乳腺淋巴瘤的彩色多普勒超声诊断及鉴别诊断

目的探讨乳腺淋巴瘤的彩色多普勒超声声像图特点,提高超声诊断符合率。方法回顾性分析福建省肿瘤医院2011年6月至2020年1月21例乳腺淋巴瘤患者24个病灶的彩色多普勒超声声像图特征,统计诊断符合率。结果患者均为女性,18例单侧乳腺发病,3例双侧乳腺发病,所有病例均经粗针穿刺活组织检查或手术病理证实为原发性或继发性乳腺淋巴瘤。病理类型包括弥漫大B细胞淋巴瘤18例(85.7%),间变性大细胞淋巴瘤激酶(ALK)阴性间变性大细胞淋巴瘤1例,伯基特淋巴瘤1例,伯基特淋巴瘤或介于弥漫大B细胞淋巴瘤与伯基特淋巴瘤之间不能分类的淋巴瘤1例。病灶长径(5.7±2.1)cm,范围1.4~16.0 cm,超声均表现为实性病灶;肿块型病灶19个(79.2%),弥漫型病灶5个(20.8%)。病灶按内部回声特点分为单纯低回声型(2个,8.3%)、高回声裹挟型(12个,50.0%)和低-高回声交织型(10个,41.7%)。按Adler血流半定量法分级,病灶血流情况为Ⅰ级3个(12.5%),Ⅱ级6个(25.0%),Ⅲ级15个(62.5%)。彩色多普勒超声病灶检出率为100.0%(24/24),但诊断符合率仅为41.7%(10/24)。结论乳腺淋巴瘤多数为弥漫大B细胞淋巴瘤,彩色多普勒超声可有效检出病灶,但诊断符合率较低。大部分乳腺淋巴瘤呈肿块型生长,内部血流信号较丰富,当乳腺病灶超声声像图呈低回声裹挟或交织高回声时,应考虑到乳腺淋巴瘤的可能。

Diagnosis and differential diagnosis of breast lymphoma by color Doppler ultrasound

Objective:To explore the characteristics of color Doppler ultrasound images of breast lymphoma, and to improve the coincidence rate of ultrasound diagnosis.Methods:The color Doppler ultrasound images characteristics of 24 lesions in 21 patients with breast lymphoma in Fujian Cancer Hospital from June 2011 to January 2020 were retrospectively analyzed, and the diagnostic coincidence rate was counted.Results:All the patients were female, 18 cases were unilateral, 3 cases were bilateral. ALL cases were confirmed as primary or secondary breast lymphoma by coarse needle biopsy or surgical pathology. Pathological types included 18 cases (85.7%) of diffuse large B-cell lymphoma, 1 case of anaplastic large cell lymphoma kinase (ALK)-negative anaplastic large cell lymphoma, 1 case of Burkitt lymphoma, 1 case of Burkitt lymphoma or unclassifiable lymphoma with features intermediated between diffuse large B-cell lymphoma and Burkitt lymphoma. The maximum diameter of the lesions was (5.7±2.1) cm (range 1.4-16.0 cm), and all lesions were solid in ultrasound images; 19 lesions (79.2%) were mass-type and 5 lesions (20.8%) were diffuse. According to the characteristics of internal echo, the lesions were divided into hypoechogenicity (2 lesions, 8.3%), hyperechogenicity packed with hypoechogenicity (12 lesions, 50.0%), and hyperechogenicity interweaved with hypoechogenicity (10 lesions, 41.7%). According to Adler semi-quantitative method, the blood flow of the lesions was 3 lesions (12.5%) in grade Ⅰ, 6 lesions (25.0%) in grade Ⅱ, and 15 lesions (62.5%) in grade Ⅲ. The detection rate of lesions by color Doppler ultrasound was 100.0% (24/24), but the diagnostic coincidence rate was only 41.7% (10/24).Conclusions:Most of the breast lymphoma is diffuse large B-cell lymphoma, and the lesions can be effectively screened by color Doppler ultrasound, but the diagnostic coincidence rate is low. Most of the breast lymphoma grows in the form of mass with abundant internal blood flow signals. When the ultrasound image of the breast lesion is hyperechoic packed or interweaved with hypoechoic, the possibility of breast lymphoma should be considered.