【摘要】 目的探讨BI-RADS 4类乳腺肿块超声造影呈不均匀性增强的病理基础。方法乳腺肿块女性患者96例,共96个肿块,常规超声诊断为BI-RADS 4类,超声造影表现为不均匀性增强。对肿块行病理及免疫组化染色,计算微血管密度(MVD)。结果 96个乳腺肿块,44个良性肿块超声造影表现为不均匀性增强,内见少许条状增强或部分灌注缺损区,血管走行规则,边界清;病理示肿块内间质成分较多,发生玻璃样、黏液样变性及钙盐沉积,导管扩张或脓肿形成;免疫组化显示血管分布均匀,未见不成熟血管。52个恶性肿块超声造影表现为不均匀性增强,13个肿块见周边放射性增强,血管走行不规则,21个肿块造影后范围增大;病理示肿块内瘤细胞坏死或间质出血及大片胶原化;免疫组化示肿块边缘区较中央区新生血管多,可见异常扩张的大血管和裂隙状新生血管并存。恶性肿块MVD高于良性肿块(P<0.01)。结论乳腺良恶性肿瘤超声造影均可表现为不均匀性增强,但其病理基础不同,通过与病理改变对照分析,可提高对BIRADS 4类乳腺肿块超声造影特点的认识。更多还原

【Abstract】 Objective To explore the pathological basis of heterogeneous enhancement in contrast-enhanced ultrasonography(CEUS)of BI-RADS category 4 breast tumor. Methods Totally 96 patients with 96 breast masses diagnosed as BI-RADS-US category 4 by conventional ultrasound,and CEUS showed heterogeneous enhancement. Immunohistochemical staining was performed on surgery specimen and microvessel density(MVD)was evaluated.Results Of all the 96 BI-RADSUS category 4 breast tumors that were confirmed by histopathology results,44 of them were benign and 52 were malignant. The benign tumors displayed heterogeneous enhancement with smooth vessels and clear margin by CEUS. The conventional pathology exhibited many mesenchyme components with hyaline or myxoid degeneration and calcium salt deposition,duct expansion and abscess. The malignant tumors displayed heterogeneous enhancement with unregular vessels distribution by CEUS. Marginal enhancement was observed in 13 tumors and 21 tumors had a larger size at CEUS. The conventional pathology showed cell necrosis,hemorrhage,or large scope of collagen. By immunohistochemical staining,it was found that the margin part contained more microvessels in malignant lesions compared to the inside part. The MVD of malignant tumors was significantly higher compared with that of the benign tumors(P <0.01). Conclusion Heterogeneous enhancement can be observed in CEUS of both benign and malignant breast lesions,but the pathological basis is different.更多还原