三维超声成像在良恶性乳腺肿块鉴别诊断的价值

The value of three-dimensional ultrasonography in differential diagnosis of breast tumors

目的研究三维超声在二维彩色超声和X线钼靶照像(简称钼靶)诊断不同的乳腺疑难肿块中的鉴别诊断价值。方法对我院二维彩色超声和钼靶定性不同的35个乳腺肿块,研究其三维超声成像的特点,并与手术、病理结果进行对照分析。结果乳腺肿块超声和钼靶检查经手术病理确诊的148个肿块中,两种方法定性不同的35个肿块占23.6%,钼靶误诊17个肿块,误诊率为11.5%;二维彩色超声误诊18个肿块,误诊率为12.2%(与乳腺纤维囊性增生症患者混淆的15例,占83.3%),通过三维超声灰阶表现汇聚征和冠状切面来判断其良恶性,误诊率降低为2.7%(4/148)。结论三维容积超声成像可观察到二维超声所不能显示的冠状切面,更直观、更形象地获得肿块立体形态及与周围组织的关系,提高了彩色超声对乳腺纤维囊性增生症的良恶性鉴别诊断的正确性,但对无症状的乳腺慢性炎症和常规超声漏诊病例尚需造影等进一步检查。

Objective To investigate the value of three-dimensional ultrasound in the differential diagnosis of breast tumors which are difficult to diagnose after examination of two-dimension color Doppler ultrasound and mammography. Methods Thirty-five breast tumors with different qualitative analysis after examination of two-dimensional color Doppler ultrasound and mammography were referred for the investigation of three-dimensional ultrasonical characteristics, and compared with surgical and pathological results. Results The results of breast tumor ultrasound and mammography confirmed by surgery and pathology of 148 lesions, thirty-five lesions about 23.6% were proved to be different in qualitative analysis using the examination of two-dimensional color Doppler ultrasound and mammography. Seventeen lesions examined by Molybdenum palladium were proved to be misdiagnosed, the rate was 11.5%. Eighteen lesions examined by two-dimensional color Doppler ultrasound were proved to be misdiagnosed, the rate was 12.2% （ 15/18 about 83.3% confused with mammary dysplasia）. The misdiagnosis rate decreased to 2.7% through the convergence of three-dimensional gray-scale performance and integrity of the interface levy to estimate benign or malignant tumor. Conclusion Three-dimensional volume image could observe the coronal section which could not be shown in two-dimensional ultrasound, the image of three-dimensional about lesion morphology and the relationship with the surrounding tissue. The correctness of differential diagnosis of two-dimensional color Doppler ultrasound images of the mammary dysplasia was improved. However, asymptomatic chronic inflam- matory and some missed cases still need further examination by ultrasonic angiography. More than ten years after presentation of three-dimensional imaging, due to the rapid improvement about computer technology and ultrasound imaging, the paper is used to advance three-dimensional volume imaging to scan the breast tumors which are difficult to diagnose, and investigate the value of three-dimensional ultrasound in differential diagnosis of breast tumors.