摘要
目的探讨不同类型乳腺叶状肿瘤(PTB)的超声声像图特征并分析其误诊原因。方法选取61例不同类型PTB患者乳腺肿块的位置、大小、数目、形态、回声等形态学特征,对比超声检查确诊PTB以及误诊患者声像图特征,并与病理结果对照分析,总结误诊原因。结果1)本组PTB 61例,良性43例(70.5%),交界性10例(16.4%),恶性8例(13.1%),伴腋窝淋巴结转移1例(0.16%)。良性组肿块平均最大径(3.0±1.42)cm,交界性/恶性组肿块平均最大径(5.5±1.33)cm,两组间比较差异有统计学意义(P<0.01);交界性/恶性组PTB诊断准确率明显高于良性组(P<0.05);乳腺BI-RADS系统区分PTB肿块良恶性趋势差异有统计学意义(P<0.01);2)61例超声检查诊断PTB 19例,准确率31.1%(19/61),误诊42例,误诊率68.9%(42/61);超声检查确诊PTB组肿块大于3 cm者占比明显大于误诊为纤维腺瘤、乳腺癌和不定性肿块组(P<0.05);本组肿块声像图以分叶/融合状、回声不均匀、伴暗区、后方回声增强为主要特征,少见后方回声衰减及钙化(P<0.05);误诊为腺瘤组肿块多体积相对小、形态规则、回声均匀、少分隔(P<0.05),血流分布以0~I级为主;误诊为乳腺癌组肿块多形态不规则、回声不均匀(P<0.01),血流分布均以II~III级为主;不定性组肿块兼有腺瘤和乳腺癌两者特征。结论乳腺PTB在超声声像图具有特征性表现,对中、老年女性、较大不规则肿块、回声不均、伴暗区及后方回声增强、血流丰富者应考虑PTB,但超声检查声像图特征对于PTB鉴别诊断仍需进一步探究。
Objective To investigate the ultrasonographic features of phyllodes tumour of the breast(PTB)and to analyze the misdiagnosis reason.Methods In this work,the position,size,number and morphology of breast masses in 61 patients with different types of PTB were analyzed retrospectively.We analyzed the ultrasonic characteristics of PTB diagnosed and misdiagnosed by ultrasound,compared with pathological results,and summarized the causes of misdiagnosis.Results 1)Among the 61 PTB patients,43(70.5%)were benign,10(16.4%)were borderline,8(13.1%)were malignant,and 1(0.16%)was associated with axillary lymph node metastasis.The mean maximum diameter was(3.0±1.42)cm in the benign group and(5.5±1.33)cm in the borderline/malignant group,and the difference between the two groups was statistically significant(P<0.01).The diagnostic accuracy of PTB in borderline/malignant group was significantly higher than that in benign group(P<0.05).The tendency of BI-RADS system to distinguish benign from malignant masses was statistically significant(P<0.01);2)Among the 61 cases,19 cases were diagnosed with PTB by ultrasonic examination,with an accuracy rate of 31.10%(19/61),and 42 cases were misdiagnosed with a misdiagnosis rate of 68.90%(42/61).The proportion of PTB group diagnosed by ultrasound with a mass larger than 3 cm was significantly higher than that misdiagnosed as fibroadenoma,breast cancer and uncertain mass(P<0.05).The mass sonogram was mainly characterized by lobules/fusion,uneven echo,accompanied by dark area,and enhanced posterior echo,while the posterior echo attenuation and calcification were rare(P<0.05).Misdiagnosed as adenoma,the mass was mostly small in size,regular in shape,homogeneous in echo and few in separation(P<0.05),and the blood flow distribution was mainly grade 0~I.The tumors were misdiagnosed as cancer with irregular polymorphic morphology and uneven echo(P<0.01),and the blood flow distribution was dominated by grade II~III.The lumps in the uncertain group had both features of adenoma and cancer.Conclusion The possibility of PTB should be considered in older female with large mass,irregular shape,uneven echo,enhanced echo and rich blood flow.However,the differential diagnosis of PTB by ultrasonographic features still needs further study.
作者
张彦
董磊
张莹莹
王翔
闫光烈
ZHANG Yan;DONG Lei;ZHANG Yingying;WANG Xiang;YAN Guanglie(Department of Ultrasound, No. 960 Hospital of the Joint Logistic Support Force PLA, Jinan 250031, P.R.China)
出处
《医学影像学杂志》
2021年第4期600-604,共5页
Journal of Medical Imaging
关键词
超声检查
乳腺
叶状肿瘤
误诊
Ultrasound
Breast
Phyllodes tumor
Misdiagnosis
