乳腺叶状肿瘤的超声表现及病理对照

Ultrasonic features and pathology of phyllodes tumor of breast(PTB):a comparative analysis

目的:通过对乳腺叶状肿瘤(PTB)的超声声像图特征及其病理基础的分析来提高对本病的认识。方法:回顾性分析本院的乳腺叶状肿瘤患者经手术病理证实30例作二维及彩色多普勒血流显像(CDFI)超声的表现与病理结果对照。结果:30例PTE患者中良性18例、交界性7例、恶性5例。二维超声图像PTB表现为明显分叶或浅分叶的肿块20例、呈椭圆形或类圆形10例,具有体积较大、内部回声不均匀而后方回声增强、良性者有包膜边界清而恶性者边界模糊不清等特征。CDFI表现出良性病例血流0～Ⅰ级,恶性病例血流Ⅱ～Ⅲ级、并且阻力指数偏高(RI≥0.75)。PTB病理表现以大量间质异形细胞成分为主并膨胀性生长、变性坏死侵犯包膜等病变,此病理基础与上述声像图特征相对应。结论:超声对PTB的术前诊断、鉴别诊断和术后随访具有一定的临床价值,尤其CDFI显示肿瘤的血供情况能为临床提供重要的诊断依据。

Objective：To investigate the ultrasonographic features as related to pathology of phyllodes tumor of breast （PTB） for a better understanding of this disease. Methods ：The features of 2D ultrasound imaging and color Doppler flow imaging （CDFI） among 30 surgery-confirmed PTB patients in our hospital were retrospectively analyzed and compared with pathological findings. Results： Of the 30 PTB cases, 18 were found with benign,7 cases with borderline and 5 with malignant lesions. The 2D ultrasound imaging showed conspicuous or slight lobulated PTB in 20 cases and ovoid or round-shaped PTB in 10 cases characterized by large-size, heteroechoic mass and back wall enhancement, with clear encapsulation of benign lesions and ill-demarcated malignant lesions. The blood supply as indicated by CDFI was grades 0-I in benign tumors and grades 11- m in malignant tumors （where resistant index was also elevated, ≥0.75 ）. The pathology of PTB was mainly manifested by a large number of interstitial heteromorphic cells with expansive growth, degenerative necrosis and/or capsule invasion. Conclusion：Ultrasonography is of important clinical value in preoperative diagnosis, differential diagnosis and postoperative follow-up of PTB. In particular, the blood supply of indicated by CDFI may provide diagnostic evidence in clinical practice.