乳腺腺病X線磁共振傳統(tǒng)影像診斷的回顧與新發(fā)現(xiàn)

周麗萍　朱繼紅

[摘要] 近年來，我國乳腺腺病的發(fā)生率呈快速上升的趨勢(shì)。究其原因，一方面可能與我國經(jīng)濟(jì)社會(huì)結(jié)構(gòu)轉(zhuǎn)型背景下，婦女生育年齡推遲、母乳喂養(yǎng)次數(shù)減少、超重肥胖、缺乏運(yùn)動(dòng)有關(guān);另一方面也得益于我國乳腺疾病早期診斷技術(shù)的進(jìn)步及篩查理念的推廣。作為一種常見的乳腺良性疾病，人們對(duì)乳腺腺病的認(rèn)識(shí)已經(jīng)過了百余年之久，但其與乳腺癌的關(guān)系目前并不十分明確。乳腺腺病的診斷;依賴于影像醫(yī)師的臨床經(jīng)驗(yàn)水平。正確的影像診斷，乳腺腺病的早期檢出、及時(shí)干預(yù)、臨床隨訪及療效評(píng)價(jià)，甚至避免過度檢查治療均具有巨大的意義。本文擬對(duì)乳腺腺病的X線、磁共振等傳統(tǒng)影像學(xué)診斷進(jìn)行綜述回顧，并結(jié)合筆者在臨床工作中的一些經(jīng)驗(yàn)體會(huì)進(jìn)行簡(jiǎn)單論述。

[關(guān)鍵詞] 乳腺腺病;乳腺癌;X線;磁共振

[中圖分類號(hào)] R445? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-9701（2021）20-0188-05

Retrospect and new discovery of traditional X-ray magnetic resonance imaging diagnosis of breast adenosis

ZHOU Liping? ?ZHU Jihong

Department of Radiology， Yulin First People′s Hospital in Guangxi Zhuang Autonomous Region，Yulin? ?537000，China

[Abstract] In recent years，the incidence of breast adenosis in my country has shown a rapid upward trend. The reasons may be related to the delayed childbearing age， reduced breastfeeding frequency， overweight and obesity， and lack of exercise in the context of the transformation of my country′s economic and social structure. On the other hand， it also benefits from the advances in early diagnosis technology and promotion of screening concepts for breast diseases in my country. As a common benign breast disease， people have been aware of breast adenosis for more than a hundred years， but its relationship with breast cancer is currently not very clear. The diagnosis of breast adenosis often depends on the level of clinical experience of imaging physicians. Correct imaging diagnosis， early detection of breast adenosis， timely intervention， clinical follow-up and efficacy evaluation， and even avoiding excessive examination and treatment are of great significance. This article intends to review the traditional imaging diagnosis of breast adenosis such as X-ray and magnetic resonance， and combine the author′s experience in clinical work to make a brief discussion.

[Key words] Breast adenosis; Breast cancer; X-ray; Magnetic resonance

乳腺腺病是一種慢性乳腺良性增生性疾病，1829年由英國的Astley Cooper首先對(duì)該病進(jìn)行了描述，并將該病稱為Callularhydatids，1972年我國的腫瘤防治辦公室將該病歸為“乳腺增生癥”，現(xiàn)在世界衛(wèi)生組織將該病定名為乳腺腺病。

乳腺腺病為乳腺良性疾病，預(yù)后良好，故其診斷并不常規(guī)推薦有創(chuàng)性活檢;同時(shí)該類疾病并無有意義的實(shí)驗(yàn)室檢查指標(biāo)，因此，影像學(xué)成了診斷乳腺腺病的重要手段。尤其對(duì)于乳腺腺病和乳腺惡性疾病鑒別診斷，影像學(xué)檢查具有舉足輕重的地位。但筆者發(fā)現(xiàn)，在乳腺疾病影像學(xué)早期診斷和篩查工作中常有一些不盡人意的地方，尤其在基層醫(yī)院，誤診、漏診、過度檢查的情況時(shí)有發(fā)生。乳腺腺病臨床病理類型多樣、病理和影像表現(xiàn)不統(tǒng)一的特性也給該疾病誤診帶來客觀難度。X線和磁共振是乳腺腺病診斷的最常用方法，因此，筆者翻閱了相關(guān)文獻(xiàn)及統(tǒng)計(jì)資料，總結(jié)了該病的X線及磁共振表現(xiàn)特點(diǎn)，并結(jié)合筆者臨床工作中總結(jié)出的體會(huì)心得加以闡述，以期為乳腺腺病規(guī)范化早期診斷提供理論依據(jù)。

1 乳腺增生癥臨床病理和影像學(xué)表現(xiàn)的相關(guān)性