乳腺叶状肿瘤的影像学表现与病理对照分析

目的 探讨不同病理学分级的乳腺叶状肿瘤(PTs)的影像学表现,提高对PTs的认识及诊断水平.方法 回顾性分析65例经手术病理证实为PTs患者的临床及影像学资料,其中61例行超声和MRI检查,44例行X线检查,并与其病理学结果相对照.结果 (1)65例PTs患者,病理类型为良性、交界性和恶性的百分比分别为32.3%(21/65)、43.1%(28/65)和24.6%(16/65);其病灶的平均最大径分别为(4.75±2.62) cm、(5.37±3.11) cm和(4.96±3.82) cm,差异无统计学意义(F=0.247,P=0.782).(2)在44例PTs患者(包括良性16例,交界性18例,恶性10例)的X线图像上,病灶透亮晕及钙化有无在三者中差异有统计学意义(P均<0.05).(3)在61例PTs患者(包括良性19例,交界性26例,恶性16例)的声像图上,不同病理类型病灶形状差异有统计学意义(P<0.05).(4)在61例PTs患者(包括良性21例,交界性24例,恶性16例)的MRI图像上,三者在T2WI上病变内低信号分隔的有无、时间-信号强度曲线(TIC)方面差异有统计学意义(P均<0.05).结论 乳腺PTs的影像学表现有助于明确其病理学分类.     

应用乳腺影像报告和数据系统分析乳腺叶状肿瘤的影像表现

目的 应用乳腺影像报告和数据系统(BI-RADS)探讨乳腺叶状肿瘤的X线、超声及MRI表现,以期提高对该病的影像诊断能力.方法 收集2004-2011年经手术病理证实的乳腺叶状肿瘤18例(20个病灶),其中良性6例,交界性5例,恶性7例.13例行乳腺X线摄影检查,13例做乳腺超声检查,4例行乳腺MRI检查.1例患者为单侧乳腺多发(3个)肿瘤,余17例为单发.按照BI-RADS术语,回顾性分析其影像表现及病变分类,并与大体及镜下病理表现对照.结果 无论良性、交界性还是恶性,影像表现为:除1例于X线摄影表现为局部致密及2例于超声表现为椭圆形,余肿块均为分叶状;边界清楚;＜5 cm肿块除1例回声不均匀,余回声(或信号)均匀,而＞5 cm者因囊变易回声(或信号)不均匀;血供丰富;未见钙化;未侵犯乳头及皮肤;未见腋窝淋巴结转移.交界性及恶性者MRI动态增强曲线为III型,扩散加权成像表现为高信号,波谱见胆碱峰.BI-RADS病变分类多为4类.结论 应用BI-RADS有利于乳腺叶状肿瘤影像结果的综合比较.     

多参数MRI检查BI-RADS分类对乳腺疾病鉴别诊断价值

目的建立一种新的与BI-RADS分类相对应的多参数乳腺MRI诊断模式,探讨多参数乳腺MRI检查对乳腺良恶性疾病的鉴别诊断价值。方法回顾分析290例乳腺疾病患者,共309个经病理证实的乳腺病灶,根据其多平面重组、ADC值测量和TIC测量曲线数据进行BI-RADS分类并与病理结果进行对照分析,分别计算癌前病变纳入良、恶性组的灵敏度和特异度。结果本组病例中多参数MRI联合BI-RADS分类对乳腺疾病鉴别诊断的敏感度和特异度分别为:1)将癌前病变纳入良性病灶、在MRI将4类归为良性组为86.6%和85.0%;2)将癌前病变纳入恶性病灶、在MRI将4类归为良性组为93.3%和66.9%,高于其它组合。病理诊断为癌前病变的治疗建议为手术切除或随访,BI-RADS1-3类对随访病灶的阳性预测值(PPV)为88.2%,BI-RADS 5类对可手术切除病灶的PPV为93.3%,而将癌前病变纳入恶性病灶后,BI-RADS 4类对恶性的PPV为48.0%。结论建立乳腺疾病MRI多参数诊断模型能更精确地判断乳腺病灶良性、癌前病变和恶性特征,对鉴别乳腺良恶性疾病有良好的应用价值。     

~1H-MRS在乳腺BI-RADS 3病变的应用价值

目的探讨MRI氢质子波谱成像(1 H-MRS)在常规动态增强MRI检查诊断的乳腺BI-RADS 3病变中的应用价值。方法应用1.5T MRI对常规动态增强MRI检查诊断为BI-RADS 3乳腺病变的34例患者、39处病灶再次行(1 H-MRS)检查。以Cho峰信噪比(SNR)≥2作为阳性的诊断标准,Cho峰阳性病灶重新评级为BI-RADS 4,阴性患者维持BI-RADS 3不变。以穿刺活检或手术病理为金标准,分析1 H-MRS胆碱峰对乳腺癌与乳腺良性病变的诊断价值。结果6处病灶(累及5例患者)1 H-MRS检查Cho峰阳性从而被重新评估为BI-RADS 4,病理证实均为乳腺癌。另外33处病灶Cho峰阴性维持BI-RADS 3分级不变,病理证实均为良性病变。1 H-MRS检查胆碱峰在乳腺良、恶性病变中有显著统计学差异(P0.001)。结论 1 H-MRS对鉴别常规动态增强乳腺MRI诊断的BI-RADS 3病变中可能存在的恶性病变具有重要作用,可进一步提高BI-RADS分级的准确性。     

MRI在乳腺疾病中的应用价值

目的:探讨MRI对乳腺疾病的临床应用价值.方法:回顾性分析135例经手术病理证实的乳腺疾病患者的病例资料.分析比较乳腺良恶性病变的MRI平扫和动态增强表现及时间-信号强度曲线(TIC)的特点,并与乳腺X线摄影结果进行对照.结果:135例患者共发现142个病灶,其中恶性病变64个,良性病变78个.乳腺良性病变的主要平扫MRI表现:T1WI呈低信号42个、等信号32个、高信号4个;T2WI呈低信号2个、等信号20个、高信号56个.恶性病变的主要平扫MRI表现:T1WI呈低信号48个、等信号14个、高信号2个;T2WI呈低信号1个、等信号13个、高信号50个.增强扫描:良性病变多为较均匀强化,以Ⅰ型(持续强化)曲线为主(56个);恶性病变强化多不均匀、以Ⅲ型曲线(廓清型)为主(47个).动态增强扫描对乳腺良恶性病变的诊断符合率为90.8%,优于平扫MRI (71.8%)和乳腺X线摄影(65.5%).结论:MRI平扫加增强扫描是评价乳腺疾病的一种有效影像学方法,尤其是动态增强MRI更有助于良恶性病变的鉴别.     

乳腺叶状肿瘤的3.0T MRI表现

【摘要】目的：分析乳腺叶状肿瘤的MRI特征,提高对本病的MRI诊断水平。方法：回顾性分析51例经手术病理证实的乳腺叶状肿瘤的MRI资料,其中良性31例、交界性15例、恶性5例。结果：51例叶状肿瘤的主要MRI表现：分叶状或类圆形肿块,边界清晰,T2WI信号多不均匀、可见低信号分隔,动态增强扫描可见低信号分隔不强化,时间-信号强度曲线以渐进型和平台型为主。良性、交界性及恶性叶状肿瘤的ADC值分别为(1.66±0.18)×10-3、(1.54±0.17)×10-3和(1.33±0.23)×10-3mm2/s;恶性和交界性合并后（非良性）ADC值为(1.46±0.21)×10-3mm2/s,与良性肿瘤比较,差异有统计学意义（t=3.08,P<0.05）。结论：MRI能够准确显示乳腺叶状肿瘤的形态学及血流动力学特征,为术前明确诊断提供诊断依据。     

结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的处理体会

目的:评价结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的良恶性评估价值,探讨BI-RADS 4类肿块新的处理建议.方法:X线筛查为BI-RADS 4a类(105个)、4b类(42个)和4c类(19个)的151例共166个乳腺肿块,在活检前行MRI.动态增强结合扩散加权成像(DWI)进行MRI BI-RADS分类.结合X线与MRI分类提出新的良恶性评估法.统计X线与MRI诊断乳腺癌的敏感度、特异度及诊断符合率;绘制两者的ROC曲线,Z检验比较曲线下面积;统计结合MRI和X线的新的良恶性评估法发现乳腺癌的敏感性、诊断符合率和对良性病变检出率.结果:2名X线诊断医师和2名MRI诊断医师的BI-RADS分类的Kappa值分别为0.70和0.76,一致性较好.166个肿块,恶性41个,占24.7％.X线BI-RADS 4a类105个:恶性12个,MRI分类为4、5类12个;良性93个,MRI为2、3类81个.X线BI-RADS 4b类42个:恶性16个,MRI分类为4、5类15个;良性26个,MRI为2、3类16个.X线BI-RADS 4c类19个:恶性13个,MRI分类为4、5类12个;良性6个,MRI为3类2个.X线诊断敏感度、特异度为70.7％、74.4％,诊断符合率为73.5％.MRI诊断敏感度、特异性及诊断符合率为95.1％、79.2％和83.1％.X线及MRI诊断乳腺癌的ROC曲线下面积分别为0.749及0.927,两者差异有统计学意义(Z=2.282,P＜0.05).新的良恶性评估法发现乳腺癌的敏感度为100％,诊断符合率为77.7％,良性病变检出率为53.0％.结论:MRI对乳腺X线筛查为BI-RADS 4类肿块有较高的诊断价值.结合X线及MRI分类进行新的良恶性评估,能减少良性肿块不必要的活检.     

乳腺自动全容积在乳腺多发结节中偶发癌的诊断中的临床价值

目的探讨自动乳腺全容积成像(automated breast volume scanner,ABVS)在乳腺多发结节中偶发癌诊断中的临床应用价值。方法对本院因乳腺疾病就诊82例患者的临床资料进行分析,按照BI-RADS分级标准进行评估,比较常规超声和自动乳腺全容积成像在术前诊断乳腺多发结节中偶发癌的效果。结果 251个结节中,常规超声检出BIRADS分级为4b级及以上病灶20个,其中良性病灶4个,恶性病灶16个。常规超声检出BI-RADS分级为4b级以下病灶231个,其中良性病灶226个,恶性病灶5个。根据上述常规超声检出BI-RADS分级结果在良恶性病灶间比较存在明显差异,且差异具有统计学意义。根据BI-RADS 4b级以上为诊断恶性病变标准进行常规超声诊断效果分析,结果显示常规超声诊断乳腺多发结节中偶发癌的敏感性、特异性及准确性76.19%,98.26%,96.41%。251个结节中,自动乳腺全容积成像检出BI-RADS分级为4b级及以上病灶22个,其中良性病灶2个,恶性病灶20个。自动乳腺全容积成像检出BI-RADS分级为4b级以下病灶229个,其中良性病灶228个,恶性病灶1个。根据上述自动乳腺全容积成像检出BIRADS分级结果在良恶性病灶间比较存在明显差异,且差异具有统计学意义。根据BI-RADS 4b级以上为诊断恶性病变标准进行自动乳腺全容积成像诊断效果分析,结果显示自动乳腺全容积成像诊断乳腺多发结节中偶发癌的敏感性、特异性及准确性95.24%,99.13%,98.80%。自动乳腺全容积成像诊断乳腺多发结节中偶发癌的敏感性明显高于常规超声,且差异具有统计学意义。而两种检查方法的特异性和准确性比较则无明显差异。结论 ABVS系统作为一种新的超声检查方式,其结合BI-RADS 4b级作为标准提高了超声对乳腺多发结节中偶发癌的诊断灵敏度,诊断效能较常规超声明显提高。     

MRI随访在乳腺BI-RADS4类病变的诊断价值

目的采用MRI随访观察乳腺病灶的变化,评价MRI随访对乳腺影像报告和数据系统(BI-RADS)4类病变的临床诊治指导价值。资料与方法回顾性分析首次MRI诊断为BI-RADS 4类患者34例,间隔3周~1年,采用MRI随访观察病灶的稳定性,当病灶增强形态、表观扩散系数(ADC)值及增强时间-信号曲线(TIC)类型提示向恶性转化时,则分类升级并推荐患者进行活检或切除;反之,分类降级建议继续随访。结果被关注病灶共计36个,随访期间升级病灶19个,其中病理证实15例恶性、1例乳腺炎;10例保持分类不变,8例病理证实6例恶性;病灶降级7例,病理证实良性1例。结论利用MRI对BI-RADS 4类病灶进行随访,当病灶增强形态、ADC值及TIC类型其中之一提示向恶性转化时,需要及时行活检或外科处理,反之可以继续随访,这种随访方式可以避免乳腺病灶的过度处理。     

探讨血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检的价值

目的探讨彩色多普勒血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检的价值。方法回顾性分析120例超声诊断为BI-RADS4级的乳腺病灶患者,结合彩色多普勒观察乳腺病灶内部及周边的血流分布,形态,数量,按照Adler的半定量方法,对血流进行分级,所有病例均进行了超声引导下穿刺活检。结果 120例超声活检结果,良性62例,恶性58例,BI-RADS4a、4b、4c的阳性预测值(positive predictive value,PPV)分别为10.8%、39.0%、90.5%,各个级别间比较均有统计学意义(P0.05),2级和3级血流的乳腺病灶PPV(79.7%)与BI-RADS4级的总PPV(48.3%)比较,差异具有统计学意义(P0.05)。BI-RADS4级乳腺病灶的良恶性在血流分级的分布具有差异性,差异具有统计学意义(P0.05)。2级和3级血流的BI-RADS4b乳腺病灶的PPV(70.0%)和总体BI-RADS4b乳腺病灶的PPV(39.0%)比较,差异有统计学意义(P0.05)。结论血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检具有指导价值,4a的PPV较低,可以短期随访观察,但对于伴有2级和3级血流的BI-RADS4a级乳腺病灶,由于其PPV比整体BI-RADS4a级乳腺病灶的PPV高,建议穿刺活检;对于2级和3级血流的4b乳腺病灶,由于其PPV较高,一定要尽早穿刺活检,明确良恶性;对于2级和3级的4c乳腺病灶,由于其PPV很高,不建议穿刺活检,直接手术处理。     

Imaging findings in phyllodes tumors of the breast

Purpose

To study the radiological appearance and pathological features of breast phyllodes tumors (PTs), and to enhance the recognition of the tumor.

Materials and methods

Clinical and imaging findings were retrospectively reviewed in 24 women with PTs confirmed by surgical pathology. All of the 24 patients had preoperative MRI and sonography, and 10 had preoperative mammography.

Results

The histologic findings were benign, borderline and malignant PTs in 16.7% (4/24), 45.8% (11/24) and 37.5% (9/24) of cases, respectively. The tumor size (p = 0.001), irregular shape on sonographic imaging (p = 0.039), internal non-enhanced septations (p = 0.009), silt-like changes in enhanced images (p = 0.006) and signal changes from T2-weighted to enhanced images on MRI (p = 0.001) correlated significantly with the histologic grade; the BI-RADS category of the MRI could reflect the PT's histologic grade with a correlation coefficient of 0.440 (p = 0.031). If the category BI-RADS ≥4a was considered to be a suspicious malignant lesion, the diagnostic accuracy of mammography, US and MRI would be 70% (7/10), 62.5% (15/24) and 95.8% (23/24), respectively.

Conclusion

The tumor size and several US and MRI findings can be used to help preoperatively determine the histologic grade of breast PTs. When a patient presents with a progressively enlarging, painless breast mass, MRI should be recommended first.     

Predicting the pathological grade of breast phyllodes tumors: a nomogram based on clinical and magnetic resonance imaging features

Objective:To explore the potential factors related to the pathological grade of breast phyllodes tumors (PTs) and to establish a nomogram to improve their differentiation ability.Methods:Patients with PTs diagnosed by post-operative pathology who underwent pretreatment magnetic resonance imaging (MRI) from January 2015 to June 2020 were retrospectively reviewed. Traditional clinical features and MRI features evaluated according to the fifth BI-RADS were analyzed by statistical methods and introduced to a stepwise multivariate logistic regression analysis to develop a prediction model. Then, a nomogram was developed to graphically predict the probability of non-benign (borderline/malignant) PTs.Results:Finally, 61 benign, 73 borderline and 48 malignant PTs were identified in 182 patients. Family history of tumor, diameter, lobulation, cystic component, signal on fat saturated T₂ weighted imaging (FS T₂WI), BI-RADS category and time–signal intensity curve (TIC) patterns were found to be significantly different between benign and non-benign PTs. The nomogram was finally developed based on five risk factors: family history of tumor, lobulation, cystic component, signal on FS T₂WI and internal enhancement. The AUC of the nomogram was 0.795 (95% CI: 0.639, 0.835).Conclusion:Family history of tumor, lobulation, cystic components, signals on FS T₂WI and internal enhancement are independent predictors of non-benign PTs. The prediction nomogram developed based on these features can be used as a supplemental tool to pre-operatively differentiate PTs grades.Advances in knowledge:More sample size and characteristics were used to explore the factors related to the pathological grade of PTs and establish a predictive nomogram for the first time.     

Imaging of gastrointestinal stromal tumor (GIST): relation between CT findings and grade of malignancy

PURPOSE: To report the relation between CT findings and the grade of malignancy in gastrointestinal stromal tumor (GIST), especially the uncommitted type of GIST. MATERIALS AND METHODS: A total of 14 patients with histologically proven GIST (uncommitted type) underwent CT. Tumors were divided into three grades. HISTOLOGICALLY: Benign (mitotic index [MI] < 2/10 high-power fields [HPF]), borderline (2/10 HPF < or = MI < or = 5/10 HPF), and malignant (5/10 HPF < MI). We evaluated tumor size, cystic component, margin, and early enhancement. RESULTS: All benign tumors were smaller than 5 cm, and most malignant tumors reached 5 cm. The size of borderline tumors was between the sizes of benign and malignant tumors. No benign tumors had cystic components, whereas all borderline and malignant tumors except for one case had cystic components. Only two huge malignant tumors had unclear margins. The relation between early enhancement and the grade of malignancy showed no tendency, but all duodenal tumors showed marked early enhancement irrespective of grade. CONCLUSION: The grade of malignancy of GIST (uncommitted type) and size, presence of cystic components, and margin were highly correlated. That is, 1) tumors smaller than 5 cm with no cystic components can be diagnosed as benign, whereas 2) tumors that have cystic components are borderline or malignant. 3) Tumors that have cystic components and unclear margin can be diagnosed as actively malignant.     

乳腺叶状肿瘤的MRI表现及临床病理学分析

目的:分析乳腺叶状肿瘤(phyllodes tumors,PTs)的MRI表现,以提高MRI的诊断价值。方法:回顾性分析8例PTs患者的临床及影像资料,包括肿瘤在T1WI、STIR序列上的信号强度,肿瘤大小、形状、边缘、内部强化方式、早期强化率、时间-信号强度曲线(time-signal intensity curve,TIC)类型及ADC值;比较PTs与正常腺体ADC值的差异。结果:8例乳腺PTs中,3例良性,4例交界性,1例恶性。MRI平扫T1WI呈等及较低信号,STIR呈高信号,3例肿瘤内见低信号未强化分隔,6例见裂隙状高信号;最大径线2.4~7.5cm;2例呈圆形、类圆形,6例呈分叶状;8例边缘均较清晰;增强扫描病灶均呈不均匀强化;7例PTs早期强化率大于100%,1例50%且100%;TIC类型1例为流入型,5例为平台型,2例为廓清型。DWI病灶均呈高信号,且ADC值低于正常腺体,PTs平均ADC值为(1.30±0.25)×10-3 mm2/s,正常腺体ADC值为(1.64±0.12)×10-3 mm2/s,二者差异有统计学意义(t=3.375,P0.05)。结论:乳腺PTs的MRI征象具有一定的特征性,结合其临床特点综合分析,可提高其术前诊断准确率。     

Malignant or borderline mucinous cystic neoplasms have a larger number of loculi than mucinous cystadenoma: a retrospective study with MR

PURPOSE: To determine whether there is any correlation between the number of loculi and the pathological grade of malignancy in mucinous cystic tumors of the ovary. MATERIALS AND METHODS: We retrospectively studied MR images of 67 pathologically proven mucinous cystic tumors of the ovaries. Of these 67 cases, 38 were cystadenomas and 29 were malignant lesions (18 borderline malignancy and 11 adenocarcinomas). We counted the number of loculi and measured the maximum diameter of masses on MRI. We compared the number, the maximum diameter, and the ratio of the number of loculi to the maximum diameter in each adenoma and malignancy using Student's t-test. RESULTS: The mean number of loculi was 18.2 in cystadenoma and 80.9 in malignant lesions. The mean maximum diameter of tumors was 13.0 cm in cystadenoma and 18.7 cm in malignant lesions. The mean ratio of the number of loculi to the maximum diameter was 1.3 in adenoma and 5.4 in malignant lesions. The differences between the benign and malignant lesions were statistically significant in number (P = 0.001), maximum diameter (P = 0.011), and ratio (P = 0.002). CONCLUSION: Ovarian mucinous neoplasm of borderline malignancy and mucinous adenocarcinomas had a larger number of loculi than adenomas.     

Phyllodes tumours of the breast: radiological presentation,management and follow-up

Objective:

Phyllodes tumours (PTs) are rare neoplasms accounting for <1% of breast lesions. With increased breast awareness and screening programmes, smaller PTs are being detected. The purpose of this study was to determine the clinical, radiological and pathological presentation of PTs and to evaluate the role of imaging follow-up, for which there are no specific guidelines.

Methods:

A retrospective study of all patients diagnosed with PT in a symptomatic unit between January 2006 and March 2013 was carried out. Patients were identified using breast care and electronic patient record databases.

Results:

53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs.

Conclusion:

Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology.

Advances in knowledge:

We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.Phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms accounting for <1% of all breast lesions.¹ In the literature, they have been described as occurring in females aged 35–55 years, typically 15–20 years older than females with fibroadenomas (FAs) and with a higher incidence in Asian females.^2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed.⁴ Histologically, PTs can be identified by their distinctive leaf-like architecture and increased stromal cellularity.⁵ Typically, PTs present as a palpable breast lump and were traditionally differentiated from FAs based on their larger size at presentation.⁶ However, with increased breast awareness and screening programmes, smaller and incidental lesions are being found on imaging.⁶ In symptomatic breast clinics, including this institution, “triple assessment” consisting an initial physical examination, followed by radiological imaging (ultrasound and/or mammography) and histological sampling either by fine-needle aspiration cytology (FNAC) or core biopsy is the standard diagnostic pathway for palpable breast lesions. The purpose of triple assessment is to provide a more accurate pre-operative diagnosis to ensure proper surgical planning and avoiding re-excision or tumour recurrence.⁷According to the World Health Organization criteria, there are two grading systems for PTs; a two-tiered system or a three-tiered system.⁸ Our institution employs the three-tiered system, the subgroups being benign, borderline and malignant. Grading is based on semi-quantitative assessment of stromal cellularity, cellular pleomorphism, mitotic activity, margin appearance and stromal distribution. The standard procedure for treatment, no matter what the grade of the PT, is surgical wide local excision, preferably with clear margins of at least 1 cm. However, owing to the fact that most PTs are not fully diagnosed pre-operatively, initial surgery does not always provide adequate margins necessitating frequent post-operative re-excision of the margins.³The purpose of our study was to determine the radiological findings in females diagnosed with PT in our institution, including both initial presentation and subsequent representations. Based on the findings of the study and review of the literature, a suitable protocol for the imaging follow-up of these females was to be proposed.     

99Tcm—MIBI显像对腮腺区肿块的诊断价值

目的探讨99Tc^m_MIBI显像在腮腺肿块术前定性诊断中的价值。方法对32例单侧腮腺肿块患者术前行腮腺区99Te^m-MIBI显像,所有病例均行早期和延期显像以判断肿块性质。判断结果与病理诊断相比较。定性分析行Fisher确切概率法检验,组间病变侧与对侧放射性摄取比值（T／N）比较行t检验。结果99TcA^m．MIBI显像对腮腺区恶性肿瘤诊断的灵敏度、特异性和准确性分别为90．00％（9／10）、86．36％（19／22）和87．50％（28／32）。22例腮腺区良性肿块中显像阴性19例（86．36％）,假阳性3例（13．64％）;10例腮腺恶性肿块中显像阳性9例（90．00％）,假阴性1例（10．00％）;定性分析经Fisher确切概率法检验差异有统计学意义（P=0．00018）。腮腺区良恶性肿块T／N：早期相分别为1．45±0．38和1．65-t-O．63,两者差异有统计学意义（t=20．4,P〈0．01）;延期相分别为1．43±0．56和1．77-4-0．59,两者差异也有统计学意义（t=2．4,P〈0．05）。结论99Tc^m一MIBI显像可作为腮腺区肿块术前定性诊断的有效辅助手段。     

乳腺叶状肿瘤声像图特征及误诊分析

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。