超声造影鉴别诊断肉芽肿性小叶性乳腺炎和乳腺癌的临床价值

The clinical value of contrast-enhanced ultrasonography in differential diagnosis of granulomatous lobular mastitis and breast cancer

目的 探讨超声造影对肉芽肿性小叶性乳腺炎(GLM)和乳腺癌鉴别诊断的临床价值。方法 选取本院诊断治疗的GLM和乳腺癌患者80例,分为GLM组(42例)和乳腺癌组(38例)。超声造影后观察造影剂状况,评估病灶直径、形态及边缘、微小钙化、回声、内部血流、血管阻力指数(RI)、腋窝淋巴结异常等。结果 GLM病变累及范围及程度不同,超声造影图像特征多样,24例实性肿块,内部呈低回声,呈假肾征。10例弥散型形态不规则、边界不清、后方回声增强。8例管状型,病灶组织及周边出现不规则低回声结构,部分患者合并腋窝淋巴结肿大。GLM组病灶造影剂早期进入时间、高增强、造影剂分布不均匀百分比为28.57%、11.90%和23.81%,低于乳腺癌组52.63%、68.42%和76.32%,差异有统计学意义(P<0.05)。GLM组病灶最大直径为(6.13±0.81)mm,高于乳腺癌组(3.58±0.74)mm,GLM组病灶边缘毛刺或成角百分比26.19%,低于乳腺癌组81.58%,差异有统计学意义(P<0.05)。GLM组微小钙化、内部血流(Ⅱ+Ⅲ级)、RI≥7等百分比分别为9.52%、52.38%、21.43%、23.81%、16.67%,低于乳腺癌组76.32%、63.16%、81.58%、68.42%、88.95%,差异有统计学意义(P<0.05)。结论 超声造影可通过评估病灶边缘形态、钙化、回声及血供等特点,在GLM与乳腺癌的鉴别诊断显示出一定优势。

Objective Contrast-enhanced ultrasonography are performed in patients with granulomatous lobular mastitis(GLM)and breast cancer to observe and evaluate the characteristics of ultrasound image and to provide the basis for clinical dif⁃ferential diagnosis.Methods Eighty patients with GLM and breast cancer diagnosed and treated in our hospital were divided in GLM group(42 cases)and breast cancer group(38cases).After contrast-enhanced ultrasound,the contrast agent was observed,and the diameter,shape and edge of the lesion,minimal calcification,echo,internal blood flow,vascular resistance index(RI),lymph node abnormalities were evaluated.Results The extent and severity of GLM lesions varyied,and the features of contrast-enhanced ultrasound images WERE diversed. There were 24 cases of solid masses with low echogenicity and pseudone⁃ phrotic signs inside. 10 cases showed irregular diffuse morphology, unclear boundaries, and enhanced posterior echogenicity. Eight cases were tubular, with irregular hypoechoic structures appearing in the lesion tissue and surrounding areas. Some pa⁃ tients also had enlarged axillary lymph nodes. The early entry time, high enhancement and uneven distribution of contrast me⁃ dium in GLM group were 28.57%, 11.90% and 23.81%, which were lower than 52.63%, 68.42% and 76.32% in breast cancer group (P<0.05). The maximum diameter of lesions in GLM group was (6.13 ± 0.81) mm, which was higher than that in breast cancer group (3.58 ± 0.74) mm. The percentage of burr or angulation of lesions in GLM group was 26.19%, which was lower than that in breast cancer group (81.58%). The difference was statistically significant (P<0.05). The percentages of microcalcifi⁃ cation, internal blood flow (Ⅱ+Ⅲ) and RI ≥ 7 in GLM group were 9.52%, 52.38%, 21.43%, 23.81% and 16.67% respec⁃ tively, which were lower than 76.32%, 63.16%, 81.58%, 68.42% and 88.95% in breast cancer group (P<0.05). Conclusion Contrast-enhanced ultrasound has some advantages in the differential diagnosis of GLM and breast cancer by evaluating the fea⁃ tures of the margin, calcification, Echo and blood supply of the lesions.