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摘要: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.
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Keywords:
- breast, phyllodes tumor /
- fibroadenoma /
- ultrasound /
- color Doppler
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北京协和医院感染内科李太生教授等经过4年研究，在国际上率先报道了中国艾滋病病毒(human immunodeficiency virus，HIV)感染者14. 6%合并乙型肝炎病毒(hepatitis B virus，HBV)感染，但高共感率并未影响到目前国产一线抗艾药物的疗效和肝毒性。相关论文5月17日在线发表于全球艾滋病研究领域最著名的杂志《艾滋病》上，与5月10日出版的《新英格兰医学杂志》呼吁全球警惕艾滋病合并乙肝病毒感染带来的肝损伤严重后果形成呼应。
经过长期规范的“鸡尾酒”治疗后，艾滋病患者体内病毒得到有效控制，由机会性感染引发的艾滋病患者死亡率逐年下降。与此同时，合并肝脏、肾脏、心血管及神经系统的疾病以及糖尿病等代谢性疾病，正成为影响艾滋病患者健康状况的主因。2008年，李太生教授意识到，摸清HIV感染人群中究竟有多少人合并HBV感染，合并感染对艾滋病的起病、发展及治疗会带来哪些影响，对乙肝高发的中国乃至东南亚国家和地区的艾滋病防控工作具有重要的现实意义。
自2008年起，李太生带领课题组从全国12个医疗中心募集了550例HIV感染者纳入该项研究，对这些从未接受过“鸡尾酒”疗法和其他抗艾治疗的初治患者免费发放国产一线抗艾药物，并依乙肝“两对半”的情况将患者分为从未感染组、既往感染组、慢性乙肝组以及单纯乙肝核心抗体阳性组4大组别，进行长达48周的随访观察。结果发现，HIV感染人群中14. 6%合并感染慢性乙肝，合并感染者CD4水平相对较低。分析原因，可能是二者感染途径相同、HIV感染后免疫力的下降使乙肝感染率提高所致。值得欣慰的是，研究同时发现，目前国产一线抗艾药物对HIV感染者的治疗效果并不受是否感染HBV的影响，产生肝毒性的几率也较小。
(北京协和医院党委综合办 段文利)
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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)
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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)
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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)
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