超聲對乳腺葉狀腫瘤與纖維腺瘤鑒別診斷的價值

Value of sonography in the differential diagnosis of phyllodes tumors and fibroadenomas of the breast

目的回顧性分析乳腺葉狀腫瘤(phyllodes tumors,PT)和纖維腺瘤(breast fibroadenoma,BF)的聲像圖特徵,評價超聲在其鑒別診斷中的價值。方法回顧性分析中國澳門鏡湖醫院2009年~2020年間經病理診斷為葉狀腫瘤和纖維腺瘤患者的超聲圖像特徵及病理資料。結果40例均經手術病理證實為乳腺葉狀腫瘤,其中病理診斷為良性29例(72.5%)、交界性9例(22.5%)、惡性2例(5.0%),術前超聲波診斷葉狀腫瘤共6例,診斷準確15%,術前誤診為纖維腺瘤共25例(62.5%),9例診斷為惡性腫瘤。另81例經手術病理證實的纖維腺瘤中,術前診斷纖維腺瘤共65例,診斷準確80.2%。良性葉狀腫瘤與纖維腺瘤超聲表現上僅病變大小具有統計學差異(P<0.05),而非良性葉狀腫瘤與纖維腺瘤超聲表現上腫塊的形態、大小、邊界、内部見鈣化等具有統計學差異(P<0.05)。結論超聲鑒別乳腺葉狀腫瘤和纖維腺瘤有一定的困難,熟悉其聲像圖特徵可以提高超聲診斷的正確率,對腫瘤的鑒別診斷也有一定的價值。

Objective This was a retrospective analysis of sonographic characteristics to evaluate the value of sonography in the differential diagnosis of phyllodes tumors(PT)and breast fibroadenomas(BF).Methods The sonographic characteristics of PT patients and BF patients confirmed by histopathology at Kiang Wu Hospital from 2009 to 2020 were retrospectively studied.Results Pathological analysis revealed that of the 40 PT patients,29(72.5%)were benign PT,9(22.5%)were borderline PT,and 2(5.0%)were malignant PT.The accuracy rate of diagnosis was 15%.Twenty-five patients(62.5%)were misdiagnosed with BF.In addition,81 cases of BF were confirmed by postoperative pathology,65 cases were diagnosed preoperatively,and the accuracy rate of diagnosis was 80.2%.The ultrasonic images of benign PTs and BFs showed significant differences only in lesion size(P<0.05),while nonbenign PTs and BFs showed significant differences in shape,size,boundary,internal cystic degeneration and calcification(P<0.05).Conclusion It was difficult to distinguish between PTs and BFs.However,familiarity with their sonographic characteristics could improve the accuracy of diagnosis and has certain value in differential diagnosis.