超声分级为BI-RADS 4a乳腺疾病超声特点及病理诊断

Ultrasonographic features and pathological diagnosis of breast disease with ultrasound classification as BI-RADS 4a

目的分析超声BI-RADS分级为4a的乳腺疾病的临床资料、超声图像及病理诊断,归纳该分级的疾病谱及声像图特征,总结该分级下乳腺疾病的检出情况。方法回顾性分析82例乳腺疾病患者在无锡市第四人民医院就诊且手术,在该院术前B超BI-RADS分级为4a的各类乳腺疾病的临床、影像学及病理学资料。结果82例B超分级为BI-RADS 4a的乳腺疾病患者术后病理有48例良性疾病,占58.5%,有34例恶性疾病,占41.4%。良性疾病中,纤维腺瘤最常见,恶性疾病中,浸润性导管癌最常见。82例患者中,肿瘤性疾病68例,占82.9%,炎症性疾病6例,占7.3%,余8例为腺病。结论乳腺超声为BI-RADS 4a级包括疾病谱很广,以良性为主,也包含一部分恶性征象不典型的恶性疾病。在临床工作中,超声科医生需认真判断乳腺病灶的超声特点,灵活调节探头频率和增益,尽量给出正确的分级和可能的疾病判断。临床医生需理解并掌握乳腺超声的声像图特征,结合临床表现及其他辅助检查结果,给出合适的诊疗方案,尽量减少漏诊率和误诊率。

Objective To summarize the characteristics of BI-RADS 4a breast diseases under ultrasonic examination referring to patients’ clinical data and pathological reports. Methods 82 patients who were firstly-diagnosed and treated in the Affiliated Hospital of Jiangnan University were included. The ultrasonograms were retrospectively reviewed along with the correlated pathological and clinical findings. Results 48 (58.5%) cases were benign, among which fibroadenoma was the most common. 34 cases (41.4%) were malignant, among which invasive ductal carcinoma was the most common. 68 of the 82 cases were neoplastic disease (82.9%), 6 (9.8%) were inflammatory disease, and 8 (7.3%) were adenosis. Conclusions The patients who are graded BI-RADS 4a by ultrasonic examination may have completely different diseases. Beyond the most common benign diseases, few of them are malignancies with atypical, even ambiguous sonographic features. Therefore, in clinical practice, sonologists should set appropriate parameters of ultrasonic devices appropriately, and evaluate the sonographic features carefully, in order to make the correct grading and diagnosis. While for clinicians, it is necessary to learn to read the ultrasonographic features along with patients’ manifestations, and finally reduce the misdiagosis and missed diagnosis of such diseases.