自动乳腺全容积成像在非肿块型乳腺癌中的应用价值

Value of automated breast volume scanner in non-mass-like breast carcinoma

目的探讨非肿块型乳腺癌的自动乳腺全容积成像（ABVS）表现。方法回顾性分析49例经手术病理证实的非肿块型乳腺癌，分析病灶的内部回声特点、有无钙化、冠状面特征及周边改变情况，并参照乳腺影像报告和数据系统（BI—RADS）进行评估分类。结果49例非肿块型乳腺癌中，导管原位癌27例（55．10％），浸润性导管癌21例（42．86％），浸润性小叶癌1例（2．04％）。ABVS影像表现：伴或不伴增厚的片状低回声区43例（87．76％），散在或簇状分布的微钙化41例（83．67％），冠状面呈“汇聚征”6例（12．24％），1例（2．04％）有皮肤增厚、皮下水肿。导管原位癌与浸润性导管癌相比较：导管原位癌内微钙化的检出率略高（85．19％对80．95％，P=0．715），冠状面呈“汇聚征”则以浸润性导管癌出现率高（19．05％对7．41％，P=0．383），但差异均无统计学意义（P〉0．05）。BI-RADS-ABVS分类，44例术前BI—RADS分级为4a～5级，5例术前诊断为0～2级，诊断符合率89．80％。结论非肿块型乳腺癌的ABVS影像表现有一定的特点，片状低回声区、微钙化、冠状面“汇聚征”等均是非肿块型乳腺癌的重要征象，注重非肿块型乳腺癌这些征象的观察和分析，可以提高检出率和减少漏诊率。

Objective To analyze sonographic characteristics of the automated breast volume scanner （ABVS） in non-mass-like breast carcinoma.Methods 49 patients with non-mass-like breast carcinoma were confirmed by pathology after operation.All of the patients underwent ABVS,the sonographic characteristics of internal echo and microcalcifications in the lesions, the retraction phenomenon in coronal plane and surrounding change were analyzed.All the lesions were assessed by breast imaging reporting and data system （BI-RADS）.Results In 49 patients with non-mass-like breast carcinoma, 27（55.10%） cases were ductal carcinoma in situ,21（42.86%） cases were infitrating ductal carcinoma,and 1 （2.04%） case were infitrating lobular carcinoma.The findings of ABVS： 43 （87.76%） lesions appeared as segmental hypoechoic areas, 41 （83.67 % ） lesions appeared as scattered or clustered microcalcifications, 6 （ 12.24 % ） lesions appeared as the retraction phenomenon in coronal plane, and 1 （2.04%） lesion appeared as pachyderma and subcutaneous dropsy.Microcalcifications in ductal carcinoma in situ appeared more than that in infitrating ductal carcinoma （85.19 % vs 80.95 %, P = 0.715） ;the retraction phenomenon in coronal plane of infitrating duetal carcinoma were higher than that of ductal carcinoma in situ（19.05% vs 7.41%, P = 0.383）, but there were no significant difference in those between ductal carcinoma in situ with infitrating ductal carcinoma（ P 〉0.05）. All the cases were assessed according to BI-RADS,including 4a - 5 category 44 cases,0 - 2 category 5 cases. The coincidence rate in diagnosis of ABVS were 89.80%.Conclusions The ABVS features of non-mass-like breast carcinoma are characteristic. Segmental hypoechoic areas, microcalcifications and the retraction phenomenon in coronal plane are important for the diagnosis of non-mass-like breast carcinoma, ABVS can improve the detect ability and decrease the missed diagnosis of non-mass-like breast carcinoma.