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1、200例乳位腺占性病变超图像与病理结果分析19952000年随机抽样200例乳腺肿瘤超诊断与最后病理结果相对照，符合率达93，现报告如下。1资料与方法1.1病例：乳腺肿瘤200例，均为女性。年龄在1470岁之间。肿瘤生长部位：乳腺外上相限129例，占64.5；内上相限48例，占24；乳头周围12例，占6，其它部位11例，占5.5。1.2仪器：1.2.1超：erforma650型超声波诊断仪；探头频率：3.5MHz；1.2.2病理：Olymu双目显微镜，1010及1045倍。中薄切片，H-E染色。1.3方法：采用水囊或衬垫进行间接探测，根据病变部位取仰卧或侧卧位进行检查。正常乳腺声像图由浅入深，
2、依次为皮肤：呈一增强的弧形光带，厚约23mm，界限清楚、整洁；浅筋膜：较薄常不显像；皮下脂肪组织：较厚，密度低，呈低回声伴有散在的弱光点，但有时可见三角形增强光条，为库柏氏韧带（Cooperligament);乳腺结构：主要由乳腺腺叶和乳腺导管构成，腺叶呈中等强度的光点光斑。导管呈圆形或椭圆形暗区，排列交错但大小尚一致。同时查到胸大肌，位于乳腺腺叶深层，为一片均质暗区。1.4与病理诊断符合率比较：本组200例乳腺占位病变的术前超初步定性诊断，与病理诊断的符合率达93。2诊断：乳腺占位性病变,由于病变性质不同，组织学成分和结构各异，超回声特点的基础，是组织的病理变化，且以组织结构异型性对超回声影
3、响最大，现分述如下。乳腺囊性增生病：超声特点：乳腺常明显增大，内部结构紊乱，回声增多增强，可查到分布不均的粗大光点或光斑，还常查及边界不甚清晰的结节状回声，如乳腺导管囊状扩张，则可探及大小不等的囊性图像，囊边缘有时可呈现毛糙状突出光影。病理特点：以小叶和纤维增生和乳腺导管扩张、囊肿形成为主，扩张的导管和囊肿上皮呈瘤样增生，部分上皮呈大汗腺化生。乳腺纤维腺瘤：B超特点：乳腺正常回声存在，其间可探及边缘光滑、境界清楚的肿物，内部分布均匀弱光点，后部回声多增强，如果后方出现声影，则为肿瘤内出现钙化所致。较大的纤维腺瘤囊性变时，可查及液性暗区。病理特点：该瘤主要由增生的结缔组织和乳腺小导管、管泡组成。
4、结缔组织多为增生纤维母细胞和纤维细胞，常有粘液样变、胶原纤维化、钙化甚至骨化。乳腺囊肿：B超特点：多为单发整齐光滑、边界清楚的圆形或椭圆形肿物，内部为均质的无回声区，囊后壁回声增强，囊肿两侧呈暗区，即“侧方声影征”。病理特点：乳腺管常阻塞，呈囊性扩张，囊壁较薄，为一层扁平上皮，细胞无增生表现，囊壁内含清亮液体。乳腺乳头状导管癌：B超特点：肿物边界不整，内部回声不均匀，含有强回声条索，有蟹足样浸润，后方呈衰减暗区。病理特点：镜下见肿瘤部分或大部分呈分枝乳头状结构，间质血管丰富，结缔组织纤维纤细。乳腺髓样癌：B超特点：肿瘤多呈圆形，边界较清楚且光滑，内部回声比硬癌及乳头状癌强，有时可见边缘不规则的
5、的液性暗区，后方多无衰减。病理特点：镜下见癌肿由大小不等的癌细胞团块状癌巢组成，间质甚少常有数量不等的淋巴细胞和浆细胞浸润。乳腺硬癌：B超特点：肿瘤边界不整、境界不清，内部呈密集强回声，后部回声明显衰减呈衰减暗区是其特点。病理特点：肿瘤大部分为致密的结缔组织，常有透明样变性。癌细胞比例较少，呈不规则的细小条索状或小巢状排列，浸润性较强，常侵入乳腺周围脂肪组织、筋膜和皮下组织。3讨论：超声波检查只能作为定位诊断，而有些初步定性（只估计良恶性）诊断也只能靠超声波检查人员的临床经验来确定。近5年来，为了积累超初步定性的临床经验，分析不同病变的组织成分与超声波回声的相关性，对乳腺占位性病变的超诊断与最
6、终病理结果相对照，积累了较多经验，与病理诊断的符合率达93，现将经验总结如下:1.圆形或类圆形的肿块，回声均匀、边界清楚良性肿瘤最常见。2.形态不规则的肿块，边界不规则，内部回声不均，有时出现条索状或成簇的强回声，导管癌和其它癌肿较大时可产生这些改变。3.肿瘤边界较清晰，内部为均质无回声区，后壁回声增强呈“蝌蚪征”或两侧出现“侧方声影征”，多属于乳腺囊肿或生长迅速的肿瘤出现坏死液化。4.衰减特性，具有重要的诊断意义。衰减与病变中的纤维组织多寡有关。一般组织中纤维成分超过75时，衰减明显可有声影出现，如硬癌。含有25的纤维成分时，多有回声增强的表现。5.肿瘤与周围组织的关系：良性肿瘤由于膨胀性占
7、位性效应时，主要是推移和压迫周围组织，恶性肿瘤则表现为正常结构破坏或呈蟹足样生长。综上所述，尽管目前超多是定位诊断，而且对病变的诊断上缺乏特征性，但通过近几年的努力，特别反复对乳腺病变的B超诊断与病理诊断比较，进行回顾性分析，我们认为进一步提高超初步定性诊断，还是有可能的，可以与病理医生长期合作，并可以将这种对照分析，同时配合临床表现如发病年龄、局部皮肤体征（溃疡、溢液、桔皮样、湿疹样改变、乳头凹陷等），势必会更加提高B超对乳腺占位性病变的准确率。参考文献“文秘114有”版权所1.李德旺,邹建中,蔡汉中主编.临床超声手册.第一版.北京：科技出版社，1993，391324.2.青木虎吉.超音波整
8、形外科领域应用.医学，平成237(3):568,199830kA1DkaGhn3XtKknBYCUDxqA7FHYi2CHhI92tgKQcWA3PtGZ7R4I30kA1DkaGtgKQcWA3P tGZ7R4I30kA1DkaGhn3XtKknBYCUDxqA7FHYi2CHhI92tgKQcWA3PtGshLs50cLmTWN60eo8Wgqv7XAv2OHUm32WGeaUwYDIAWGMeR4I30kA1DkaGhn3XtKknBYCUDxqA7FHYi2CHhI92tgKQcWA3PtGZ7R4I30kA1DkaGtgK tGZ7R4I30kA1DkaGhn3XtKknBYCUDx
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