于单纯低能图像，尤其对非钙化灶提升明显。
  • 高级别导管原位癌钙化更多、病灶更大、强化显著度更高。
  • 不同核分级间强化百分比和强化形态无显著差异，分级需结合钙化形态。

核心结论

  • CEM对导管原位癌的诊断优于单纯低能图像，总体敏感度为89.3%。
  • 不同核分级导管原位癌在CEM上表现存在差异，高级别钙化更多、病灶更大、强化更显著。

研究设计与样本

  • 单中心回顾性研究，纳入190例纯导管原位癌患者，共196个病灶，6例为双侧。
  • 所有患者术前两周内完成对比增强乳腺X线摄影检查。
  • 对CEM图像进行回顾性评估，比较不同核分级导管原位癌的诊断效能。

关键影像表现/征象

  • 高级别导管原位癌较低级别显示更多钙化及更大病灶范围。
  • 高级别导管原位癌强化显著度高于低级别和中间级别。
  • 低级别导管原位癌多形性钙化和细线样分支状钙化少于中、高级别。
  • 不同核分级间强化百分比和强化形态无显著差异。

诊断标准与关键数值

  • CEM对导管原位癌总体敏感度为89.3%，单纯低能图像为72.4%，差异P<.001。
  • CEM对钙化性导管原位癌敏感度为96.8%，单纯低能图像为91.2%，P=.016。
  • CEM对非钙化性导管原位癌敏感度为76.1%，单纯低能图像为39.4%，P<.001。
  • CEM对低、中、高级别导管原位癌敏感度分别为83.3%、87.3%、93.8%。
  • 单纯低能图像对低、中、高级别导管原位癌敏感度分别为61.1%、65.8%、84.0%。

临床应用与阅片要点

  • 日常阅片应重视对比增强图像对非钙化性导管原位癌的补充价值。
  • 评估导管原位癌范围时优先参考CEM，因其对病灶范围的显示优于单纯低能图像。
  • 看到钙化多、范围大且强化显著的病灶需警惕高级别导管原位癌可能。

局限性

  • 单中心回顾性设计存在选择偏倚和结果外推局限。

以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。

英文原文（摘要）· 点击展开

AIM: To assess the value of contrast-enhanced mammography (CEM) in the diagnosis of breast ductal carcinoma in situ (DCIS) and to analyse the correlation between the CEM manifestations and pathological nuclear grades of DCIS.

MATERIALS AND METHODS: This single-center retrospective study included 190 patients with pure DCIS who underwent CEM within two weeks preoperatively. The CEM images of 196 DCIS lesions (bilateral DCIS in six patients) were reviewed to evaluate the diagnostic performance of CEM for DCIS with different nuclear grades.

RESULTS: CEM showed significantly higher sensitivity to DCIS (89.3%) than low-energy image alone (72.4%; P < .001), whether for calcified (96.8% vs. 91.2%; P = .016), noncalcified (76.1% vs. 39.4%; P < .001), low-grade (83.3% vs. 61.1%; P = .008), intermediate-grade (87.3% vs. 65.8%; P < .001) and high-grade DCIS (93.8% vs. 84.0%; P = .008). CEM was equally sensitive in diagnosing different grades of DCIS (P = .183). CEM was superior to low-energy image alone in showing the extent of DCIS lesions. In CEM, high-grade DCIS showed more calcifications and larger size than low-grade DCIS, and showed higher enhancement conspicuity than low- and intermediate-grade DCIS (P < .05). Low-grade DCIS showed less pleomorphic and fine linear branching calcifications than intermediate- and high-grade DCIS (P < .05). The three grading groups were not different in terms of enhancement percentage and enhancement morphology (P > .05).

CONCLUSIONS: CEM was superior to low-energy image alone in DCIS diagnosis. Different nuclear grades of DCIS manifested differently on CEM.

来源：Clin Radiol，查看原文。版权归原作者所有。

引用

  1. Wang, Wang, Shao, et al. Preoperative contrast enhanced mammography evaluation of breast ductal carcinoma in situ and comparative analysis with pathological grading. Clin Radiol. 2026. PMID: 42287862. doi:10.1016/j.crad.2026.107392
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供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。