乳腺纤维囊性变的超声表现特征探讨

The ultrasonographic characteristics of fibrocystic breast change

目的探讨乳腺纤维囊性变(fibrocystic breast change , FBC)的超声表现特征,提高FBC的超声诊断与鉴别诊断水平.方法收集2014年1月至2019年2月在福建医科大学附属协和医院就诊,并经术后病理证实为的55例FBC患者(60个病灶)与39例乳腺浸润性导管癌(invasive ductal carcinoma , IDC)患者(42个病灶)的声像图特征进行对比观察.结果 FBC组与IDC组病灶超声表现为形态不规则者分别为86 .7%与88 .1%,两者差异无统计学意义( P >0 .05),但 FBC组肿块边缘呈"蟹足"或"毛刺"的显示率较低( P <0 .05 ). FBC组后方回声增强与囊性变的出现率分别为 81 .7%与71 .7%,均明显高于IDC组的38 .1%与16 .7%,两者差异均有统计学意义(P<0 .001).此外, FBC组还表现为极少出现高回声晕及乏血供等特征(均 P <0 .001).结论乳腺纤维囊性变超声常表现为不规则,甚至出现"蟹足"、"毛刺"等,易误诊为恶性肿块,但病灶后方回声多呈增强、内部可见小囊腔、乏血供和极少见高回声晕等可能是其特征性表现,可与恶性肿块鉴别,值得深入探讨.

Objective To investigate the ultrasonographic features of fibrocystic breast change (FBC) and improve the ultrasonographic diagnosis and differential diagnosis of FBC. Methods Fifty-five patients of FBC with 60 lesions and 39 patients of invasive ductal carcinoma (IDC) with 42 lesions, which were confirmed by pathology after operation in the Affiliated Union Hospital of Fujian Medical University from January 2014 to February 2019 were enrolled. The preoperative sonographic findings of FBC and IDC were retrospectively analyzed and compared. Results There was no significant difference between the two groups in the rates of showing irregular shape, which were 86.7% in FBC group and 88.1% in IDC group, respectively (P>0.05), but the rate of showing crab feet or burrs on the edge of lesions in FBC group was lower than that in IDC group(P<0.05). The occurrence rates of posterior echo enhancement and cystic degeneration in FBC group were 81.7% and 71.7% respectively, which were significantly higher than those in IDC group (38.1% and 16.7%)(P<0.001). In addition, the FBC group showed fewer features such as hyperechoic halo and more features such as hypovascular supply than that of IDC group (all P<0.001). Conclusions In terms of ultrasonic features, including irregular shape or even crab feet and burrs, FBC can be easily misdiagnosed as malignant tumors. However, posterior echo enhancement, interior scattered small cysts, lack of blood supply and rare hyperechoic halo may be the characteristics of FBC, which can be differentiated from malignant tumors.