不同病理类型乳腺癌的实时灰阶超声造影研究  

Malignant Tumors of the Breast:Contrast-enhanced Ultrasonographic Findings of Different Histologic Types

作　　者：许萍[1] 王怡[1] 汪晓虹[1] 富丽娜[1] 

机构地区：[1]复旦大学附属华山医院超声医学科,上海市200040

出　　处：《中国超声医学杂志》2013年第3期238-242,共5页Chinese Journal of Ultrasound in Medicine

基　　金：上海市浦东新区科技发展基金创新资金(No.PKJ2008-Y04)

摘　　要：目的对不同病理类型乳腺癌的实时灰阶超声造影图像特征进行分析,以期进一步提高乳腺癌术前超声的诊断准确率。方法回顾性分析不同病理类型乳腺癌组的超声造影形态学增强模式和时间强度曲线定量参数,并分别比较各乳腺癌组常规超声与超声造影的诊断准确率。结果浸润性导管癌组超声造影后病灶内造影剂分布不均匀征象占87%,局灶性充盈缺损21个(全部恶性组中共24个,占88%),其造影平均峰值强度较低(4.9)。导管原位癌组造影后其恶性特征最显著,形态不规则(82%),边界不清晰(82%),病灶内造影剂分布不均匀(94%),周围扭曲或穿入血管(88%)。髓样癌有别于其他乳腺癌组表现为形态规则、边界清晰、造影剂分布均匀、造影后肿块无明显增大,但其平均峰值强度(9.6)在各病理组中最高,且所有病灶均显示其周围有穿入或扭曲血管结构。本研究中,超声造影提高了乳腺导管原位癌、髓样癌和导管内乳头状癌组的诊断准确率,分别达到94%、100%和100%。结论不同病理类型乳腺癌间具有一些不同的超声造影增强特征,超声造影对于常规超声诊断较困难的部分早期及特殊病理类型乳腺癌具有一定应用价值。Objective To explore the characteristics of different histologic types of malignant breast lesions at re- al-time gray scale contrast-enhanced ultrasound（CEUS） and try to improve the ultrasound diagnostic accuracy rate of breast cancer. Methods We retrospectively reviewed the contrast-enhanced sonographic findings of all the different histologic types of malignant breast lesions including morphologic features and the quantitative parameters and correla- ted them with histology. Accuracy was then calculated to assess the diagnostic performance of CEUS. Results 87% of invasive ductal carcinoma（IDC） showed heterogeneous enhancement. Of all the 24 perfusion defects, IDC account for 88%（21/24）. Low average peak intensity （PI） of 4.9 was detected. Ductal carcinoma in situ （DCIS） excellently showed the features of irregular shape （82 %）, poorly-defined margin （82 %）, heterogeneous enhancement （94 % ）, penetrating or tortuous surrounding vessels （88%）. Contrary to the other malignancies, medullary carcinoma exhibi- ted regular shape, well-defined margin, homogenous enhancement, and no change in size before and after contrast en- hancement. But all the lesions of medullary carcinoma showed penetrating or tortuous surrounding vessels and the highest average PI value of 9.6. DCIS,medullary carcinoma and intraductal papillary carcinoma achieved an improved diagnostic accuracy rate （94 %, 100 % and 100 %, respectively）. Conclusions The imaging characteristics of CEUS are variable in different pathologic types of breast cancer. CEUS is a useful adjunct to conventional ultrasound in diagno- sing some early and special pathologic types of breast cancer.

关 键 词：乳腺癌 病理学 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]