| [Background and objectives]Due to specific invasive breast cancer's unique biological characteristics,low morbidity,and high heterogeneity,the clinical course and prognosis of different types of it is different.Referring to the reports at home and abroad,most of them are exploring one aspect of a particular type such as pathology,imaging,etc.Because some specific types of breast cancer are even reported only in case,the research data is limit and there is no large sample of imaging and pathological findings that serve as a guide to clinical work.This paper retrospectively analyzed the clinical imaging feature and pathology of a group of specific invasive breast cancer to investigate its different characteristics relative to invasive ductal carcinoma(IDC),in order to make more accurate diagnosis before surgery,to provide the imaging basis for the more accurate judgment of tumor growth,recurrence,metastasis,changes and prognosis before and after treatment.Because of invasive lobular breast cancer(ILC)is a special group of the most common type of invasive carcinoma,and Invasive micropapillary carcinoma(IMPC)lymph node metastasis rate and a high degree of malignancy,the subject together were analyzed emphatically,the subject were analyzed together emphatically.[Materials and Methods]1.Clinical informationFirst part,there were 106 cases of specific invasive breast cancer confirmed by operation and pathology,including 41 cases of invasive lobular carcinoma,17 cases of invasive micropapillary carcinoma,1 cases of secretory carcinoma,9 cases of invasive papillary carcinoma,6 cases of invasive cribriform carcinoma and 9 cases of neuroendocrine carcinoma,3 cases of medullary carcinoma,8 cases of tubular carcinoma,of which one is found in bilateral side,12 cases of mucinous carcinoma.In the second and third part,41 cases of invasive lobular carcinoma and 17 cases of invasive papillary carcinoma proved by operation and pathology were collected respectively.2.Methods2.1 EquipmentUsing Siemens(Mammomat Novation)and Hologic(Selenia Dimensions)all-digital breast machine,preoperative cranio-caudul view and Medial-Lateraloblique view,ones of the plus side of the film and local pressure to enlarge,all of them are folly automatic exposure.Using Philiph IU 22 ultrasound diagnostic apparatus,real-time linear array high-frequency probe,the frequency of 7.5-10MHz,both breast and bilateral axillary scan.Paraffin sections and immunohistochemical analysis were performed after operation.2.2 Standard of the image evaluationThe diagnostic criteria refer to the fourth edition of the American Society of Radiology Breast Reporting and Data System(ACR BI-RADS),and if the opinions are the on the contrary,with the superior physician to discuss to a unified diagnosis.2.3 Report classThe description and classification of the report is based on BI-RADS,which is divided into 0-6 categories.2.4 StatisticsSPSS20.0 statistical were used to analyze,we set P<0.05 as statistically significant.The Wilcoxon rank sum test was used to compare the age of the two independent samples.The Pearson ?2 test or the Fisher exactness method were used to compare the images' factor.[Results]Part1:The X-ray findings of specific invasive breast cancer are mostly simple mass,while IDC is mostly calcified with mass/focal asymmetry.The proportion of round/oval lobulated mass in specific invasive breast cancer(45.3%)is higher than that in invasive ductal carcinoma(24.4%).Total calcification rate(37.4%)and malignant calcification rate(50%)of the specific invasive breast cancer calcified was lower than that in invasive ductal carcinoma(57%,73.7%),linear and branching calcification rate(7.5%)was lower than that in invasive ductal carcinomas(17.5%);regional and sample/linear distribution rate(22.5%)is lower than that of invasive ductal carcinoma(43.8%).Ultrasonic mixed echo(7.2%)posterior echo enhancement(9.6%)was higher than that of invasive ductal carcinoma(3.8%,3.8%).Mixed echogenic mass on the shortest diameter(>4.5cm),X-ray and ultrasound morphologically regular mass and clear boundary rate(100%,50%,83.3%)were significantly higher than that in invasive ductal carcinoma(0%,0%,0%),the rate of the elderly(over 51 years)special type carcinoma(83.3%)was significantly higher than that in invasive ductal carcinoma(33.3%).The undervalued rate of X-ray and ultrasound(25.2%,23.1%)was higher than that of invasive ductal carcinoma(11%,3.8%).Diagnostic underestimation mainly focuses on morphologically regular mass,and structural distortion.The percentage of Luminal A-like subtype in special breast cancer(27.1%)was higher than that of invasive ductal carcinoma(2%).The percentage of HER-2 overexpression subtype and basal-like subtype in special breast cancer(10.3%,3.7%)were lower than that in invasive ductal carcinoma(22.0%,8.0%).The lymph node metastasis rate in specific breast cancer(31.8%)was lower than that in invasive ductal carcinoma(54.0%).Part 2:The main X-ray findings of invasive lobular carcinoma are simple mass(34.1%),while IDC is ruostly calcified with mass/focal asymmetry.The shape,edge and density of mass were not statistically significant compared with invasive ductal carcinoma.The proportion of structural distortion and focal asymmetry in ILC(25%,13.6%)was higher than that in IDC(9.1%,2.7%).The proportion of branching calcification in invasive lobular carcinoma(6.7%)was lower than that of IDC(17.5%).Intermediate type calcification proportion(33.3%)is higher than that of IDC(14%).Regional,sample/linear distribution ratio(0%,20%)are lower than that of IDC(14%,29.8%).The ratio of tumor at the edge of an infiltrating/burr(93.1%)of the invasive lobular carcinoma was higher than that of IDC(54.4%),and the ratio of posterior echo attenuation(75.9%)was higher than that of IDC(29.1%).The difference was statistically significant.The Luminal type A ratio of invasive lobular carcinoma with structural distortion and with focal asymmetry(27.3%,30%)were higher than that of IDC(0%,0%),and both the HER-2 overexpression subtype and basal-like subtype ratios(9.1%,0%)were lower than IDC(30%,37.5%).The diagnostic underestimation rate of invasive lobular carcinoma(19.5%)was higher than that of IDC(11%),and the diagnostie underestimation mainly focused on structural distortion and focal asymmetry.Part 3:The main manifestation of Invasive papillary carcinoma(52.4%)and invasive ductal carcinoma(46.4%)were calcified with focal asymmetry/mass.The proportion of round/oval IMPC lesions were(26.7%)is higher than that of IDC(4.7%).The rate of intermediate calcification in invasive papillary carcinoma(33.3%)was higher than that in IDC(14%),and the ratio of segment/linear distribution(8.3%)was lower than that of IDC(29.8%).In invasive papillary carcinoma ER and PR were highly expressed(82.4%,52.9%),and the rate of basal-like subtype(0%)was lower than that of IDC(8%).The proportion of tumor which is larger than 5cm in invasive papillary carcinoma(33.3%)was significantly higher than that in IDC(3.5%).The grade ?metastasis rate of lymph node(47%)was higher than that of IDC(14%).There are two cases of Invasive papillary carcinoma in this group were undervalued.1 case diagnosed as BI-RADS3 showed round/oval,clear border mass,and 1 case diagnosed as BI-RADS4a was clustered with intermediate calcification.[Conclusions]1.The X-ray findings of specific invasive breast cancer are mostly simple mass.and morphologically regular mass and clear boundary rate were higher than that in IDC,while simple calcification was rare.The appearance rate of malignant calcification which has characteristic morphology and distribution was lower than invasive ductal carcinoma;ultrasonic mixed echo and posterior echo enhancement were more common in invasive ductal carcinoma compared with invasive ductal carcinoma.The pathological types of some cases can be inferred when combined with X-ray and clinic.In general,the clinical and imaging features of specific cancers have some overlap with benign and malignant lesions.Since its underdiagnosis rate was higher than invasive ductal carcinoma,it still need to rely on pathological diagnosis.The proportion of The Luminal type A and B in specific invasive breast cancer were higher than that in EDC.2.Invasive lobular carcinoma is mainly characterized by irregular shape and marginal burr like mass,which is difficult to distinguish with IDC.Structural distortions and focal asymmetries were followed.The proportion of Luminal type A was higher than that of IDC.In invasive lobular carcinoma,structural distortion is difficult to display,and diagnosis is easy to underestimate.The proportion of intermediate calcification was higher than that of IDC,and the branch like calcification and regional,segmental/line like distribution were lower than IDC.Ultrasonic posterior echo attenuation and the edge of invasion/burr were more common than IDC,and have good value in differential diagnosis.3.In invasive papillary carcinoma,an irregular mass with calcification was commonly seen in X-ray and ultrasonography,which is difficult to identify with IDC.It is difficult to distinguish between it and benign tumor when it shows a mass with round/oval shape and clear boundary.The proportion of intermediate calcification was higher than that of IDC and the segmental/line like distribution were lower than IDC.The proportion of tumor which is larger than 5cm in invasive papillary carcinoma was significantly higher than that in IDC,The grade ? metastasis rate of lymph node was higher than that of IDC.It suggests a high degree of malignancy. |
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