高频彩色多普勒超声对乳腺黏液腺癌不同病理亚型的作用研究

Analysis of the ultrasound characteristics of different subtypes of mucinous breast carcinoma

目的回顾性分析不同病理类型乳腺黏液腺癌的超声声像图特征,从而提高术前乳腺黏液腺癌不同亚型的超声诊断准确率。方法分析43名患者共44例手术切除或穿刺活检证实为乳腺黏液腺癌病灶的声像图资料,包括病灶的边界、边缘、形态、回声类型、生长方向、钙化、后方回声、血流分级、腋窝淋巴结形态,并对病灶进行BI-RADS分类。将超声声像图特征与手术或活检后病理结果进行对比,总结出不同亚型的乳腺黏液腺癌的超声声像图特征。结果 44例乳腺黏液腺癌病理类型分为21例单纯型黏液腺癌和23例混合型黏液腺癌,混合型黏液腺癌大多数表现为病灶边界不清(73.9%)、边缘模糊毛刺(73.9%)、形状不规则(91.3%)、以及内部回声不均匀(87%)、病灶内钙化更多见(52.2%)。混合型黏液腺癌的淋巴结转移率明显高于单纯型黏液腺癌(P<0.05)。对比术前病灶的BI-RADS分类及术后病理诊断,超声对恶性病灶诊断准确率68%,单纯型黏液腺癌和混合型黏液腺癌的诊断准确率分别为48.6%、87%。结论不同病理类型乳腺黏液腺癌间具有一些不同的声像图特征。混合型黏液腺癌大多数表现为病灶边界不清、边缘模糊毛刺、形状不规则、回声不均匀、病灶内钙化多见;单纯型乳腺黏液腺癌通常表现为边界清晰、形态规则、钙化少见、淋巴结转移少等良性肿块声像特征,超声对其误诊率较高,需提高警惕。

Objective Retrospectively evaluate the sonographic features of different types of mucinous breast carcinoma to improve the preoperative ultrasound diagnostic accuracy rate. Methods Sonographic features of 44 cases of MBC proven by pathological biopsy were analyzed,including the margin,lesion boundary,shape,echo pattern,lesion growth pattern,calcification,posterior acoustic feature,blood flow,lymph node form and data system（BI-RADS） classification for the lesion to sum up the different subtypes of breast ultrasonic ultrasonographic features of mucinous carcinoma. Results21 cases of pure mucinous carcinoma（PMBC） and 23 cases of mixed mucinous carcinoma（MMBC） were founded. MMBC were more likely to have unclear boundary（73. 9%）, indistinct or spiculate of margin（73. 9%）, irregular shape（91. 3%）,heterogeneous internal echo（87%）,more calcification in lesions（52. 2%）. Lymph node metastasis in MMBC was obviously higher than that of PMBC（P〈0. 05）. Compared with preoperative of the BI-RADS classification and pathological diagnosis,ultrasonography in diagnosing accuracy rate was 68% in malignant lesions,48. 6% in PMBC and 87% in MMBC. Conclusion There are some different ultrasonographic characteristics in different types of breast mucinous carcinoma. MMBC are more likely to have unclear boundary,indistinct or spiculate of margin,irregular shape,more calcification in lesions. On the contrary,PMBC has a circumscribed boundary,abrupt interface edge,rare calcification,rare lymph node metastasis and are easily misdiagnosed as benign lesions. We should pay more attention to avoid misdiagnosis in ultrasonography.