乳腺黏液腺癌超声误诊原因分析

Causes of Misdiagnosis of Mucinous Breast Carcinoma by Ultrasound

目的分析乳腺黏液腺癌(mucinous breast carcinoma,MBC)的超声表现特点、误诊原因及防范措施,以降低MBC误诊率。方法对超声检查曾误诊的MBC 11例的临床资料进行回顾性分析。结果 11例均为女性,7例因乳房肿块就诊,2例因乳头溢液就诊,2例因单位体检X线钼靶可见乳房组织有钙化病灶就诊。入院后经超声检查误诊为乳腺纤维腺瘤5例,良性叶状肿瘤2例,浸润性导管癌4例。11例均行手术治疗,术后病理检查确诊为单纯型MBC 7例,混合型MBC 4例。7例单纯型MBC于超声引导下行微创立体旋切术,术后6个月随访,超声检查均示乳腺局部结构未见明显异常,且无复发。4例混合型MBC均行改良根治术,术中常规清扫腋窝淋巴结,1例术后8个月时复查超声见胸壁局部复发伴骨转移,转至外院接受125I粒子放射性治疗;3例分别于术后6、9和7个月时复查超声示单纯局部复发,均再次行淋巴结清扫术,并接受中医辅助治疗,治疗2个月后复查超声未出现复发病灶。结论超声检查作为物理诊断方法,在MBC临床诊断及病理分型中具有一定局限性。临床医师应结合疾病本身特征对MBC进行综合评价,以与易混淆乳腺良恶性病变进行鉴别,减少误诊误治。

Objective To analyze the ultrasonic manifestations,misdiagnosis causes and preventive measures of mucinous breast carcinoma(MBC)so as to reduce the misdiagnosis rate of MBC.Methods The clinical data of 11 cases of MBC misdiagnosed by ultrasound were retrospectively analyzed.Results Eleven patients were female,including 7 with breast lumps,2 with visible breast calcification by mammography and 2 with breast galactorrhea.After admission,5 cases were misdiagnosed with breast fibroadenoma,2 with benign lobular tumor and 4 with invasive ductal carcinoma by ultrasound.All 11 patients underwent surgery and postoperative pathological examination confirmed 7 cases of simple MBC and 4 cases of mixed MBC.Seven patients with simple MBC received minimally invasive rotary varicotomy guided by ultrasound,and after 6 months of follow-up,ultrasound showed excellent outcome,Ultrasound examination showed no obvious structural abnormality in breast lesions and no recurrence.Four patients with mixed MBC were given the modified radical operation,and axillary lymph nodes were routinely removed during operation.One patient was found to have local recurrence of chest wall and bone metastasis at 8 months after operation,and was transferred to another hospital for 125 I-particle radiotherapy.Three patients were found to have simple local recurrence by ultrasound at 6,9 and 7 months after operation,respectively,.They underwent lymph node dissection again,and received TCM adjuvant treatment in our hospital.There was no recurrence of the lesion by ultrasound after 2 months of treatment.Conclusion Ultrasound,as a method of physical diagnosis,has certain limitations in the clinical diagnosis and pathological classification of MBC.Therefore,clinicians should make a comprehensive evaluation of MBC in combination with the features of the disease,so as to distinguish it from benign and malignant breast lesions,thus reducing misdiagnosis and mistreatment.