高频超声及实时剪切波弹性成像对男性乳腺良恶性疾病的诊断价值

Diagnostic value of high frequency ultrasound and real-time shear wave elastography in differentiation of benign and malignant male breast diseases

目的探讨高频超声和实时剪切波弹性成像(SWE)在男性乳腺良恶性疾病中的应用价值。方法选择175例经病理诊断的男性乳腺肿块患者,年龄12~86岁,平均年龄41.71岁。根据病理诊断结果分为恶性组和良性组,恶性组36例,良性组139例。全部患者行乳腺高频超声检查,记录并对比二者临床特点(包括年龄、病灶位置、触痛、血性溢液、非血性溢液)和超声征象(包括肿块最大切面长径、形态、回声模式、边缘、内部微钙化、声晕、后方回声特点、方位、血流分级和弹性成像情况)。结果恶性组以高龄[(63.52±14.19)岁vs(34.80±16.69)岁]、血性溢液(5.56%vs 0.00%)多见(P<0.05),良性组多为双侧(53.96%vs 0.00%)和触痛性肿块(44.60%vs 2.78%)(P<0.001)。高频超声检查结果显示,与良性乳腺肿块相比,形态不规则(66.20%vs 86.48%)、边缘不光整(67.13%vs 91.89%)、非平行位(28.71%vs75.67%)、回声晕(10.65%vs 27.03%)、微钙化(0.00%vs 24.33%)、血流信号丰富(12.50%vs 80.19%)多为恶性(P<0.05)。最大切面长径、回声模式和后方回声特点在良恶性组中差异无统计学意义(P>0.05)。SWE结果显示,恶性组最大杨氏模量值(Emax)和平均杨氏模量值(Emean)均高于良性组[(178.96±75.35)kPa vs(27.36±18.95)kPa、(125.04±84.21)kPa vs(18.47±13.03)kPa。P<0.001]。结论高频超声及SWE对于男性乳腺疾病良恶性的鉴别具有一定的临床诊断价值。

Objective To explore the application value of high-frequency ultrasound and real-time shear wave elastography(SWE)in diagnosing male benign and malignant breast diseases.Methods A total of 175 male breast masses diagnosed by pathology were enrolled,which aged 12-86 years old with mean age of 41.71 years old.According to pathological results,all of them were divided into malignant group(n=36)and benign group(n=139).All of them underwent breast ultrasound examination,and the clinical features(age,lesion location,tenderness,bloody or non-bloody effusion)and ultrasound signs(largest section of mass,shape,echo pattern,margin,internal microcalcification,acoustic halo,rear echo characteristics,orientation,blood flow classification and elastography)were recorded and compared.Results There was more senility[(63.52±14.19)years old vs(34.80±16.69)years old],nipple hemorrhage(5.56%vs 0.00%)(P<0.05)in malignant group than in benign group,and more bilateral(53.96%vs 0.00%)and tender mass(44.60%vs 2.78%)(P<0.001)in benign group than in malignant group.The results of high-frequency ultrasound examination showed that compared with benign breast masses,the malignant morphology was significantly irregular(66.20%vs 86.48%),with more uneven edge(67.13%vs 91.89%),non-parallel position(28.71%vs 75.67%),echo halo(10.65%vs 27.03%),microcalcification(0.00%vs 24.33%),and abundant blood flow signals(12.50%vs 80.19%)(P<0.05).There was no significant difference in characteristics of the maximum section length,echo pattern,and rear echo between benign group and malignant group(P>0.05).The results of SWE showed that the maximum Young’s modulus(Emax)and mean Young’s modulus(Emean)in malignant group were significantly higher than those in benign group[(178.96±75.35)kPa vs(27.36±18.95)kPa,(125.04±84.21)kPa vs(18.47±13.03)kPa](P<0.001).Conclusion It is demonstrated that high-frequency ultrasound and SWE showed certain clinical differential diagnosis and treatment value for benign and malignant male breast diseases.