目的 探讨全数字化乳腺摄影(full-field digital mammography,FFDM)对非肿块型乳腺癌的诊断价值.方法 回顾性分析67例经手术病理证实的非肿块型乳腺癌及癌前病变患者的FFDM表现,总结其特征.全部病例采用GE平板2000D全数字化乳腺摄影机检查,体位常规采用头尾位(CC位)、内外斜位(MLO位),必要时加摄侧位及局部点片.对临床未触及包块而FFDM发现可疑乳腺癌及癌前病变者均行术前定位.对乳头溢血者行乳导管造影.结果 67例非肿块型乳腺癌及癌前病变中,临床触及肿块者50例,未触及肿块者17例.影像表现为微钙化28例,结构扭曲19例,致密影11例,全乳密度增高伴皮下水肿3例,未见异常6例.合并异常血管增粗20例,皮肤增厚收缩9例,乳头凹陷12例,大导管相2例,淋巴结肿大10例.病理类型以浸润性导管癌最多,占71.6 %,其次是导管原位癌,占13.4%,4例癌前病变均为不典型增生.结论 FFDM对非肿块型乳腺癌具有重要价值.%Objective To study the application of full-field digital mammography (FFDM) for non-mass breast cancer. Methods 67 cases with non-mass breast cancers or precancerous lesions were confirmed by operation and pathology retrospectively . All patients were examined by FFDM(GE Senographe 2000D ). Craniocaudal view (CC) and mediolateral oblique(MLO ) were conducted for every patient. Lateral position or spot view was achieved if necessary. Preoperative localization was conducted for all patients with non-palpable mass but doubtful breast cancer or precancerous lesion in FFDM. Patients with nipple discharge underwent galactogra-phy. Results There were 67 cases with non-mass breast cancers or precancerous lesions, including 50 palpable lesions and 17 non-palpable lesions. The findings of FFDM showed microcalcification in 28 cases,architectual distortion in 19 cases, focal density in 11 cases,high density of whole breast parenchyma with subcutaneous edema in 3 cases and no abnormal in 6 cases. Other findings included abnomal vessels in 20 cases,skin thickend and contracted in 9 cases,nipple retraction in 12 cases, duct enlargement in 2 cases, lymph node enlargement in 10 cases. The majority of the lesions in pathology were infiltrative duct carcinomas (71. 6%) , and the next was duct carcinoma in situ(13. I%). 4 cases with precancerous lesion were atypical hyperplasia. Conclusion FFDM has important value for the detection of non-mass breast cancer.
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