乳腺叶状肿瘤X射线表现与临床及病理对照分析

Comparative Analysis of Mammographic Findings and Pathological Features of Phyllodes Tumor of Breast

目的探讨乳腺叶状肿瘤X射线表现与其临床及病理改变的相关性,以确定其不同特征及其病理组织学基础,达到提高临床诊断率及指导治疗的目的。方法分析我院2010年1月至2013年1月期间经手术病理证实的28例乳腺叶状肿瘤患者的临床及X射线影像学资料,观察其影像表现并与病理结果进行对照分析。结果 28例乳腺叶状肿瘤中,良性17例,交界性8例,恶性3例。X射线摄片显示瘤体26例,另外2例仅显示单侧乳腺非对称致密影,其中23例均归为BI-RADS 4类或4类以上。肿瘤直径约2.8～10.2 cm。以3 cm为界,肿瘤直径≥3 cm者与<3 cm者相比,出现良性与非良性叶状肿瘤(交界性及恶性)的概率差异无统计学意义(Ρ>0.05)。良性和非良性叶状肿瘤的分叶状况差异也无统计学意义(Ρ>0.05),然而非良性叶状肿瘤多表现为边界模糊肿块(Ρ<0.05)。2例良性叶状肿瘤见异常血管,1例良性叶状肿瘤见钙化,良性叶状肿瘤(8/17)和非良性叶状肿瘤(2/11)出现"透明晕"征象比较差异无统计学意义(Ρ>0.05)。结论乳腺叶状肿瘤的一些典型X射线表现结合临床改变有利于早期发现病变,但良性与非良性叶状肿瘤的影像学表现无明显差异,该病的确认及组织学分型必须依靠病理学检查。

Objective To investigate the mammographic appearance of breast phyllodes tumors and the relationship of mammographic appearance to clinicopathologic features,and to determine the differential characteristics and pathologic basis.Methods The clinical and imaging findings of 28 patients with surgically confirmed phyllodes tumors from January 2010 to January 2013 were analyzed retrospectively.The radiological features were compared with pathology.Results Seventeen benign,8 intermediate,and 3 malignant phyllodes tumors were identified by the histopathologic review.Mammography demonstrated the tumors as a mass lesion in 26 cases and asymmetric opacity in 2 cases.The tumors were 2.8-10.2 cm in diameter.The difference of rate of intermediate and malignant phyllodes tumors and benign phyllodes tumors was not statistically significant between ≥3 cm and 3 cm in diameter（Ρ0.05）.Although all the tumors showed lobulated margins except for 4 cases in the benign phyllodes tumors,it was not a significant finding（Ρ0.05）.However,poorly defined borders in the malignant and intermediate phyllodes tumors were more frequent than those in the benign phyllodes tumors（Ρ0.05）.Abnormal blood vessels were seen in 2 cases of benign phyllodes tumors and calcification was seen in 1 case of benign phyllodes tumors,while 10 tumors were surrounded by a clear halo,of them 8 were the benign phyllodes tumors and 2 were the intermediate and malignant phyllodes tumors（Ρ 0.05）.Conclusions Mammographic features combined with clinical behavior can be helpful for early detection,but definite diagnosis and classification should be verified by histopathologic examination.