乳腺良恶性钙化的声像学特征分析

Ultrasonographic characteristics of benign and malignant calcification of breast

目的探讨乳腺良恶性钙化的声像学特征及其在乳腺良恶性病变鉴别诊断中的价值。方法回顾性分析64例乳腺钙化患者的术前超声表现,并与手术病理及钼靶乳腺摄片(48例)结果相对照,对比分析乳腺良恶性钙化的声像图特点及其诊断价值。结果64例乳腺钙化病灶病理诊断良性钙化30例,恶性钙化34例。恶性钙化的声像图表现为钙化伴有结节,钙化病灶小,数量多,呈点状,分布呈簇状,后方无声影,无快闪伪像。而良性钙化则钙化伴或不伴有结节,钙化病灶粗大,数量少,形状差异大,呈斑状或团块状,分布呈局灶性,后方多有声影,多有快闪伪像,乳腺微钙化检出率在良性(6/30,20.0%)与恶性(30/34,88.2%)病变间差异有统计学意义(P<0.05)。微钙化、粗钙化、斑块状钙化3种类型的分布构成比在良恶性病变间差异有统计学意义(P<0.01)。超声诊断乳腺癌的敏感性为94.1%,特异性93.3%,准确性93.8%。术前超声检查与钼靶摄片诊断符合率比较差异无统计学意义(P>0.05)。结论超声与钼靶乳腺摄影均为检查乳腺钙化的重要方法,乳腺良恶性钙化的声像学特征有助于乳腺良恶性病变的鉴别诊断。

Objective To assess the ultrasonographic characteristics of the benign and malignant calcification in breasts, in order to differentiaiate the benign and malignant breast tumors. Methods Breast calcifications in 64 patients were retrospectively reviewed and compared with pathology as well as mammography. The ultrasonographic characteristics of the breast benign and malignant calcifications were analyzed for improving the differential diagnosis. Results All of the 64 patients had pathologic results. There were 30 cases with benign calcification and 34 with malignant calcification. The characteristics of malignant calcification revealed nodules, with microcalcification appearing multiple punctuation, cluster without acoustic shadowing and absence of color Doppler twinkling artifact. The benigh calcification revealed small amount of coarse, aniso-shape, plague-like or ball like nodular or non-nodular focuses with back shadowing and color Doppler twinkling artifact. The detection rate of the micro calcification between the benign and malignant tumors was significantly different (P<0.05). The constituent ratio of micro calcification, coarse calcification and plaque calcification have extremely significant difference between the benign and malignant tumors (P<0.01). The sensibility、specificity and accuracy of the ultrasound in diagnosing breast cancer were 94.1%, 93.3%and 93.8% respectively, indicating no significant difference between the ultrasound and the mammography. Conclusions Ultrasound and the mammography are all the important modelities for the diagnosis of breast calcification. The ultrasonographic characteristics of the benign and malignant calcification may conduce the differential diagnosis of breast tumors.