乳腺硬化性腺病的影像表现及病理分析

The study of the imaging features and pathological of breast sclerosing adenosis

目的分析乳腺硬化性腺病(sclerosing adenosis,SA)的X线、超声及磁共振成像(magnetic resonance imaging,MRI)表现,结合病理结果,探讨影像检查术前诊断硬化性腺病的价值。材料与方法回顾分析41例(43个病灶)病理证实为乳腺硬化性腺病的X线、超声、MRI表现,与病理结果对照,并进行乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)分类,以BI-RADS分类≥4B诊断为恶性,计算误诊率和准确率。结果 43个硬化性腺病病灶中,29例单纯硬化性腺病,5例伴大汗腺化生,4例伴纤维腺瘤,4例伴导管内乳头状瘤,1例伴灶状钙化。(1)X线表现:39例SA患者X线钼靶检查表现为不规则结节(23.1%)、不对称致密(20.5%)、结构扭曲(20.5%)、肿块合并钙化(20.5%)、单纯钙化(7.7%),其中3例未见异常。(2)超声表现:38例患者超声检查,35例为结节,3例未见异常。大多病灶呈低回声(92.1%),无或少量点线状血流信号(92.1%),回声不均匀(71.1%),边界清晰(76.3%)。(3)MRI表现:29例患者MRI检查,65.5%(19/29)呈不均匀长T2WI信号;所有病灶均有强化;37.9%(11/29)病灶呈条片状、区域性强化,62.1%(18/29)呈肿块样强化,其中7例病灶伴有星芒状改变;病灶时间信号曲线(time intensity curve,TIC)Ⅰ型11例,Ⅱ型16例,Ⅲ型2例;扩散加权成像(diffusion weighted imaging,DWI)序列13例呈等信号,16例呈稍高信号。根据BI-RADS分类,乳腺X线摄影、超声及MRI诊断SA的误诊率分别为19.4%(10/39)、17.1%(6/35)和17.2%(5/29),3种检查结合,术前诊断准确率为93.1%(27/29)。结论乳腺硬化性腺病在X线摄影多为不规则结节、钙化,超声多为回声不均匀的无或少血流信号的低回声结节,MRI多T2序列信号不均匀,增强扫描为界限不清的团片状或星芒状小肿块。病变形态、增强扫描时间信号曲线及DWI图像对鉴别病变良、恶性有较大参考价值。3种检查结合,有助于提高SA术前诊断准确率。

Objective： To analyze the imaging features of breast sclerosing adenosis （SA） in mammography, ultrasound and MRI, and to explore their diagnostic values in preoperative examination. Materials and Methods： Imaging fndings in 41 women （43 cases） with SA lesions confirmed by pathology were retrospectively reviewed （including 39 cases of mammography, 38 cases of ultrasound and 29 cases of MRI）, imaging features of the disease were observed, and staged according to the breast imaging reporting and data system （BI-RADS）. Malignancy were defined as BI-RADS≥4B, and misdiagnosis rates were calculated. Results： In the 43 SA lesions, 29 were simple SA lesions, and additional apocrine metaplasia, fibroadenoma, intraductal papilloma and focal calcifcations were observed in 5, 4, 4 and 1 lesions, retrospectively. （1） Mammography findings： 39 women included irregular nodules （23.1%）, asymmetric density （20.5%）, structural distortions （20.5%）, calcifed masses （20.5%） and simple calcifcations （7.7%）, and no abnormal fnding was observed in three cases. （2） 38 patients were examined by ultrasound, 35 were nodules, and 3 had no abnormalities. Most of the lesions were hypoechoic （92.1%）, no or a small number of linear blood flow signals （92.1%）, the echo was uneven （71.1%）, and the boundary was clear （76.3%）. （3） 29 patients with SA undergoing MRI, 65.5% were inhomogeneous long T2WI signal; All lesions showed marked enhancement, including 37.9% lesions showed irregular patchy or regional enhancement, 62.1% lesions with mass-like enhancement enhanced （7 star-shaped masses included）. For the time intensity curve （TIC）, 11 cases were typeⅠ, 16 cases typeⅡ, and 2 cases type Ⅲ, DWI lesions showed slightly higher signal in 16 casea. The misdiagnosis rates of mammography, ultrasound and MRI were 19.4% （10/39）, 17.1% （6/35） and 17.2% （5/29）, respectively. Combined these three methods, the accuracy were 93.1%. Conclusions： The majority of SA lesions showed nodules or calcifcation in mammography, ultrasound showed uneven hypoechoic nodules with less or no blood fow, the MRI showed inhomogeneous long T2WI signal, star-shaped mass-like lesions on enhanced. Morphology, time intensity curve and DWI image of lesions may show great value in identifcation of benign and malignant lesions. Combined these three methods, the diagnostic accuracy of SA can be improved.