乳腺黏液腺癌超声声像图特征与临床病理分型的对照及误诊分析

doi:10.16150/j.1671-2870.2020.04.012

摘要/Abstract

摘要：

目的： 探讨不同类型乳腺黏液腺癌的超声声像图特点和病理学特征,并分析超声误诊的原因。方法： 回顾性分析68例乳腺黏液腺癌患者共70个病灶的超声声像图表现、临床资料及病理检查结果。结果： 68例乳腺黏液腺癌患者的平均发病年龄为（54.5±23.3岁）（30~86岁）,其中40例（58.8%）患者为50岁以上。病理检查结果提示,单纯型黏液腺癌占57.4%（39/68）,混合型占42.6%（29/68）; 16.2%（11/68）的患者发生了淋巴结转移。本组共70个病灶中,位于右侧乳房的占41.4%（29/70）,位于左侧乳房的占58.6%（41/70）,病灶位置以外上象限多见41.4%（29/70）。单纯型黏液腺癌患者中,病灶形态不规则形占76.9%（30/39）,混合型患者中病灶呈不规则形占80.6%（25/31）;与混合型黏液腺癌相比,单纯型黏液腺癌病灶形态不规则病灶中呈分叶状者较多（25例比7例）（P<0.05）;单纯型黏液腺癌病灶边界欠清者占48.7%（19/39）,混合型黏液腺癌病灶则以边界不清为主77.4%（24/31）;单纯型及混合型病灶均以后方回声增强最为多见,分别为74.4%（29/39）、48.4%（15/31）。单纯型病灶探及血流信号者占71.8%（28/39）,混合型病灶探及血流信号占80.6%（25/31）。单纯型及混合型黏液腺癌中乳腺影像报告和数据系统（Breast Imaging Reporting and Data System, BI-RADS）分类为可疑恶性者分别占87.2%（34/39）和93.5%（29/31）,误诊率分别为12.8%（5/39）、6.5%（2/31）,均是因肿块多表现为形态规则、边界尚清晰、后方回声无改变等类似良性病变特征而被误诊。结论： 乳腺黏液腺癌超声表现与病理分型间有一定相关性,单纯型乳腺黏液腺癌病灶多呈分叶状,边界欠清,后方回声增强,有时与良性肿瘤难以鉴别;混合型黏液腺癌则常有浸润性生长的影像学特征。

关键词: 乳腺肿瘤, 黏液腺癌, 超声检查, 病理学

Abstract:

Objective: To explore the ultrasonographic and pathological features for different types of mucinous breast carcinoma(MBC), and to analyze the causes for ultrasonic misdiagnosis. Methods: A total of 68 MBC patients with 70 lesions were enrolled, and ultrasonographic manifestations, clinical data and pathological results were analyzed retrospectively. Results: Among 68 patients aging from 30-86 years old (54.5±23.3 years old), 40 cases (58.8%) were over 50 years old.Pathology examination revealed that pure MBC accounted for 57.4% (39/68), and the other cases were mixed MBC(42.6%,29/68); 16.2% of patients(11/68) had lymph node metastasis. Among the 70 lesions, 41.4%(29/70) were located on the right breast, 58.6% (41/70) on the left breast. In addition, the locations of 41.4%(29/70) lesions were outside the upper quadrant. Irregular morphology was observed in 76.9% (30/39) of pure MBC lesions, and in 80.6% (25/31) of mixed MBC lesions.Lobulated pure MBCs were more than mixed MBCs(25 cases to 7 cases)（P<0.05). There was 48.7% (19/39) of pure MBC lesions with unclear boundary, while there was 77.4%(24/31) of mixed MBC lesions with it. Both pure MBC and mixed MBC lesions showed more posterior acoustic enhancement on ultrasonography [74.4%(29/39) and 48.4% (15/31), respectively]. Blood flow were detected in 71.8% cases (28/39) of pure MBC and in 80.6% cases(25/31) of mixed MBC.The pure MBC and mixed MBC lesions that were classified as suspicious or malignant by BI-RADS accounted for 87.2% (34/39) and 93.5% (29/31) respectively, and the misdiagnosis rates were 12.8% (5/39) and 6.5% (2/31). The misdiagnosed masses were characterized by regular morphology, the clear boundaries and the absence of posterior acoustic enhancement,which accounted for misdiagnosis. Conclusions: The ultrasonic manifestations of MBC have certain relationship with pathological type of MBC. The lesions of pure MBC are usually lobulated with unclear boundary and enhancement of posterior acoustic features, which make it difficult to distinguish between benign and malignant lesions. Mixed MBC presents with more aggressive imaging characteristics on the ultrasonography.

Key words: Breast carcinoma, Mucinous adenocarcinoma, Ultrasonography, Pathology

中图分类号:

R737.9

闫冰, 王海飞, 曹云云, 牛建梅. 乳腺黏液腺癌超声声像图特征与临床病理分型的对照及误诊分析[J]. 诊断学理论与实践, 2020, 19(04): 386-390.

YAN Bing, WANG Haifei, CAO Yunyun, NIU Jianmei. Comparative analysis of ultrasonographic features and clinicopathological types for mucinous breast carcinoma and analysis of the causes for misdiagnosis[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(04): 386-390.

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指标	单纯型（n=39）	混合型（n=31）
形态椭圆形不规则形	9（23.1%） 30（76.9%）	6（19.4%） 25（80.6%）
边界清欠清不清	8（20.6%） 19（48.7%） 12（30.7%）	2（6.5%） 5（16.1%） 24（77.4%）
内部回声均匀不均匀	2（5.1%） 37（94.9%）	0（0%） 31（100%)
后方回声增强衰减无改变	29（74.4%） 2（5.1%） 8（20.5%）	15（48.4%） 2（6.5%） 14（45.2%）
钙化有无血流信号无有内部周边内部及周边 BI-RADS分类 3类 4类、5类及0类	4（10.3%） 35（89.7%） 11（28.2%） 12（30.8%） 9（23.1%） 7（17.9%） 5（12.8%） 34（87.2%）	10（32.3%） 21（67.7%） 6（19.4%） 8（25.8%） 7（22.6%） 10（32.2%） 2（6.5%） 29（93.5%）