角田 博子¹, 植野 映², 東野 英利子¹, 秋貞 雅祥²

Hiroko TSUNODA¹, Ei UENO², Eriko TOHNO¹, Masayoshi AKISADA²

¹筑波大学附属病院放射線科, ²筑波大学臨床医学系

¹The University of Tsukuba, ²The University of Tsukuba, Institute of Clinical Medicine

キーワード : Breast carcinoma, Ductal spreading, Real time echography

It is generally believed that a cluster of the tiny calcifications on a mammogram and a stenosis or interruption on a ductogram suggest ductal spreading of breast carcinoma. However there have been no reports about ductal spreading evidence in echograms. We have occasionally detected a hypoechoic tubular lesion around a primary tumor on real time echograms and have wondered if it might suggest ductal spreading.
In this study we selected 5 mastectomy cases in which preoperative biopsies had not been performed to obtain specimens whose composition corresponded to that of the tissue in preoperative echograms. These cases were confirmed as malignant by echography, mammography or cytology before surgery.
Just before surgery, we recorded more than forty sonographic pictures in parallel with the hypoechoic tubular structure and drew a line at the scan line on the skin. After mastectomy these specimens were fixed with formalin. A series of histological slides, 4 micrometers in thickness, at intervals of 300 micrometers was made from these specimens in a section about 1 cm thickness at the center of that line. As a consequence of comparing the echographic images with the histological slides, we were able to obtain morphologically identical pairs of echograms and histological slides in 4 out of 5 cases.
In one case, the comparison could not be performed successfully because a non-alignment of the histological slides occured, but histologically the mammary duct contained ring-like structures in which cancer cells were detected.
Although we can not determine whether or not cancer cells exist at one point of the dilated duct, we have at least shown that hypoechoic tubular structures are correlated with cancer-spreading mammary ducts.
Thus, we emphasize that breast echography is able to suggest the possibility of ductal spreading of breast carcinoma.