Palpable Breast Cancers without Mammographic Mass: Ultrasonographic Findings with Core Needle Biopsy

臨床上可觸診但乳房攝影未見腫瘤之乳癌：其超音波表現及超音波引導粗針生檢之結果

林吉晉(Gi-Gin Lin) ； 張潤忠(Yun-Chung Cheung) ； 陳耀亮(Yao-Liang Chen) ； 饒啟明(Kee-Min Yeow) ； 呂嘉偉(Kar-Wai Lui) ； 吳樹鏗(Shu-Hang Ng) ； 吳冠群(Koon-Kwan Ng) ； 黃浩輝(Ho-Fai Wong)

《中華放射線醫學雜誌》 29卷5期 (2004/10) Pp. 231-237

摘要

本研究之目的，在研究臨床上可觸診但乳房攝影未見之乳癌，其超音波表徵及超音波引導粗針生檢之結果。同時討論其超音波特表徵與淋巴結狀態與腫瘤大小之相關。
本研究針對28位經手術證，臨床上可觸診但乳房攝影未見之乳碰病例，施行超音波檢查及超音波引導粗針生檢。我們回顧其乳房攝影及超音波影像，並分析超音波引導粗針生檢成效，比較超音波特徵與組織學證實之淋巴結狀態與腫瘤大小之相關。
在本研究的28名病例中，病灶邊緣完整有16例，邊緣不規則有6例，邊緣模糊有6例。有2例術前粗針生檢診斷為異常增生，有6例術前粗針生檢診斷為原位癌的病灶，術後診斷分別為原位癌及侵犯性癌。但是沒有任何臨床治療上的延誤發生。超音波表徵尚無法預測淋巴結狀態。以皮爾森檢查相關檢定，超音波及病理下的乳癌大小具中度相關。
臨床上可觸診但乳房攝影未見之乳癌，超音波可以用來偵測病灶，引導施行粗針生檢，以作為術前診斷之依據。以超音波測量術前乳癌病灶大小具有中度可信度。

關鍵字

診斷 ； 乳癌 ； 針生檢 ； 超音波

並列摘要

The purpose of this study is to report ultrasonographic findings and ultrasonographically guided core needle biopsy in the clinical setting of palpable breast cancers without visible mass on mammograms. Lymph node status and cancer size are discussed.
Twenty-eight surgically proved cases of palpable breast cancers without any mammographically visible mass were enrolled. All the patients underwent preoperative sonography and ultrasonographically guided core needle biopsy. Mammograms and sonograms were reviewed. The efficacy of ultrasonographically guided core needle biopsy and the correlation of ultrasonographic features with surgical histopathological diagnoses, lymph node status and cancer size were analyzed.
On sonograms of our 28 cases, the outline of the lesion was circumscribed in 16 cases, irregular in 6, and indistinct in the other 6. All our two cases of atypical ductal hyperplasia and 6 of the 14 cases of ductal carcinoma in situ (28%) were histologically undergraded with ultrasonographically guided core needle biopsy and subsequently turned out to be ductal carcinoma in situ and invasive ductal carcinoma, respectively, after surgery. No clinical management was delayed. The sonographic features were not a significant predictor of the pathological subtypes of ductal cancer and lymph node status. The cancer sizes on sonogram were moderately correlated (r= 0.555, p-value= 0.002) by Pearson correlation.
In the clinical setting of palpable cancers, ultrasonography enabled us to detect mammographically occult masses and effectively obtain core tissue for pre-operative diagnosis. US measurement of cancer size was moderately reliable as correlating with surgical specimens.

並列關鍵字

Breast nesplasms ； biopsy ； Breast nesplasms ； diagnosis ； Breast nesplasms ； Localization Ultrasound ； guidance