超聲檢查在原發性乳腺淋巴瘤診斷中的臨床價值及其與Ki-67表達的關系

孫小玲　李霞　何薇　褚洪毅

摘要：目的 ?探討超聲檢查在原發性乳腺淋巴瘤診斷中的臨床價值及其與Ki-67表達的關系。方法 ?抽取2014年1月～2019年12月我院收治的21例原發性乳腺淋巴瘤患者的臨床資料，均行常規超聲檢查及免疫組化檢查，以Ki-67表達80%為界分為Ki-67表達≥80%組與Ki-67表達<80%組，分析原發性乳腺淋巴瘤患者的超聲圖像特征及其與Ki-67表達的關系。結果 ?21例腫塊型患者中20例為單發腫塊，1例多發腫塊;腫塊橫徑20～82 mm，平均橫徑（23.13±11.81）mm;腫塊多位于乳腺中央部位或外上象限，多表現為不規則形態或橢圓形，邊緣不光整，多數無毛刺征，存在不均勻內部回聲，少部分為均勻內部回聲，后方回聲多數表現為增強，多數腫塊病灶內有較強的血流信號，Adler血流分級Ⅱ～Ⅲ級。Ki-67表達<50%者2例，Ki-67表達50%～79%者5例，Ki-67表達80%～100%者14例，其中Ki-67表達≥80%組腫塊的毛刺征占比低于Ki-67表達<80%組（14.29% vs 100.00%），差異有統計學意義（P<0.05）;兩組大小、邊緣、形態、內部回聲、后方回聲、血流信號占比比較，差異均無統計學意義（P>0.05）。結論 ?原發性乳腺淋巴瘤在超聲表現上有一定的特征，且其超聲表現與Ki-67表達水平存在一定的關系，二者結合有助于進一步明確原發性乳腺淋巴瘤患者的超聲特征，從而提高超聲檢查對此病的檢出率，為臨床診斷、治療、預后判斷提供參考依據。

關鍵詞：原發性乳腺淋巴瘤;超聲表現;毛刺征;Ki-67表達

中圖分類號：R733.4 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.18.023

文章編號：1006-1959（2020）18-0077-03

The Clinical Value of Ultrasound in the Diagnosis of Primary Breast Lymphoma and

Its Relation with the Expression of Ki-67

SUN Xiao-ling，LI Xia，HE Wei，CHU Hong-yi

（Department of Ultrasound，People's Hospital of Pidu District，Chengdu 611730，Sichuan，China）

Abstract：Objective ?To explore the clinical value of ultrasound in the diagnosis of primary breast lymphoma and its relation with the expression of Ki-67.Methods ?The clinical data of 21 patients with primary breast lymphoma admitted to our hospital from January 2014 to December 2019 were collected. Routine ultrasound and immunohistochemical examinations were performed. The Ki-67 expression was 80% as the boundary. Ki-67 expression ≥80% group and Ki-67 expression <80% group， the ultrasound image characteristics of patients with primary breast lymphoma and its relationship with Ki-67 expression were analyzed.Results ?Among 21 patients with mass type， 20 cases were single masses and 1 case was multiple masses; the transverse diameter of the masses was 20-82 mm， and the average transverse diameter was （23.13±11.81） mm; the masses were mostly located in the central part of the breast or the upper outer quadrant， and the manifestations were mostly Irregular shape or oval shape， uneven edges， most of them have no burr sign， uneven internal echo， a small part of uniform internal echo， most of the posterior echo is enhanced， and most tumors have strong blood flow signals， Adler blood Stream classification Ⅱ～Ⅲ. Ki-67 expression was less than 50% in 2 cases， Ki-67 expression was 50% to 79% in 5 cases， Ki-67 expression was 80% to 100% in 14 cases， and Ki-67 expression was greater than or equal to 80%. The proportion is lower than that of the Ki-67 expression <80% group （14.29% vs 100.00%），the difference was statistically significant （P<0.05）; the proportion of the two groups' size， edge， shape， internal echo， rear echo， and blood flow signal In comparison， the differences were not statistically significant （P>0.05）. Conclusion ?Primary breast lymphoma had certain features on ultrasound， and its ultrasound features had a certain relationship with Ki-67 expression level. The combination of the two helped to further clarify the ultrasound features of patients with primary breast lymphoma. So as to improve the detection rate of this disease by ultrasound examination， provide reference basis for clinical diagnosis， treatment and prognosis judgment.

Key words：Primary breast lymphoma;Ultrasound appearance;Glitch sign;Ki-67 expression

原發性乳腺淋巴瘤（primary breast lymphoma，PBL）屬于乳腺惡性腫瘤中的一個類型，此病是原發于乳腺淋巴結外組織的一種惡性腫瘤疾病，發病率很低，僅占乳腺惡性腫瘤的0.05%～0.53%[1]。原發性乳腺淋巴瘤的首發部位為乳腺，可伴或不伴局部淋巴結轉移，絕大多數患者為女性[2]，臨床多表現為單側無痛性乳房腫塊，同時可伴腋窩淋巴結腫大，術前較難與乳腺纖維腺瘤或乳腺癌鑒別。由于原發性乳腺淋巴瘤較為罕見，臨床尚未見關于該病的大樣本研究，其臨床表現以及影像學特征也相對缺乏特異性，因此臨床診斷難度較高，易出現誤診、漏診現象，影響患者治療及預后效果[3，4]。研究顯示[5，6]，Ki-67表達水平與PBL患者的超聲表現存在一定相關性，二者結合可能對提高此病的診斷效率有益。本研究2014年1月～2019年12月我院收治的21例原發性乳腺淋巴瘤患者臨床資料，分析其超聲影像學特征及其與Ki-67表達的關系，現報道如下。……