被超声误诊的乳腺黏液癌的声像图特征及误诊原因分析

Analysis of the sonographic features of misdiagnosed mucinous breast carcinomas and its misdiagnosis causes

目的分析乳腺黏液癌(MBC)超声误诊的原因,以期降低误诊率。方法收集2014年1月至2017年9月在该院经病理确诊的117例MBC患者,依据超声检查结果分为诊断正确组(n=101)和误诊组(n=16),比较两组的超声图像特征及临床病理特征,分析误诊的原因。结果与诊断正确组比较,误诊组具有边界清楚(93.7%vs.21.8%)、形态规整(87.5%vs.10.9%)、不易出现微钙化(6.3%vs.49.5%)、后方回声增强(75.0%vs.37.6%)、不易出现周边组织浸润(25.0%vs.78.2%)、患者较年轻[大于35岁比例:68.8%vs.92.1%]、以单纯型为主(68.8%vs.40.6%)、病灶较小(肿瘤直径大于2 cm比例:37.5%vs.74.3%)、肿块柔软(31.3%vs.3.0%)、临床分期较早等特征。结论病灶较小(<2 cm)、患者较年轻(<35岁)及病灶超声图像缺乏恶性特征是MBC误诊的主要原因,后方回声增强是被误诊的MBC相对特异性的超声表现。

Objective To analyze the causes of misdiagnosis of mucinous breast carcinoma(MBC),in order to reduce the misdiagnosis rate.Methods A total of 117 cases of patients who were pathologically diagnosed with MBC in this hospital from January 2014 to September 2017 were collected and divided into the correctly diagnosis group(n=101)and the misdiagnosed group(n=16)according to the ultrasound examination results.The ultrasound image characteristics and clinicopathological characteristics of the two groups were compared,and the causes of misdiagnosis were analyzed.Results Compared with the correctly diagnosed group,the misdiagnosed group had clear boundaries(93.7%vs.21.8%),regular morphology(87.5%vs.10.9%),less microcalcification(6.3%vs.49.5%),posterior enhanced echogenicity(75.0%vs.37.6%),less invasive growth(25.0%vs.78.2%),more younger patients(the proportion of patients over 35 years old:68.8%vs.40.6%),more pure mucinous breast carcinomas(68.8%vs.40.6%),smaller lesions(the proportion of lesions larger than 2 cm:37.5%vs.74.3%),more soft lesions(31.3%vs.3.0%),earlier clinical staging and other characteristics.Conclusion Small lesions(<2 cm),young(<35 years old)and lack of malignant features of the ultrasound images are main causes of misdiagnosis for MBC.Posterior echo enhancement is a relatively specific ultrasonography manifestation of misdiagnosed MBC.