乳腺叶状肿瘤患者不同病理分型的超声表现

doi:10.3760/cma.j.issn.2095-7041.2019.05.005

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摘要目的探讨不同病理学分型的乳腺叶状肿瘤的彩色多普勒超声表现。方法回顾性研究。纳入江阴市中医院及东南大学医学院附属江阴医院2008年1月—2018年9月49例经手术治疗及病理证实为乳腺叶状肿瘤的患者。49例患者均为女性,年龄17～74(45.78±10.50)岁;术后病理分型诊断为良性乳腺叶状肿瘤20例(40.81%)、交界性21例(42.86%)、恶性8例(16.33%)。采用美国放射学会超声乳腺影像报告和数据系统(BI-RADS)标准进行评估,并比较良性、交界性及恶性三种病理亚型的肿瘤病灶最大径线、超声BI-RADS分类、血供差异,以及不同大小肿瘤超声声像图表现差异。结果三种病理亚型肿瘤病灶最大径线分别为(3.57±2.17)cm、(5.00±3.71)cm及(2.88±1.52)cm,差异无统计学意义(F=2.083, P＞0.05);49例患者超声BI-RADS分类,0类6例、3类24例、4类12例、5类7例,三种病理亚型的超声BI-RADS分类差异具有统计学意义(H=22.732, P＜0.05);良性、交界性及恶性肿瘤的富血供率分别为35.00%(7/20)、52.45%(11/21)及8/8,差异有统计学意义(χ²=12.782, P＜0.01)。超声灰阶声像图显示,病灶最大径≥5 cm的肿瘤内部液化发生率为6/10,高于最大径＜5 cm肿瘤液化发生率17.9%(7/39),差异有统计学意义(χ²=5.224, P＜0.05)。结论当乳腺肿瘤在超声声像图上表现为分叶状、囊性变时要考虑叶状肿瘤的可能,应用超声BI-RADS分类可能有助于鉴别良性、交界性及恶性乳腺叶状肿瘤,当乳腺内病灶呈现富血供时要考虑恶性可能,但该病确诊仍需依靠病理。

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	张子宁
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	邵清
	赵可

关键词 ：乳腺肿瘤, 叶状瘤, 超声检查, 诊断

Abstract：Objective To study the diagnostic value and method of color Doppler ultrasonography in different pathological types of breast phyllodes tumor.Methods The characteristics of ultrasonographic images were analyzed retrospectively in 49 female patients with breast phyllodes tumor in Jiangyin Hospital of Traditional Chinese Medicine and the Affiliated Jiangyin Hospital of Southeast University Medical College from January 2008 to September 2018, ranged from 17-74 (45.78±10.50) years old. The pathological percentages of benign, borderline and malignant were 40.81% (20/49), 42.86% (21/49) and 16.33% (8/49), respectively. The maximum diameter line of the lesion, ultrasound breast imaging reporting and data system(BI-RADS) assessment category and the level of blood supply according to color Doppler ultrasonography were compared among benign, borderline and malignant pathological types.The ultrasonographic finding of two tumors of different diameter sizes(≥5 mm vs. ＜5 mm) were compared.Results The mean maximum diameter line of the lesions among three pathological types were (3.57±2.17) cm, (5.00±3.71) cm, (2.88±1.52)cm, respectively, and there was no significant difference (F=2.083, P＞0.05). In all the 49 patients, 6 patients were ultrasound BI-RADS categorised 0, 24 patients were categorised 3, 12 patients were categorised 4 and 7 patients were categorised 5. The ultrasound BI-RADS assessment category, among benign, borderline and malignant of breast phyllodes tumor, had statistically significant difference (H=22.732, P＜0.05). According to the color Doppler ultrasonography, the rich blood supply rate of benign, borderline and malignant lobar tumors were 35.00%(7/20), 52.45%(11/21)and 8/8, respectively, with significant difference (χ²=12.786, P＜0.01). Grayscale sonography showed the incidence of internal liquefaction of maximum diameter ≥5 cm was 6/10, higher than that of ＜5 cm (17.9%, 7/39)(χ²=5.224, P＜0.05).Conclusions The possibility of phyllodes tumor should be considered when breast tumor is lobulated and cystic on ultrasound. The ultrasound BI-RADS assessment category maybe helpful to distinguish benign, borderline and malignant of breast phyllodes tumor. The possibility of malignancy should be considered when the breast lesion present with rich blood supply. However, the diagnosis still depends on pathology.

Key words： Breast neoplasms Phyllodes tumor Ultrasonography Diagnosis

收稿日期: 2019-01-29

基金资助:无锡市卫生计生委妇幼健康科研项目( FYKY201504)

通讯作者: 薛勤,Email:xueqin010305@hotmail.com

引用本文:

张子宁, 薛勤, 邵清, 赵可. 乳腺叶状肿瘤患者不同病理分型的超声表现[J]. 中华解剖与临床杂志, 2019, 24(5): 449-453.
Zhang Zining, Xue Qin, Shao Qing, Zhao Ke. Ultrasonographic findings of phyllodes tumor of breast with different pathological types. Chinese Journal of Anatomy and Clinics, 2019, 24(5): 449-453.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2019.05.005 或 http://www.cjac.com.cn/CN/Y2019/V24/I5/449

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