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Clinicopathological and Sonographic Features of Breast Malignant Tumors in Young Women
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摘要:
目的 总结年轻乳腺恶性肿瘤患者的临床病理特征及超声声像图特征。 方法 回顾性分析2007年1月至2008年12月在本院进行手术并被病理证实为乳腺恶性肿瘤的40例年轻患者(≤ 35岁)的临床病理资料与超声影像资料。 结果 40例患者平均年龄(29.88±5.12)岁。14例患者(35%)有肿物短期内快速生长病史。3例患者为妊娠哺乳期乳腺癌。35例患者(共40个恶性病灶)接受超声检查, 超声漏诊5个病灶, 误诊4个病灶, 31个病灶在术前超声诊断为恶性肿瘤, 诊断准确率为77.5%。超声声像图主要表现为形态不规则(97.1%)、边界不清(82.9%)、内部回声不均匀(97.1%)、微小钙化常见(74.3%)、血流丰富(Ⅱ~Ⅲ级80.0%)。15例(37.5%)患者采用保乳术, 4例(10.0%)采用乳房单纯切除术, 21例(52.5%)采用乳腺癌改良根治术。病理类型以浸润性导管癌最常见, 占67.5%(27/40)。22例(55%)患者有腋窝淋巴结转移。对40例患者平均随访(64.08±5.87)个月, 8例(20%)患者出现复发或转移。平均复发时间为术后(17.17±12.02)个月。 结论 年轻乳腺恶性肿瘤患者的肿瘤复发率高, 淋巴结转移率高, 超声声像图表现多样。 Abstract:Objective To summarize the clinicopathological and sonographic features of breast malignant tumors in young women. Methods We retrospectively analyzed the clinical, pathological, and sonographic data of 40 young women (≤ 35 years) with pathologically proven malignant tumors of the breast udergoing operation in our hospital from January 2007 to December 2008. Results The mean age of these 40 women was (29.88±5.12) years. The tumors grew rapidly in 14 patients (35%). Three women were at pregnancy or lactation period. Thirty-five patients with a total of 40 malignant tumors underwent ultrasound examination, among which 5 tumors (12.5%) were missed, 4 (10.0%) misdiagnosed as benign tumors, and 31 correctly diagnosed as malignant tumors, yielding an accuracy of 77.5%. The sonographic features of the malignant tumors in young women were as follows:irregular shape (97.1%), ill-defined margin (82.9%), heterogeneous echostructure(97.1%), microcalcifications (74.3%), and rich blood flow (gradeⅡ-Ⅲ) (80.0%). Fifteen women (37.5%) underwent breast-conserving surgery, 4(10.0%) underwent simple breast resection, and 21(52.5%) underwent modified radical mastectomy. Invasive ductal carcinoma was the most common pathological type (n=27, 67.5%). Axillary lymph node metastasis was found in 22 women (55%). During the follow-up[(64.08±5.87) months; range, 56-78 months], 8 (20%) patients suffered from recurrence or metastasis. The average time for recurrence was (17.17±12.02) months (range, 4.0-36.0 months) after the surgery. Conclusion The recurrent rate and lymph node metastasis rate of breast malignant tumors are high in young women after surgical treatment, along with complicated and diverse sonographic features. -
Key words:
- breast /
- malignant tumor /
- young patient /
- ultrasonography
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图 1 32岁女性患者，右乳外上象限浸润性导管癌伴腋窝淋巴结转移
A.肿瘤大小2.8 cm×1.5 cm，形态不规则，边界不清；B.肿瘤内簇状分布微小钙化；C.肿瘤周边血流较丰富；D.腋窝肿大淋巴结1.7 cm×1.8 cm，纵横比＞1，皮髓质分界不清
表 1 年轻乳腺恶性肿瘤患者的临床病理特征
临床病理特征 例数 年龄(岁) ≤20
[例(%)]21~30
[例(%)]31~35
[例(%)]就诊原因 自行触及肿物 34 4(80) 14(93.3) 16(80) 乳头溢液 3 1(20) 1(6.7) 1(5) 体检发现 3 0 0 3(15) 肿瘤大小 ＜2 cm 11 1(20) 6(40) 4(20) ≥2 cm 29 4(80) 9(60) 16(80) 淋巴结转移 有转移 22 0 8(53.3) 14(70) 无转移 18 5(100) 7(46.7) 6(30) 病理分型 浸润性癌 30 1(20) 12(80) 17(85) 原位癌 5 1(20) 1(6.7) 3(15) 乳腺肉瘤 4 3(60) 1(6.7) 0 其他 1 0 1(6.7) 0 ER表达* 阳性 19 1(100) 7(58.3) 11(57.9) 阴性 13 0 5(41.7) 8(42.1) PR表达* 阳性 18 1(100) 8(66.7) 9(47.4) 阴性 14 0 4(33.3) 10(52.6) c-erbB-2表达* 阳性 7 0 0 7(36.8) 阴性 25 1(100) 12(100) 12(63.2) P53表达† 阳性 5 0 2(18.2) 3(17.6) 阴性 24 1(100) 9(81.8) 14(82.4) Ki-67表达* 阳性 23 0 8(72.7) 15(78.9) 阴性 9 2(100) 3(27.3) 4(21.1) 手术方式 保乳术 15 3(60) 6(40) 6(30) 乳房单纯切除术 4 1(20) 2(13.3) 1(5) 乳腺癌改良根治术 21 1(20) 7(46.7) 13(65) 复发或转移 有 8 2(40) 4(26.7) 2(10) 无 32 3(60) 11(73.3) 18(90) ER：雌激素受体；PR：孕激素受体；浸润性癌：浸润性导管癌伴或不伴浸润性小叶癌；原位癌：导管内癌伴或不伴小叶原位癌；*32例患者进行了ER、PR、c-erbB-2和Ki-67表达检测；†29例患者进行了P53表达检测 
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表 2 年轻乳腺恶性肿瘤患者的超声声像图特征
声像图表现 肿瘤个数 百分比(%) 形态 规则 1 2.9 不规则 34 97.1 边界 清晰 6 17.1 不规则 29 82.9 内部回声 均匀 1 2.9 不均匀 34 97.1 后方回声 增强 2 5.7 不变 25 71.4 衰减 8 22.9 内部有无回声 有 6 17.1 无 29 82.9 微小钙化 有 26 74.3 无 9 25.7 血流丰富程度 0级 0 0 Ⅰ级 7 20.0 Ⅱ级 7 20.0 Ⅲ级 21 60.0
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