乳腺纤维腺瘤的超声诊断及误诊分析

目的探讨乳腺纤维腺瘤的典型与非典型超声特征及诊断结果，对超声误诊率进行分析。 方法回顾性分析2015年至2020年在湖北医药学院附属太和医院经手术病理证实的乳腺纤维腺瘤患者392例（401个肿块）的典型与非典型超声声像图特征及诊断结果。以病理结果为标准，比较不同年龄、不同直径大小、不同非典型特征以及不同病理类型的肿块超声误诊率的差异。 结果401个肿块中，超声观察到非典型特征的123个，其中正确诊断40个，误诊83个；超声表现为典型特征的278个，均正确诊断。直径＜1 cm病灶的误诊率（31.5%）和直径＞3 cm病灶的误诊率（34.9%）显著高于直径1~3 cm病灶的误诊率（16.8%），差异均有统计学意义（P均＜0.017）。非典型特征≥2种的肿块其超声误诊率（83.5%）显著高于无非典型特征（0）及有1种非典型特征肿块的误诊率（38.6%），差异均有统计学意义（P均＜0.001）。复杂型纤维腺瘤87个，非复杂型纤维腺瘤314个，复杂型纤维腺瘤的误诊率（71.2%）显著高于非复杂型纤维腺瘤（6.7%），差异有统计学意义（χ²=1.731，P＜0.001）。复杂型纤维腺瘤以非典型特征≥2种的肿块居多（79.3%），与非复杂型纤维腺瘤的非典型特征比较，差异有统计学意义（χ²=2.870，P＜0.001）。 结论纤维腺瘤的超声误诊率与非典型特征的多少、肿块直径的大小有关，复杂型纤维腺瘤超声声像图更易表现出非典型特征而被误诊。

Ultrasonic diagnosis of breast fibroadenoma and analysis of causes of misdiagnosis

ObjectiveTo investigate the typical and atypical ultrasound features of breast fibroadenoma, and analyze the causes of ultrasound misdiagnosis. MethodsA retrospective analysis was performed on 392 cases (401 masses) of breast fibroadenoma confirmed by surgery and pathology at Taihe Hospital Affiliated to Hubei Medical College from 2015 to 2020. Based on the pathological results, we compared the ultrasonic misdiagnosis rate by patient ages, tumor diameter, atypical feature, and pathological type. ResultsAmong the 401 masses included, 123 atypical features were observed by ultrasonography, of which 40 were correctly diagnosed and 83 were misdiagnosed; 278 cases with typical ultrasonic features were diagnosed correctly. The misdiagnosis rate of lesions with a diameter less than 1 cm (31.5%) and larger than 3 cm (34.9%) was significantly higher than that of lesions with a diameter of 1~3 cm (16.8%; P＜0.017). The ultrasonic misdiagnosis rate of tumors with ≥2 atypical features (83.5%) was significantly higher than that of tumors without atypical features (0) and with 1 atypical feature (38.6%; P＜0.001). There were 87 complex fibroadenomas and 314 noncomplex fibroadenomas. The misdiagnosis rate of complex fibroadenomas (71.2%) was significantly higher than that of noncomplex fibroadenomas (6.7%; χ²=1.731, P＜0.001). The number of atypical features of complex fibroadenoma was often more than or equal to 2, and the percentage of complex fibroadenomas with more than or equal to 2 atypical features was significantly higher than that of noncomplex fibroadenomas (χ²=2.870, P＜0.001). ConclusionThe ultrasonic misdiagnosis rate of fibroadenoma is related to the number of atypical features and the size of the mass. Complex fibroadenoma are more likely to show atypical ultrasonic features and be misdiagnosed.