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目的 探讨彩色多普勒超声在乳腺叶状肿瘤与纤维腺瘤鉴别诊断及不同病理类型乳腺叶状肿瘤诊断中的应用价值。 方法 回顾性分析在本院就诊并被病理证实的87个乳腺叶状肿瘤的超声声像图特征, 并以病理证实的120个乳腺纤维腺瘤为对照(病理结果为诊断金标准)。 结果 乳腺叶状肿瘤患者的年龄大于乳腺纤维腺瘤患者, (39.86±9.68)岁比(34.23±12.33)岁(P < 0.05);叶状肿瘤直径大于纤维腺瘤, (3.70±2.26) cm比(1.92±1.13) cm (P < 0.05)。彩色多普勒超声显示, 肿瘤形状、后方回声及内部是否存在无回声区在乳腺叶状肿瘤与纤维腺瘤之间的差异具有统计学意义(P < 0.05);肿瘤大小和彩色多普勒血流分级是乳腺叶状肿瘤的独立危险因素(OR值分别为1.36和1.82, P < 0.05)。患者年龄、肿瘤大小、纵横比及各种超声征象在良性、交界性、恶性乳腺叶状肿瘤中差异无统计学意义(P>0.05)。 结论 乳腺叶状肿瘤和纤维腺瘤在超声声像图特征上具有较多重叠, 对年龄较大、肿瘤体积较大、内有无回声区、肿物后方回声衰减或肿物内血流丰富者应考虑乳腺叶状肿瘤的可能。不同病理类型的叶状肿瘤无特征性声像图表现。 Abstract:Objective To investigate the value of color Doppler sonography in the diagnosis of phyllodes tumors with different pathologic types and in the differential diagnosis of phyllodes tumor and fibroadenoma. Methods The sonographic characteristics of 87 breast phyllodes tumors confirmed by histopathology from Janurary 2005 to December 2009 were retrospectively studied. In addition, 120 breast fibroadenoma confirmed by histopathology between June 2008 and August 2008 were set as the control group. The pathologic results were regarded as the gold standard. Results The patients with phyllodes tumors were older than the patients with fibroadenoma[(39.86±9.68) years vs. (34.23±12.33) years; P < 0.05]. The diameter of phyllodes tumor was larger than that of fibroadenoma[(3.70±2.26) cm vs. (1.92±1.13) cm; P < 0.05]. As shown by color Doppler sonography, the shape of the tumor, retrotumor acoustic phenomenon, and cystic area were significantly different between phyllodes tumor and fibroadenoma (P < 0.05). The tumor size and Color Doppler flow grade were independent risk factors of phyllodes tumors (OR=1.36 and 1.82, respectively; both P < 0.05). Benign, borderline, and malignant phyllodes tumors displayed no significantly different sonographic findings. Conclusions There is a substantial overlap in the sonographic characteristics between phyllodes tumors and fibroadenoma. If lobulation, posterior acoustic shadowing, and cystic area are observed under color Doppler sonography, a diagnosis of phyllodes tumor can be considered. Sonography can not distinguish benign, borderline, or malignant phyllodes tumors. -
Key words:
- breast, phyllodes tumor /
- fibroadenoma /
- ultrasound /
- color Doppler
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图 1 患者女, 48岁, 体检发现右乳肿物, 超声诊断右乳囊实性占位, 性质待定
A.灰阶超声发现右乳上象限囊实性肿物, 3.5 cm× 2.0 cm, 实性回声2.0 cm× 1.4 cm (*所示), 其旁为无回声区(箭头所示); B.彩色多普勒血流显像示实性回声内部Ⅰ级血流(1 ~ 2处短棒状血流信号)病理证实为乳腺叶状肿瘤(交界性)
图 2 患者女, 35岁, 右乳肿块半年余, 超声诊断右乳实性结节, 纤维腺瘤可能性大
A.灰阶超声发现右乳下象限低回声, 2.4 cm×1.2 cm, 卵圆形, 边界清晰, 内部回声欠均匀; B.彩色多普勒血流显像示肿瘤内部Ⅱ级血流(3 ~ 4处点状或短棒状血流信号)病理证实为乳腺叶状肿瘤(交界性)
图 3 患者女, 39岁, 左乳肿物2年余, 近半年明显增大, 超声诊断右乳实性占位, 性质待定
A.灰阶超声发现右乳下象限低回声, 4.4 cm× 2.4 cm, 分叶状(箭头所示), 边界清晰, 内部回声欠均匀; B.彩色多普勒血流显像示肿瘤内部Ⅱ级血流(3 ~ 4处点状或短棒状血流信号)病理证实为乳腺叶状肿瘤(良性)
表 1 三种不同病理类型乳腺叶状肿瘤分类标准
表 2 乳腺叶状肿瘤和纤维腺瘤的声像图特征
表 3 良性、交界性及恶性叶状肿瘤的声像图特征
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