彩色多普勒血流显像及乳腺内筋膜韧带声像变化对鉴别诊断乳腺小肿块的价值

背景与目的:彩色多普勒血流显像(colorDopplerflowimaging,CDFI)已广泛应用于乳腺肿块的超声诊断,但CDFI结合乳腺内筋膜韧带(浅、深筋膜和Cooper韧带)的声像变化在鉴别诊断乳腺小肿块(直径≤2cm)中应用的文献报道甚少。本研究探讨CDFI结合乳腺筋膜和Cooper韧带的声像改变在鉴别诊断小乳癌的应用价值。方法:对乳腺肿块直径≤2cm的110例患者(经术后病理确诊为良性52例,恶性58例)进行CDFI检查,分析乳腺病灶内部和周边的血流分布及多普勒频谱。根据血流丰富程度分成四个等级,并结合乳腺内筋膜韧带(浅、深筋膜和Cooper韧带)受浸润情况的观察,将诊断结果与病理结果进行对照。结果:超声对乳腺良、恶性小肿块诊断的符合率分别为:90.4%、84.5%。假阳性率为9.6%;假阴性率为15.5%。良恶性肿块的血流分级和收缩期流速峰值(Vmax)、阻力指数(RI)及浅、深筋膜和Cooper韧带的声像变化均有显著性差异。结论:CDFI结合乳腺内筋膜及韧带的声像变化,对乳腺小肿块的诊断和鉴别诊断具有一定的临床应用价值。

Values of color Doppler flow imaging and imaging changes of breast fascia and ligament in differential diagnosis of small breast neoplasms

BACKGROUND & OBJECTIVE: Color Doppler flow imaging (CDFI) has been widely applied to the diagnosis of breast neoplasms. But combined use of CDFI and imaging changes of breast fascia and ligament (superficial and deep fascia, and Cooper's ligament) on the differential diagnosis of small breast neoplasms (< or =2 cm) has rarely been reported. This study was to explore the value of combined use of CDFI and imaging changes of breast fascia and ligament in differential diagnosis of small breast neoplasms. METHODS: CDFI was performed on 110 patients with small breast neoplasms. Among them, 52 cases were diagnosed to be benign by pathologic examination after surgery, while the rest 58 were malignant. The blood flow and Doppler image inside and around the breast lesions were analyzed. Four grades were classified according to blood flow imaging. The infiltration of breast fascia and ligament was also considered. The CDFI result was compared with that of pathologic examination. RESULTS: The correct diagnosis rates of CDFI in diagnosing benign and malignant small breast neoplasms were 90.4% and 84.5%, respectively. The false-positive and false-negative rates of CDFI were 9.6% and 15.5%, respectively. There were obvious differences in blood flow grading, systolic maximum velocity (V(max)), resistance index (RI), and imaging changes of superficial, deep fascia and Cooper's ligament between benign and malignant small breast neoplasms. CONCLUSION: Combination of CDFI with imaging changes of breast fascia and ligament is valuable in clinical diagnosis and differential diagnosis of small breast neoplasms.