目的：观察非肿块型乳腺导管内癌（ductal carcinoma in situ,DCIS）患者的超声表现,探讨其与临床、病理学特征及免疫组化指标表达间的相关性。方法：回顾性分析我院68例非肿块型DCIS患者术前的临床资料及超声检查结果,并观察其术后病理特征及雌激素受体、孕激素受体、人表皮生长因子受体2（human epidermal growth factor receptor 2,HER2）、Ki-67指数等免疫组化指标表达情况。根据超声图像特征,将患者分为导管型（Ⅰ型）、腺体型（Ⅱ型）、钙化型（Ⅲ型）和结构紊乱型（Ⅳ型）4组,分析4组DCIS患者的超声表现与其临床病理特征及免疫组化指标之间的相关性。结果：68例DCIS患者中,导管型为21例（30.9%）,腺体型为10例（14.7%）,钙化型为31例（45.6%）,结构紊乱型6例（8.8%）。各型患者间在年龄、月经状态、临床症状、前哨淋巴结转移、雌孕激素受体及Ki-67指数表达方面差异均无统计学意义（P>0.05）;导管型中以病理组织学表现为低级别的单纯DCIS、免疫组化指标HER2阴性表达为多见（81.0%）（P<0.05）;钙化型中以HER2阳性表达为多见（64.5%）（P<0.05）。中低级别DCIS及HER2阴性表达与导管型之间存在相关性,而高级别DCIS及HER2阳性表达与钙化型之间存在相关性（P<0.05）。结论：非肿块型DCIS患者的部分超声征象与其病理特征及免疫组化指标表达情况间存在一定相关性。
Objective: To evaluate the ultrasonographic (US) features of non-mass ductal carcinoma in situ (DCIS) of the breast and their correlation with clinical, pathological characteristics and biomarkers. Methods: A total of 68 non-mass DCIS patients were enrolled in this study. Clinical and pathological characteristics, biomarkers including estrogen receptor(ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 index and preoperative ultrasound imaging data were collected. The sonographic features were classified as four types: type Ⅰ: ductal type; type Ⅱ: glandular type; type Ⅲ: calcification type; type Ⅳ: architectural distortion type.Correlations between various US features and clinicopathological characteristics, biomarkers were analyzed. Results: For US, type Ⅰ was 21cases (30.9%); type Ⅱ 10 cases（14.7%）, type Ⅲ 31 cases (45.6%), and type Ⅳ 6 cases(8.8%). There were no significant differences in age, menopausal status, sentinel lymph node metastasis, clinical symptoms, ER, PR and Ki-67 index in the 4 groups. Type Ⅰ groupwas more likely to have low grade DCISand HER2 negative expression, and type Ⅲ groupwas more likely to have HER2 positive expression (all P<0.05). Low and intermediate grade DCIS, HER2 negative expressionwere associated significantly withtype I (P<0.05). High grade DCIS and HER2 positive expressionwere associated significantly with typeⅢ (P<0.05). Conclusions: Our findings suggest that some of theultrasound features of non-mass DCIS are associated with the histopathologic characteristics andbiomarkers.
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