高频超声对乳腺肿块内钙化的特征性分析

Analysis of calcification in breast masses by high-resolution sonography

目的 应用高频超声观察分析乳腺肿块内钙化的大小、形状和分布特征,进一步探讨其与良恶性之间的关系。方法 51例高频超声检查具钙化显像的乳腺疾病患者,其中恶性病变30 例,良性病变21 例,全部病例均获病理诊断。结果 根据钙化大小将病变内钙化分为三种类型:①微钙化;②粗钙化;③弧形钙化。进一步将微钙化分为a.小斑点状钙化;b.珍珠状钙化;c.簇状钙化。30例恶性病变,其中微钙化29例,粗钙化仅1例;良性21 例中,微钙化13 例,粗钙化4 例,弧形钙化4例,微钙化多发生于恶性病变中,而粗钙化和弧形钙化则多出现于良性病变中,两组具有显著差异(χ2 =12.22,P<0.001。在有详细记录的42例微钙化中,恶性肿块钙化多呈团簇状分布(22/42),良性钙化多为单一或松散分布的珍珠状和斑点状(12/42),统计学具有显著差异(χ2=16.44,P<0.001 );另有7 例(7/42)恶性病变亦显示松散分布的斑点状钙化。结论 簇状钙化是乳腺癌的特征,单一或松散分布的珍珠状钙化、粗钙化及弧形钙化多为良性病变,值得注意的是斑点样钙化为良恶性病变所共有,单一或稀少松散分布多为良性病变,两个或以上较为聚集出现时应结合其他二维征象及彩色多普勒血流频谱特征等有助于提高乳腺癌的诊断率。

Objective To analyze and evaluate the size, shape and distribution characteristics of calcification in breast masses by high-resolution sonography for the differentiation of the benign masses from the malignant ones. Methods Fifty-one cases with calcification in which included 30 malignant and 21 benign masses in breast masses were evaluated and analyzed by high-resolution sonography . All cases had pathological results. Results According to the sizes, calcifications were classified: type 1, micro calcification; type 2, coarse calcification and type 3, curved calcification. Furthermore, micro calcifications were divided into three types due to their shapes and distributions: a, spot calcification, b, pearl calcification, c, clustered calcification. Of the 30 malignant cases, 29 were micro calcifications and only one coarse calcification, whereas 13 cases were micro calcifications, 4 were coarse calcification and 4 curved calcification in the 21 benign cases. Micro calcifications were more likely to be found in malignant diseases, and coarse calcification, curved calcification were more likely to be in benign diseases. There is a significant difference between the two groups (χ 2=12.22, P <0.001). Moreover, of the 42 micro calcifications, the calcification features of malignant masses tended to be appeared clustered distributions (22/42), and benign calcifications tended to be appeared single or loose distributions with pearl or spot micro calcifications (12/42). Statistic significance was different between malignant and benign masses (χ 2=16.44, P <0.001). Additionally, 7 malignant masses (7/42) appeared loose distributions of spot micro calcifications. Conclusion Clustered calcification can be characters of breast cancer. Most of pearl micro calcifications, coarse and curved calcifications with single or loose distributions are benign lesions. Spot micro calcification can be appeared in both malignant and benign lesions in which single or loosely sparse distributions are more likely to be benign lesions. Relatively accumulated distribution with two or more spot calcifications, combining with gray-scale and color Doppler sonographic features can improve the diagnostic accordance of breast cancer.