乳腺非肿块型病变的超声诊断  

Ultrasound Diagnosis of Non-mass-like Breast Lesions

作　　者：王知力[1] 唐杰[1] 李俊来[1] 万文博[1] 徐建红[1] 

机构地区：[1]解放军总医院超声诊断科,北京100853

出　　处：《中国医学影像学杂志》2013年第1期13-15,19,共4页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(81101059)

摘　　要：目的探讨乳腺非肿块型病变的超声表现,提高超声诊断率。资料与方法回顾性分析经手术或穿刺活检病理确诊的57例乳腺非肿块型病变的超声表现,并与病理结果进行对照。结果 57例非肿块型乳腺病变中,恶性病变39例(68.4%),非恶性病变18例(31.6%)。42例(73.7%)病变表现为片状低回声区,12例(21.1%)表现为含散在微钙化的片状低回声区,3例(5.3%)表现为散在或簇状分布的微钙化,后方伴或不伴声衰减。超声诊断的准确性为68.4%,敏感性为94.9%,特异性为11.1%,阳性预测值为69.8%,阴性预测值为50.0%。导管内癌微钙化比例(47.1%,8/17)显著高于浸润性导管癌(15.8%,3/19)(χ2=4.918,P<0.05)。恶性组腋下异常淋巴结的发生率显著高于非恶性组(χ2=4.503,P<0.05)。结论非肿块型乳腺病变多以含或不含微钙化的片状低回声及微钙化的形式表现,超声诊断敏感性较高,但特异性很低。病变内部微钙化的存在对于导管内癌的诊断具有一定意义。腋下是否存在异常淋巴结对于良恶性病变的鉴别诊断有一定帮助。Purpose To investigate the ultrasound characteristics and improve the ultrasound diagnosis of non-mass-like breast lesions. Materials and Methods The ultrasound appearance of 57 pathology proven non-mass-like breast lesions was retrospectively analyzed and compared with pathology. Results In 57 non-mass-like breast lesions, 39 （68.4%） were malignant and 18 （31.6%） were non-malignant. 42 lesions （73.7%） appeared as hypoechoic area; 12 lesions （21.1%） appeared as hypoechoic area with scattered microcalcifications, and 3 lesions （5.3%） appeared as scattered or clustered microcalcifications with or without ultrasound attenuation. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were 68.4%, 94.9%, 11.1%, 69.8%, and 50.0%, respectively. Microcalcifications appeared significantly more in ductal carcinoma in site （DCIS） （47.1%, 8/17） than that in invasive ductal carcinoma （IDC） （18.8%, 3/19） （X2=4.918, P〈0.05）. Malignant group showed significantly higher incidence of abnormal lymph nodes than non-malignant group （X2=4.503, P〈0.05）. Conclusion Non-mass-like breast lesions often appear as hypoechoic areas with or without microcalcifications or only as microcalcification. Ultrasound has a high diagnostic sensitivity of non-mass-like breast lesions, but the specificity is low. The appearance of microcalcification in non-mass-like breast lesions is useful for the diagnosis of DCIS. Abnormal lymph node is helpful in the differentiation of malignant and nonmalignant lesions.

关 键 词：乳腺肿瘤 乳腺疾病 超声检查 乳房 

分 类 号：R737.9[医药卫生—肿瘤] R730.41[医药卫生—临床医学]