【作者】 杨敏；

【导师】 张迎春；

【作者基本信息】 苏州大学 ， 影像医学与核医学， 2019， 硕士

【摘要】 目的非肿块型乳腺癌由于所处时期及生长方式的特殊性,缺乏典型的超声特征,临床检出率较低,误诊率较高。本文以病理结果为金标准,通过分析非肿块型乳腺癌的超声表现特点,分析误诊的相关因素,旨在提高对非肿块型乳腺癌的诊断水平。方法对2015年01月～2019年01月在我院就诊并手术的187例非肿块型乳腺癌(超声表现为在两个不同扫查切面上不具备空间占位效应)患者资料进行回顾性分析,将超声表现分为片状低回声、导管扩张、微钙化和结构扭曲四种类型,以病理结果为金标准,分析不同的非肿块型乳腺癌超声特征,查找超声误诊的相关因素。结果1.187例单侧单发的非肿块型乳腺癌超声表现中,片状低回声118例(63.0%),导管扩张28例(15.0%),微钙化16例(8.6%),结构扭曲型25例(13.4%)。2.病理组织学类型如下:①导管原位癌(Ductal carcinoma in situ,DCIS)86例(46.0%),②导管原位癌微浸润(Ductal carcinoma in situ with microinvasion,DCIS-MI)27 例(14.4%,③浸润性导管癌(Invasive ductal carcinoma,IDC)71 例(30.0%),④浸润性小叶癌(Invasive lobular carcinoma,ILC)3 例(1.6%)。3.不同超声表现的非肿块型乳腺癌病理组织学类型如下:28例导管扩张型病灶的病理组织学类型只有两种,分别为导管原位癌和导管原位癌微浸润,其中导管原位癌所占比例为96.4%(27/28),明显大于其它3种病理类型(P<0.001)。118例片状低回声型病灶以浸润性导管癌为主(57/118,48.3%),比例高于其余3种病理类型(P=0.001)。16例微钙化型病灶的病理组织学类型所占比例分别为导管原位癌(8/16,50.0%)、导管原位癌微浸润(4/16,25.0%)、浸润性导管癌(4/16,25.0%)(P=0.808)。25例结构扭曲病灶的病理组织学类型所占比例分别为导管原位癌(8/25,32.0%)、导管原位癌微浸润(6/25,24.0%)、浸润性导管癌(10/25,40.0%)、浸润性导管癌(1/25,4.0%)(P=0.249)。4.超声BI-RADS分类4类及以上者157例,诊断符合率为84.0%(157/187)。5.超声BI-RADS分类2～3类者30例,误诊率16.0%(30/187),其中超声提示为积乳囊肿4例,导管扩张7例,乳腺增生10例,乳腺囊性增生4例,导管内乳头状瘤2例,乳腺炎1例,浆细胞性乳腺炎2例。结论1.非肿块型乳腺癌的超声表现以片状低回声为主(118/187,63.0%),病理组织学类型主要为导管原位癌(86/187,46.0%)。2.BI-RADS分类标准使超声对于非肿块型乳腺癌的定性更趋标准化,具有较高的诊断效能,希望未来将超声BI-RADS分类评估非肿块型乳腺癌建立公认的标准。3.边界模糊的片状低回声、导管扩张伴或不伴实性成分、腺体局部结构扭曲,密集分布的微钙化均可能是非肿块型乳腺癌的超声表现,应引起超声医师足够重视,以提高对非肿块型乳腺癌的诊断准确率。更多还原

【Abstract】 ObjectiveDue to its different periods and growth patterns,non-mass cancers on breast lack of typical imaging features.Therefore,the clinical detection rate is low,and the rate of misdiagnosis is high.This article uses pathological results as the gold standard to analyze the causes of misdiagnosis by analyzing the ultrasound characteristics of non-mass cancers on breast,aiming to improve the diagnosis of non-mass cancers on breast.MethodsA retrospective analysis of 187 patients who were admitted to our hospital from January 2015 to January 2019 was performed.Ultrasound findings in these patients showed no spatial space-occupying effect on two different scan sections,and surgical pathology confirmed breast cancer.Ultrasound imagings were divided into four types:hypoechoic area,ductal dilatation,microcalcification and architectural distortion.The pathological results were used as the gold standard to analyze the characteristics of different types of non-mass cancers on breast,and to find out the causes of ultrasound misdiagnosis.Results1.Among the ultrasound types of 187 non-mass cancers with a single lesion of unilateral breast,118 cases(63.0%)had hypoechoic area,28 cases(15.0%)had ductal dilatation,16 cases(8.6%)had microcalcification,and 25(13.4%)had architectural distortion.2.The pathological histology types were as follows:① ductal carcinoma in situ(86/187,46.0%),②ductal carcinoma in situ with microinvasion(27/187,14.4%),③invasive ductal carcinoma(71/187,30.0%),④invasive lobular carcinoma(3/187,1.6%)3.The histopathological types of non-mass cancers on breast with different ultrasound findings were as follows:there were only two histopathological types in 28 cases of ductal dilatation lesions,ductal carcinoma in situ and ductal carcinoma in situ with microinvasion respectively.The proportion of ductal carcinoma in situ was 96.4%(27/28),which was significantly higher than the other three pathological types(P<0.001).118 cases of hypoechoic area lesions were mainly invasive ductal carcinoma(57/118,48.3%),the proportion was higher than the other three pathological types(P=0.001).The histopathological types of 16 microcalcification lesions were ductal carcinoma in situ(8/16,50.0%),ductal carcinoma in situ with microinvasion(4/16,25.0%),invasive ductal carcinoma(4/16,25.0%)(P=0.808).The histopathological types of 25 architectural distortion lesions were ductal carcinoma in situ(8/25,32.0%),ductal carcinoma in situ with microinvasion(6/25,24.0%),invasive ductal carcinoma(10/25,40.0%),invasive lobular carcinoma(1/25,4.0%)(P=0.249).4.There were a total of 150 cases of ultrasound BI-RADS classification of 4 and above,the diagnostic accuracy rate was 84.0%(150/187).5.There were 30 cases of ultrasound BI-RADS classification in grade 2 or 3,and the misdiagnosis rate was 16.0%(30/187).Among them,ultrasound showed 4 cases of latex cysts,7 cases of ductal dilatation,10 cases of breast hyperplasia,4 cases of breast cystic hyperplasia,2 cases of intraductal papilloma,1 case of mastitis,and 2 cases of plasma cell mastitis.Conclusions1.The ultrasonographic features of non-mass cancers on breast are mainly hypoechoic areas,and the histopathological types are mainly ductal carcinoma in situ.2.BI-RADS grading standard makes ultrasound examination more standardized for qualitative diagnosis of non-mass cancers on breast,and it has high diagnostic efficiency.We hope to establish a recognized standard for the evaluation ofnon-mass cancers on breast by ultrasound BI-RADS in the future.3.Hypoechoic areas with blurred edges,ductal dilatation with or without solid components,distortion of local glandular architectures,and densely distributed microcalcifications may be ultrasound findings of non-mass cancers on breast,which should be adequately addressed by the sonographer to improve the diagnostic accuracy of non-mass cancers on breast.更多还原