高频超声对乳腺脂肪坏死的诊断价值

目的总结乳腺不同位置脂肪坏死病灶的声像图表现，探讨高频超声对乳腺脂肪坏死的诊断价值。 方法回顾性分析2014年1月至2019年9月首都医科大学附属天坛医院收治的经手术病理证实的63例乳腺脂肪坏死患者的临床及影像学资料，63例患者共69个病灶，所有患者术前均行超声检查。根据病灶的所在部位（皮下脂肪层、皮下脂肪层与腺体层均累及、腺体层），将其分为腺外型、交界型和腺内型。总结并比较不同类型组间的超声特征。 结果63例患者中22例有外伤或手术史，7例既往有乳腺炎性病变。患者多无临床症状或因偶然发现肿物就诊。根据超声声像图中病灶位置将69个病灶分为腺外型31个、交界型26个、腺内型10个，2个漏诊。腺外型与腺内型声像图特征差异均无统计学意义（P均>0.05）。交界型同腺外型和腺内型的声像图比较，部分表现差异有统计学意义，包括形状、边界、病灶血流情况、与周围组织分界、与周围皮肤关系及同侧腋窝淋巴是否肿大（P=0.045、0.001、0.025、0.001、0.001、0.019）；而有无包膜、回声类型、钙化类型、后方回声情况及患者病灶数目3组间比较差异均无统计学意义（P均>0.05）。超声漏诊2个病灶（2/69，2.9%），误诊为可疑恶性病灶（BI-RADS 4b类）5个（5/67，7.5%）。 结论乳腺脂肪坏死的声像图及临床表现多样，应用高频超声观察不同位置病灶的声像图表现，详细了解相关病史，特别是外伤史、手术史等临床信息，有助于术前正确诊断乳腺脂肪坏死。

Diagnostic value of high frequency ultrasound in breast fat necrosis

ObjectiveTo summarize the sonographic characteristics of breast fat necrosis at different locations, and estimate the diagnostic value of high frequency ultrasound for fat necrosis. MethodsClinical and imaging data of 63 patients with breast fat necrosis confirmed by surgery were retrospectively analyzed from January 2014 to September 2019 at Beijing Tiantan Hospital, Capital Medical University. The 63 patients with 69 lesions were all examined by ultrasound before operation. According to the location (fat layer, both fat layer and gland, and gland), the lesions were divided to extra-glandular type, junctional type, and intra-glandular type. Ultrasonic features of different types were summarized and compared. ResultsOf the 63 patients, 22 had a history of trauma or surgery and 7 had previous inflammatory lesions. The patients were mostly asymptomatic or the mass was discovered accidentally. According to the location of the 69 lesions in ultrasound images, excluding two missed cases, 31 belonged to extra-glandular type, 26 belonged to junctional type, and 10 belonged to intra-glandular type. There were no statistically significant differences in sonographic findings between the extra-glandular and intra-glandular types (P>0.05). We observed statistically significant differences in some sonographic features between the junctional type and extra-glandular or intra-glandular type, including shape, boundary, blood flow, relationship with adjacent tissues and skin, and enlargement of ipsilateral axillary lymph nodes (P=0.045, 0.001, 0.025, 0.001, 0.01, and 0.019, respectively). There was no significant difference in capsule, echo type, calcification type, posterior echo condition, or the number of lesions among the tree types (P>0.05). Two (2/69, 2.9%) lesions were missed by ultrasound, and five (5/67, 7.5%) were diagnosed as potential malignancies (BI-RADS 4b). ConclusionThe sonographic and clinical manifestations of breast fat necrosis are diverse. Obtaining sonographic manifestations of lesions in different locations by high frequency ultrasound, inquiring relevant history and associated diseases, especially trauma or surgical history, and acquiring other clinical information are very helpful to make a correct diagnosis of breast fat necrosis.