乳腺X线摄影及超声鉴别诊断乳腺叶状肿瘤与纤维腺瘤

Differential diagnosis of phyllodes tumor and fibroadenoma of breast using mammography and ultrasonography

目的探讨乳腺X线摄影及超声诊断及鉴别诊断乳腺叶状肿瘤与纤维腺瘤的价值。方法回顾性分析并比较经病理证实的110例乳腺叶状肿瘤和102例纤维腺瘤患者的临床、X线和超声特征。结果乳腺纤维腺瘤最大径(2.71±1.44)cm,叶状肿瘤最大径(4.61±3.35)cm,差异有统计学意义(P<0.001)。乳腺良性与恶性叶状肿瘤最大径差异有统计学意义(P=0.024)。X线检查发现乳腺叶状肿瘤与纤维腺瘤在形状、边界、密度及内部钙化差异均有统计学意义(P均<0.05);超声发现两者形状、边界、内部囊变、后方回声及血流分级差异均有统计学意义(P均<0.05)。良性、交界性与恶性叶状肿瘤中,肿块内部是否囊变差异有统计学意义(P=0.006)。结论综合分析乳腺X线、超声及临床特点可以初步鉴别乳腺纤维腺瘤与叶状肿瘤,当肿块最大径>3.0 cm,呈分叶状高密度、伴有内部囊变、血流信号较丰富时提示叶状肿瘤。

Objective To assess the clinical value of mammography and ultrasonography in diagnosis and differential diagnosis of breast phyllodes tumor and fibroadenoma.Methods Clinical,mammographic and sonographic findings were retrospectively analyzed and compared in 110 women with phyllodes tumor and 102 women with fibroadenoma confirmed by surgical pathology.Results The maximum diameter of phyllodes tumor([4.61±3.35]cm)and fibroadenoma([2.71±1.44]cm)were statistically different(P<0.001),and the difference of maximum diameter between benign and malignant phyllodes tumor was statistically significant(P=0.024).The mammogram parameters of tumor shape,margin,density and calcification were statistically different between phyllodes tumor and fibroadenoma(all P<0.05),and ultrasonography showed statistically significant differences in tumor shape,margin,internal cystic regions,posterior echo,blood flow classification(all P<0.05).Among the benign,borderline and malignant phyllodes tumors,the difference of cystic regions inside the tumor was statistically significant(P=0.006).Conclusion Combination of mammographic,sonographic and clinical findings can initially identify phyllodes tumor and fibroadenoma.When the tumor is large(>3.0 cm),lobulated,high density with internal cystic regions and abundant blood flow signal,phyllodes tumor should be considered.