特殊类型乳腺癌的超声诊断与病理学基础对照分析

目的探讨特殊类型乳腺癌的超声诊断与其病理特征的关系,提高超声检查对特殊类型乳腺癌的诊断水平。方法回顾性分析我院31例经手术或空心针穿刺病理证实为特殊类型乳腺癌患者的超声图像,研究其与病理学的相关性。结果(1)浸润性小叶癌11例、黏液癌10例、化生性癌4例、浸润性微乳头状癌2例、伴神经内分泌特征的癌2例,伴髓样特征的癌、腺样囊性癌各1例。(2)浸润性小叶癌细胞缺乏黏附性,超声多表现为形态不规则,边缘不光整,低回声肿块内伴部分高回声区,BI-RADS分类4b类5例,4c类6例;黏液癌为凝胶样病变,超声表现肿块内部可出现液化区,血流信号以Ⅰ~Ⅱ级居多,BI-RADS分类4a类3例,4b类5例,4c类2例;化生性癌易囊性变、血流信号Ⅲ级居多,BI-RADS分类4b类2例,4c类2例;浸润性微乳头状癌由于存在透明间隙,肿块边缘无“蟹足样”表现及高回声晕,BI-RADS分类4a类1例,4c类1例;伴神经内分泌特征的癌超声表现缺乏特征性,BI-RADS分类4b类1例,4c类1例;伴髓样特征的癌具有推挤性边界,BI-RADS分类4c类1例;腺样囊性癌含有腺腔结构,肿块后方回声增强,BI-RADS分类4b类1例。结论特殊类型乳腺癌有各自的声像图特征,并有特定的病理学基础。由于其典型恶性超声征象不足,对于BI-RADS分类4a类的肿块仍需提醒临床重视。

Comparative Study between Ultrasonic Diagnosis and Pathological Features of Special types of Breast Cancer

Objective Discussion the relationship between ultrasonographic and pathological features of special types of breast cancer,to improve the diagnostic level of special types of breast cancer.Methods The ultrasonographic and pathological features of 31patients with special types of breast cancer were retrospectively analyzed.Results(1)Invasive lobular carcinoma 11cases、mucinous carcinoma 10cases、metaplastic carcinoma 4cases、invasive micropapillary carcinoma 2cases、carcinomas with neuroendocrine 2cases、carcinomas with medullary features 1case、adenoid cystic carcinoma 1case.(2)Invasive lobular carcinoma cells lack adhesion,most masses had irregular shape,not circumscribed margin and partial hyperechoic zone.There were 5cases of 4band 6cases of 4cclassified by BIRADS.Mucinous carcinoma was a gelatinous lesion.Masses contained liquefied zone,the blood flow signal were mainlyⅠ-Ⅱgrade.There were 3cases of BI-RADS class 4a,5cases of class 4band 2cases of class 4c.Metaplastic carcinoma had cystic change andⅢgrade of blood flow signal.There were 2cases of class 4band 2cases of class 4cin BIRADS classification.Because of the pellucid zone,invasive micropapillary carcinoma of breast had no long speculation and no hyperechoic halo.There were 1case of BI-RADS class 4aand 1case of class 4c.The ultrasonographic findings of carcinomas with neuroendocrine were not characteristic.There were 1case of class 4band 1case of class 4cclassified by BI-RADS.Carcinomas with medullary features had a push boundary.There was 1case of class 4cclassified by BIRADS.Adenoid cystic carcinoma contained glandular cavity,and the echo was enhanced in the posterior part of the mass.1case of class 4bclassified by BI-RADS.Conclusions Special types of breast cancer had their own ultrasonographic features and specific pathological basis.Due to the lack of typical malignant ultrasound signs,clinical attention still should be paid to BI-RADS classified 4amasses.