乳腺单纯性黏液癌的超声诊断及其病理学基础

目的 分析乳腺单纯性黏液癌常规超声声像图与弹性成像特征及其病理学基础,以提高超声诊断准确率. 方法 回顾性分析15例单纯性乳腺黏液癌术前常规超声声像图表现及超声弹性成像参数（弹性图评分、弹性指数及弹性应变比值）,并与术后病理组织学对照. 结果 单纯性乳腺黏液癌不同于其他浸润性乳腺癌的声像图特点为多具有膨胀感,边界清晰,部分向脂肪层突出,呈中等近似脂肪回声,后方回声增强,肿物内部彩色多普勒血流信号不丰富,周边可见血流绕行,缺乏穿入型血流.15例肿块弹性图评分较低为3.2 ±0.77,病灶整体弹性指数为2.91 ±1.03,弹性应变比值为1.88 ±0.41.其病理学特点为癌细胞被大量黏液包绕,黏液间可见稀少的间质纤维分隔. 结论 乳腺黏液癌特殊的病理学特点决定了超声声像图表现及弹性成像特征,正确认识其病理学基础有助于单纯性黏液癌的超声诊断及鉴别诊断.

Ultrasonic diagnosis and the pathology of pure mucinous breast carcinoma

Objective To analyze the ultrasonic manifestations and elastography of pure mucinous breast carcinoma for improving the accuracy of ultrasonic diagnosis.Methods Ultrasonography and elastography parameter （elastography scores,elasto index and elasto strain ratio） of 15 cases of pure mucinous breast carcinoma（PMBC） before operation were compared with pathology after surgery.Results Ultrasonic manifestations of PMBC were different from other kinds of invasive breast carcinoma.PMBC mostly showed a smooth pushing border and clear boundary,some of which stretched out to the fat layer,tend to be isoechogenicity similar to the fat with posterior acoustic enhancement.Intratumoral color Doppler signal of PMBC was not rich,vessels often surrounded the border of lesions,while the penetrating vessel type was rare.Mean ultrasonic elastography score of 15 cases was 3.0 ±0.76,the elastic index of the whole mass was 2.91 ± 1.03,and the strain ratio was 1.88 ±0.41.Pathologic features of PMBC showed that carcinoma cells were surrounded by a large number of mucin,and few matrix fibrous septa distributed in the mucin.Conclusion The specific pathology features of PMBC determine the manifestations of conventional sonography and elastography,and the correct understanding is helpful to increase the accuracy of ultrasonic diagnosis and differential diagnosis.