彩色多普勒超声对乳腺髓样癌的鉴别诊断价值

目的 探讨乳腺髓样癌的超声表现及临床特征.方法 回顾性分析1 997年～2012年经手术病理证实的乳腺髓样癌12例,术前进行超声检查,术后病理诊断、免疫组化检测,并随机选择同期浸润性导管癌120例进行对比分析.结果 髓样癌超声表现形态规则9例（75％）,浸润性导管癌形态规则46例（38.33％）,x2=6.0343,P=0.014;髓样癌超声表现后方效应增强9例（75％）,浸润性导管癌后方效应增强31例（25.83％）,x2=12.4862,P=0.0004;髓样癌超声表现血流信号丰富5例（55.6％）,浸润性导管癌血流信号丰富51例（42.5％）,x2=0.5809,P=0.446;髓样癌超声表现腋下淋巴结肿大2例（1 6.7％）,浸润性性导管癌腋下淋巴结肿大56例（46.7％）,x2=3.9858,P=0.0459;髓样癌cerb B2表达阳性者3例（25％）,浸润性性导管癌阳性者67例（55.8％）,x2=4.1638,P=0.0413;髓样癌、浸润性性导管癌腋下淋巴结肿大与c-erbB-2表达均存在相关性（P＜0.05）.结论乳腺髓样癌超声特征表现为：体积较大,形态规则,后方效应增强,肿瘤内部血流信号丰富,腋下淋巴结肿大较少,c-erbB-2阴性表达.

Ultrasonic manifestations of breast medullary carcinoma

Objective To explore the sonographic features of mammary gland medullary carcinoma. Methods Ultra- sonography of 12 cases in breast medullary carcinoma （MC）confirmed by surgery and pathology in our hospital was retro- spectively analyzed and compared with 120 cases of infiltrating ductal carcinoma （IDC） by random selection. Preoperative ultrasound feature included tumor shape, acoustic enhancement, internal blood flow signal, positive axillary nodes. Cerb- B2 expression of MC and IDC by immunohistochemical detection in pathologic specimens were also compared and analyzed with positive axillary nodes. Results Regular margin （9/12,75%） in MC was more common than that in IDC （46/120, 38. 330//00） （;（2：6. 0343, P ~0.014）. Posterior acoustic enhancement was more common in MC（9/12,75%） than in IDC （31/120, 25.83%） （;（2=12. 4862, P ~0.0004）. The degree of blood flow signal in MC（5/9,55.6%） was similar as in IDC （51/120, 42.5%） （X2 --0. 5809, P =0. 446）. Axillary node enlargement was less common in MC （2/12,16. 7~/00） than in IDC（56/120, 46.7%） （X2-3. 9858, P =0. 0459）. Expression of c-erbB-2 in immunohistochemistry was less com- mon in MC（3/12,25%） than inIDC（67/120,55.8~/00） （X2：4.1638, P 0. 0413）. Axillary node in MC and IDC was in correlation with positive expression of c-erbB-2. Conclusion Ultrasonic characteristics of breast medullary carcinoma in- cludes regular margin, posterior acoustic enhancement, affluent internal blood flow signal, and rare axillary node, which is associated with more negative c-erbB-2.