乳腺導管內乳頭狀瘤超聲診斷回顧性分析

宋旭光 許華寧 何玉冰

摘 要：目的 回顧性分析乳腺導管內乳頭狀瘤超聲圖像特點及誤診原因，提高診斷準確率。方法 回顧性分析我院經手術病理證實的50例乳腺導管內乳頭狀瘤患者的彩色多普勒超聲圖像特點，根據聲像圖特征分為5型，觀察超聲圖像分型、血流信號分類及BI-RADS分類標準。結果 50例患者共65個病灶，37個病灶超聲診斷與病理結果相符合，診斷準確率為56.92%。其中Ⅰ型：導管擴張伴導管內實性結節，19個病灶，2個誤診；Ⅱ型：導管擴張伴遠端中斷處實性團塊，5個病灶，1個誤診；Ⅲ型：囊實性混合回聲團塊，15個病灶，5個誤診；Ⅳ型：實性團塊而無導管擴張，24個病灶，19個誤診；Ⅴ型：單純導管擴張，2個病灶，2個誤診。彩色血流信號結果：23個病灶表現為0級；19個病灶表現為Ⅰ級；10個病灶表現為Ⅱ級；13個病灶表現為Ⅲ級。BI-RADS分類結果：2類2個病灶；3類59個病灶；4A類3個病灶；4C類1個病灶。結論 乳腺導管內乳頭狀瘤的超聲表現有多種類型，診斷時應結合臨床表現，運用多種超聲成像方法綜合診斷，以便進一步提高診斷準確率。

關鍵詞：乳腺；導管內乳頭狀瘤；超聲檢查

中圖分類號：R737.9 文獻標識碼：B DOI：10.3969/j.issn.1006-1959.2018.23.045

文章編號：1006-1959（2018）23-0155-04

Abstract：Objective To retrospectively analyze the ultrasonographic features and misdiagnosis reasons of intraductal papilloma of mammary gland and improve the diagnostic accuracy. Methods The color doppler ultrasonographic features of intraductal papilloma of mammary gland in 50 patients confirmed by surgery and pathology in our hospital were retrospectively analyzed. According to the ultrasonographic features， they were divided into 5 types， and the ultrasonic image classification， blood flow signal classification and BI-RADS classification criteria were observed. Results There were 65 lesions in 50 patients， 37 lesions were diagnosed by ultrasound in accordance with pathological results， and the diagnostic accuracy was 56.92%. The Ⅰ type： duct expansion with intraductal solid nodules， 19 lesions， 2 misdiagnosis； Ⅱ type： distal catheter with intermitting position or solid mass，5 lesions， 1 misdiagnosis； Ⅲ type： cystic or solid mixed echo conglomeration， 15 lesions， 5 misdiagnosed； Ⅳ type： solid mass without duct expansion， 24 lesions， 19 misdiagnosed； Ⅴ type： pure duct expansion， and 2 lesions， 2 misdiagnosis. Color blood flow signal results： 23 lesions showed grade 0； 19 lesions characterized by Ⅰ level； 10 lesions characterized by Ⅱ level； 13 lesions characterized by Ⅲ level. BI-RADS classification results： 2 categories and 2 lesions； 59 lesions in 3 categories； category 4A： 3 lesions； category 4C： 1 lesion. Conclusion There are many types of ultrasound findings of intraductal papilloma of the breast. The diagnosis should be combined with clinical manifestations， and a variety of ultrasound imaging methods should be used for comprehensive diagnosis to further improve the diagnostic accuracy.

Key words：Mammary gland；Intraductal papilloma；Ultrasonography

乳腺導管內乳頭狀瘤（intraductal papilloma，IDP）是一種乳腺良性腫瘤，單發多見，具有一定的惡變傾向，惡變率約5%[1]。導管內乳頭狀瘤體積較小，臨床往往難以捫及，超聲作為一種無創、易行的檢查方法，在乳腺疾病診斷中具有重要價值。近年來，高頻探頭的使用大大提高了乳腺導管內乳頭狀瘤的檢出率。本文回顧性分析我院50例經手術……