乳腺叶状瘤的影像诊断

Phyllodes tumors of the breast:mammographic and sonographic findings

目的 总结分析乳腺叶状瘤X线钼靶照片和超声检查的影像学特征。方法 搜集1991年 1月至 2 0 0 3年 5月经手术、病理证实的 2 5例乳腺叶状瘤 ,其中 13例行X线钼靶摄片 ,17例行超声检查 ,回顾性分析其临床特点及影像学征象。结果 2 5例乳腺叶状瘤中病理诊断Ⅰ级者 17例 ,Ⅱ级 7例 ,Ⅲ级 1例。 13例行乳腺X线钼靶检查患者病灶表现为圆形 (7例 )或浅分叶状 (6例 )密度高于邻近腺体的肿块 ,边界清楚 (8例 )或部分不清 (5例 ) ,所有病例均未发现钙化及邻近皮肤增厚、乳头回缩、周围乳腺结构扭曲等恶性征象。行乳腺超声检查的 17例患者 ,病灶表现为低回声者 16例 ,边界规整者 16例 ,出现囊变者 10例 ,11例出现后方回声增强。结论 乳腺叶状瘤的影像学表现有一定的特点 ,但这些表现为非特征性 ,与纤维腺瘤等边界清楚的实性病灶的鉴别有一定的困难 ,对可疑病灶行切除活检非常必要。

Objective To evaluate the mammographic and sonographic findings in patients with phyllodes tumors.Methods Twenty-five patients with phyllodes tumors confirmed by surgery and histopathology during 1991.1—2003.5 were collected.Of them,13 cases underwent mammography,17 cases underwent pre-operative sonography.All mammographic and sonographic findings were retrospectively analyzed.Results The pathologic differentiation of the tumor was grade Ⅰin 17 cases,grade Ⅱin 7 cases,and grade Ⅲ in 1 case,respectively.Mammography revealed high-density(compared with surrounding fibroglandular breast tissue) round(n=7) or lobulated (n=6) masses in 13 patients.Eight of 13 tumors had well defined contours.No evidence of calcification and secondary signs of malignancy,such as skin thickening,nipple retraction or distortion of perifocal structures was detected.On sonograms,16 cases showed hypoechoic,and 16 cases had circumscribed border.Cystic areas were observed in 10 cases and posterior acoustic enhancement was present in 11 cases.Conclusion Mammographic and sonographic features of phyllodes tumors of breast are characteristic but not pathognomonic.Neither mammography nor sonography can be used to differentiate reliably phyllodes tumors from other solid lesions with well-circumscribed borders (such as fibroadenomas).Therefore,an excisional biopsy would be necessary for equivocal masses.