乳腺癌多普勒血流频谱特征及与微血管密度和肿块转移的相关性

The characteristics of Doppler flow spectral patterns and microvascular density and metastasis in breast masses

目的探讨乳腺癌多普勒血流频谱特征及其与微血管密度(MVD)和肿块转移的相关性.方法术前1周对144个乳腺良恶性肿块患者的原发灶行彩色多普勒超声扫查,观察肿块多普勒血流频谱特征,并测定血流动力学参数:收缩期血流峰值流速(PV)及加速时间(AT).采用免疫组织化学两步法对获取的乳腺癌标本行免疫组化研究,并检测MVD.结果乳腺癌病变的收缩期血流频谱表现为PV增快、AT缩短及峰值前移;舒张期频谱形态变化较大,根据舒张期流速降幅及持续时间把90例乳腺癌病变的舒张期多普勒血流频谱分为Ⅰ型(30例)、Ⅱ型(20例)、Ⅲ型(17例)、Ⅳ型(23例).4型乳腺癌患者的肿块内MVD呈上升趋势,Ⅲ型和Ⅳ型明显高于Ⅰ型.在转移组和未转移组,4型舒张期多普勒血流频谱类型在构成上存在差异,未转移组以Ⅰ型、Ⅱ型为主,转移组中4型所占比例相似.结论乳腺肿块多普勒血流频谱特征在鉴别乳腺肿块良恶性及判断是否转移有重要意义.

Objective To analyze the characteristics of Doppler flow spectral patterns in differential diagnosis between malignant and benign breast masses and in evaluating the metastasis. Methods One week before surgery 144 women with breast masses were examined with color Doppler ultrasound. The characteristics of Doppler flow spectral patterns were analyzed and the hemodynamic parameters were determined. Results （ 1 ） In malignant masses, peak velocity （PV） of systolic period was quickened and acceleration time （AT） was shortened compared with benign masses. The wave of diastolic period descended quickly or did not appear. The time of diastolic period was shorter than normal. While in benign masses, PV of systolic period was normal and AT was longer than in malignant masses. The wave of diastolic period descended slowly. （2） The Doppler flow spectral patterns in the 90 patients could be divided into 4 types according to diastolic velocity descending range and duration. （3） The 4 types were associated with MVD and tumor metastasis. The MVD in types Ⅲ and Ⅳ was higher than in type Ⅰ. Metastasis was more likely to occur in type Ⅲ. Conclusions The analysis of Doppler flow spectral patterns analysis has clinical significance in differential diagnosis between malignant and benign breast masses and in evaluating the presence or absence of metastasis.