乳腺黏液癌的影像学特征分析

目的 评价乳腺黏液癌的超声、X线等影像学特征及其与病理组织类型的相关性.方法 回顾性分析21例经手术病理证实的乳腺黏液癌患者(22个病灶)的超声、X线特征及与病理组织类型之间的关系.结果 病理组织学分类包括14个单纯型(6个富细胞型,8个少细胞型)和8个混合型病灶.超声:所有病例均存在实性肿块,85.71％(12/14)的单纯型肿块境界清晰,回声等或略低于皮下脂肪,92.86％(13/14)的单纯型病灶后方回声增强；75.00％(6/8)的混合型和14.29％(2/14)的单纯型肿块边界较模糊并细小毛刺,内部回声较脂肪回声低.超声和X线片术前怀疑恶性的比例均为63.64％(14/22).恶性X线表现包括肿块(10个)、局限性不对称致密影(2个)、结构扭曲并恶性钙化和单纯不定性钙化(各1个).肿块主要为高密度,单纯型边界清楚或呈浅分叶状,混合型边界不规则和毛刺改变.81.82％(18/22)的病灶被超声或X线之一疑诊恶性,45.45％(10/22)的病灶术前超声和X线均疑为恶性.结论 乳腺黏液癌尤其单纯型影像学特征不典型,超声和X线诊断均可能诊断为良性病变；肿块边缘特征是鉴别良恶性的重要依据,混合型肿块较单纯型更具有浸润性特征；超声和X线联合诊断有利于避免误诊,两者之一怀疑恶性时,即应行穿刺活检以明确诊断.

Analysis of image features of breast mucinous carcinoma

Objective: To evaluate the correlation between ultrasonic and X-ray features and pathological types of breast mucinous carcinoma. Methods: Twenty-one patients with 22 focuses of breast mucinous carcinoma confirmed pathologically were enrolled. The correlation between the ultrasonic and mammogram findings and histological features were analyzed retrospectively. Results: These 22 focuses of breast mucinous carcinoma included pure type (n=14) and mixed type (n=8), the former included 6 cellular type and 8 hypocellular type. On US examination, all patients had solid mass. The pure type masses showed well-defined margins without pseudocapsule and isoechogenic or hypoechoic internal echo pattern relative to that of subcutaneous fat in 85.71% (12/14) focuses, 92.86% (13/14) pure type focuses had posterior enhancement, while 75.00% (6/8) of mixed type lumps and 14.29% (2/14) of pure type lumps demonstrated as ill-defined and/or spiculated margins with hypoechogenic structure. There were 63.64% (14/22) of lesions classified as BI-RADS 4 or 5 suspected as malignancy by ultrasonography and mammograms, respectively. These mammograms features contained 10 masses, 2 focal asymmetries, 1 architectural distortion with malignant calcification and 1 isolated indifferent calcification. The main mammographic appearances of masses were well-defined margins with microlobulation for pure type, poorly differentiated or speculated margins for mixed type. There was 81.82% (18/22) of focuses suspected as malignancy by mammography or ultrasonography. There was 45.45% (10/22) of focuses suspected as malignancy by both mammogram and ultrasonography. Conclusion: Mucinous breast carcinomas, especially pure type ones do not have typical image features, which might be diagnosed as benign focuses by mammography and/or ultrasound. Margins of the masses are very important for differential diagnosis. Mixed type mucinous carcinomas have more aggressive imaging characteristics, which demonstrate ill-defined and/or speculated margins. Combination of mammogram with ultrasonography is helpful to avoiding miss. Biopsy should be performed when malignancy is suspected by mammogram or ultrasonography.