超声引导经皮微波消融治疗乳腺良性结节

Ultrasound-guided percutaneous microwave ablation therapy for breast benign nodules

目的探讨超声引导经皮微波消融（MWA）治疗乳腺良性结节的可行性和疗效。方法选择经超声引导穿刺活检病理证实的109例共207个乳腺良性结节。MWA治疗前分别行超声和（或）MR检查,后行超声引导经皮MWA治疗,消融后超声和（或）MRI显像判断治疗效果。结果消融治疗后1h结节最大径及体积增大,治疗后1、3、6及12个月后结节逐渐缩小。消融治疗前,灰阶超声显示结节呈均匀低回声,边界清楚;CDFI显示结节内血流信号为0～Ⅱ占93.24%（193/207）;超声弹性成像评分为1～2分占87.92%（182/207）;CEUS和（或）MR增强扫描显示结节内均有不同程度增强。消融治疗后,灰阶超声显示原结节区域呈不均匀高回声,边界不清;治疗后1、3、6及12个月,超声检查显示结节边界逐渐清晰,回声较治疗前轻度增强;CDFI显示血流分级为0级占89.85%（186/207）;消融治疗后1h,超声弹性成像显示结节硬度较治疗前均有所增加;治疗后1、3、6及12个月复查,结节硬度逐渐下降;CEUS和（或）增强MRI显示结节完全消融或大部分消融且消融后可见消融灶周边环状水肿带。穿刺活检见消融区呈凝固样坏死改变。结论超声引导经皮MWA治疗乳腺良性结节创伤小、恢复快、无瘢痕,具有患者易耐受、可门诊治疗等优势,是治疗乳腺良性结节安全、有效、可行的新方法。

Objective To discuss the feasibility and efficacy of ultrasound-guided percutaneous microwave ablation （MWA） for breast benign nodules. Methods Totally 109 patients with 207 benign breast nodules which was confirmed by pathology were enrolled. Ultrasound and （or） MRI were performed before and after MWA therapy. All patients underwent ultrasound-guided MWA, ultrasound and （or） MRI imaging evaluated the treatment effect after ablation. Results The size and volume of the nodules increased 1 h after MWA, which gradually decreased 1, 3, 6 and 12 months after MWA. Before MWA, nodules were all hypoechoic with clearly boundary on gray-scale ultrasound; CDFI presented the nodules with grade 0 Ⅱblood flow accounted for 93.24% （193/207）. Ultrasonic elastography （UE） presented the nodules with elastic score 1-2 accounted for 87.92% （182/207）. All nodules presented enhancement partly on both CEUS and （or） enhanced MRI. After MWA, therapic region of the nodules were hyperechoic with blur boundary, which became clearly 1, 3, 6 and 12 months after therapy. CDFI presented the nodules with grade 0 blood flow accounted for 89.85% （186/207）. The stiffness of nodules increased 1 h after MWA therapy on UE, which gradually decreased 1, 3, 6 and 12 months after MWA. Mostly nodules presented a area of edema beside the nodules on CEUS and （or） enhanced MRI. Internal region of the nodule was presented coagulative necrosis on pathology after MWA. Conclusion Ultrasound-guided percutaneous MWA for breast be- nign nodules is a new, secure and feasible method, which have many advantages, such as micro-invasion, quickly cure, clinical treatment, etc.