非典型乳腺纤维腺瘤患者自动乳腺容积扫描联合常规超声检查声像图特征与组织病理分型的关系

Relationship of ultrasonographic features of automated breast volume scanner plus conventional ultrasound with histopathological classification of atypical breast fibroadenoma

目的观察非典型乳腺纤维腺瘤患者自动乳腺容积扫描(automated breast volume scanner,ABVS)联合常规超声声像图特征,探讨其与组织病理分型的关系。方法169例乳腺纤维腺瘤患者均行ABVS联合常规超声检查及组织穿刺活检病理检查,观察超声声像图特征。根据组织病理结果分为复杂型组15例和单纯型组154例,比较2组非典型乳腺纤维腺瘤比率及非典型乳腺纤维腺瘤的超声声像图特征。结果169例患者中典型乳腺纤维腺瘤93例,表现为椭圆形,边界清晰,包膜完整,内部回声均匀;非典型乳腺纤维腺瘤76例,表现为形态不规则60例(78.9%),边缘不光整30例(39.5%),微钙化16例(21.1%),方位不平行7例(9.2%),回声不均匀6例(7.9%),后方回声衰减6例(7.9%),血流较丰富5例(6.6%),阻力指数>0.72例(2.6%),汇聚征1例(1.3%)。复杂型组非典型乳腺纤维腺瘤14例,其中乳头状大汗腺化生5例,囊肿3例,上皮钙化4例,硬化性腺病1例,乳头状大汗腺化生+硬化性腺病1例;单纯型组非典型乳腺纤维腺瘤62例;复杂型组非典型乳腺纤维腺瘤比率(93.3%)高于单纯型组(40.3%)(χ^(2)=15.558,P<0.001)。复杂型组非典型乳腺纤维腺瘤内部回声不均质、微小钙化比率(35.7%、42.9%)均高于单纯型组(1.6%、16.1%)(χ^(2)=18.265,P=0.001;χ^(2)=4.909,P=0.027),形态不规则、边缘模糊、边缘小叶、方位不平行、血流较丰富比率(78.6%、28.6%、14.3%、14.3%、14.3%)与单纯型组(56.5%、16.1%、12.9%、8.1%、4.8%)比较差异均无统计学意义(P>0.05)。结论ABVS联合常规超声检查为非典型乳腺纤维腺瘤的声像图特征多表现为形态不规则、边缘不光整及微钙化,汇聚征少见;复杂型非典型乳腺纤维腺瘤超声声像图较单纯型更易表现为内部回声不均质、微小钙化等。

Objective To observe the ultrasonographic features of automated breast volume scanner(ABVS)combined with conventional ultrasound in patients with atypical breast fibroadenoma,and to explore its relationship with histopathological classification.Methods Totally 169patients with breast fibroadenoma underwent ABVS combined with conventional ultrasound and histopathological examination to observe the ultrasonographic features.According to the histopathological results,the patients were divided into complex type group(n=15)and simple type group(n=154).The ratio of atypical breast fibroadenoma and ultrasonographic features of atypical breast fibroadenoma were compared between two groups.Results In 169patients,there were 93cases of typical breast fibroadenoma and 76cases of atypical breast fibroadenoma.The appearance of typical breast fibroadenoma was oval,with clear boundary,complete capsule and uniform internal echo.The atypical breast fibroadenoma showed irregular morphology in 60cases(78.9%),irregular edge in 30cases(39.5%),microcalcification in 16cases(21.1%),non-parallel orientation in 7cases(9.2%),uneven echo in 6cases(7.9%),posterior echo attenuation in 6cases(7.9%),abundant blood flow in 5cases(6.6%),resistance index>0.7in 2cases(2.6%)and convergence sign in 1case(1.3%).In complex type group,there were 14cases of atypical breast fibroadenomas,including 5cases of papillary apocrine metaplasia,3cases of cyst,4cases of epithelial calcification,1case of sclerosing adenopathy,and 1case of papillary apocrine metaplasia plus sclerosing adenopathy.In simple type group,there were 62cases of atypical breast fibroadenoma.The percentage of patients with atypical breast fibroadenoma was higher in complex type group(93.3%)than that in simple type group(40.3%)(χ^(2)=15.558,P<0.001).The internal echo heterogeneity and microcalcification rates of atypical breast fiabrodenoma were higher in complex type group(35.7%,42.9%)than those in simple type group(1.6%,16.1%)(χ^(2)=18.265,P=0.001;χ^(2)=4.909,P=0.027).There were no significant differences in the incidences of irregular shape,fuzzy edge,marginal lobules,non-parallel orientation and rich blood flow between complex type group(78.6%,28.6%,14.3%,14.3%,14.3%)and simple type group(56.5%,16.1%,12.9%,8.1%,4.8%)(P>0.05).Conclusions The ultrasonographic features of atypical breast fibroadenoma by ABVS plus conventional ultrasound are irregular shape,irregular edge and microcalcification,and convergence sign is rare.Complex atypical breast fibroadenoma is more likely to show internal echo heterogeneity and microcalcification than simple type.