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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (10) : 982 -986. doi: 10.3877/cma.j.issn.1672-6448.2020.10.009

所属专题: 乳腺超声 文献

浅表器官超声影像学

高频超声对乳腺脂肪坏死的诊断价值
张雨康1, 何文1,(), 张红霞1, 广旸1, 甘雨洋1   
  1. 1. 100070,首都医科大学附属北京天坛医院超声科
  • 收稿日期:2020-04-02 出版日期:2020-10-01
  • 通信作者: 何文

Diagnostic value of high frequency ultrasound in breast fat necrosis

Yukang Zhang1, Wen He1,(), Hongxia Zhang1, Yang Guang1, Yuyang Gan1   

  1. 1. Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2020-04-02 Published:2020-10-01
  • Corresponding author: Wen He
  • About author:
    Corresponding author: He Wen, Email:
引用本文:

张雨康, 何文, 张红霞, 广旸, 甘雨洋. 高频超声对乳腺脂肪坏死的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2020, 17(10): 982-986.

Yukang Zhang, Wen He, Hongxia Zhang, Yang Guang, Yuyang Gan. Diagnostic value of high frequency ultrasound in breast fat necrosis[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(10): 982-986.

目的

总结乳腺不同位置脂肪坏死病灶的声像图表现,探讨高频超声对乳腺脂肪坏死的诊断价值。

方法

回顾性分析2014年1月至2019年9月首都医科大学附属天坛医院收治的经手术病理证实的63例乳腺脂肪坏死患者的临床及影像学资料,63例患者共69个病灶,所有患者术前均行超声检查。根据病灶的所在部位(皮下脂肪层、皮下脂肪层与腺体层均累及、腺体层),将其分为腺外型、交界型和腺内型。总结并比较不同类型组间的超声特征。

结果

63例患者中22例有外伤或手术史,7例既往有乳腺炎性病变。患者多无临床症状或因偶然发现肿物就诊。根据超声声像图中病灶位置将69个病灶分为腺外型31个、交界型26个、腺内型10个,2个漏诊。腺外型与腺内型声像图特征差异均无统计学意义(P均>0.05)。交界型同腺外型和腺内型的声像图比较,部分表现差异有统计学意义,包括形状、边界、病灶血流情况、与周围组织分界、与周围皮肤关系及同侧腋窝淋巴是否肿大(P=0.045、0.001、0.025、0.001、0.001、0.019);而有无包膜、回声类型、钙化类型、后方回声情况及患者病灶数目3组间比较差异均无统计学意义(P均>0.05)。超声漏诊2个病灶(2/69,2.9%),误诊为可疑恶性病灶(BI-RADS 4b类)5个(5/67,7.5%)。

结论

乳腺脂肪坏死的声像图及临床表现多样,应用高频超声观察不同位置病灶的声像图表现,详细了解相关病史,特别是外伤史、手术史等临床信息,有助于术前正确诊断乳腺脂肪坏死。

Objective

To summarize the sonographic characteristics of breast fat necrosis at different locations, and estimate the diagnostic value of high frequency ultrasound for fat necrosis.

Methods

Clinical and imaging data of 63 patients with breast fat necrosis confirmed by surgery were retrospectively analyzed from January 2014 to September 2019 at Beijing Tiantan Hospital, Capital Medical University. The 63 patients with 69 lesions were all examined by ultrasound before operation. According to the location (fat layer, both fat layer and gland, and gland), the lesions were divided to extra-glandular type, junctional type, and intra-glandular type. Ultrasonic features of different types were summarized and compared.

Results

Of the 63 patients, 22 had a history of trauma or surgery and 7 had previous inflammatory lesions. The patients were mostly asymptomatic or the mass was discovered accidentally. According to the location of the 69 lesions in ultrasound images, excluding two missed cases, 31 belonged to extra-glandular type, 26 belonged to junctional type, and 10 belonged to intra-glandular type. There were no statistically significant differences in sonographic findings between the extra-glandular and intra-glandular types (P>0.05). We observed statistically significant differences in some sonographic features between the junctional type and extra-glandular or intra-glandular type, including shape, boundary, blood flow, relationship with adjacent tissues and skin, and enlargement of ipsilateral axillary lymph nodes (P=0.045, 0.001, 0.025, 0.001, 0.01, and 0.019, respectively). There was no significant difference in capsule, echo type, calcification type, posterior echo condition, or the number of lesions among the tree types (P>0.05). Two (2/69, 2.9%) lesions were missed by ultrasound, and five (5/67, 7.5%) were diagnosed as potential malignancies (BI-RADS 4b).

Conclusion

The sonographic and clinical manifestations of breast fat necrosis are diverse. Obtaining sonographic manifestations of lesions in different locations by high frequency ultrasound, inquiring relevant history and associated diseases, especially trauma or surgical history, and acquiring other clinical information are very helpful to make a correct diagnosis of breast fat necrosis.

图1 不同位置乳腺脂肪坏死病灶的超声声像图表现。图a为腺外型(累及皮下脂肪层),病灶呈不均匀低回声,未见明显包膜,部分边界不清,周边脂肪组织回声增强,后方回声衰减;图b为交界型(皮下脂肪层与腺体层均累及),呈囊实性混合回声,无包膜,形态不规则,边界不清,后方回声部分衰减;图c为腺内型(累及腺体层),呈囊性无回声,椭圆形,周边可见较厚包膜样结构
表1 不同分型乳腺脂肪坏死病灶的超声特征比较[个(%)]
超声特征 腺外型(n=31) 交界型(n=26) 腺内型(n=10) χ2 P
包膜 ? ? ? - 0.396
? 29(93.5) 22(84.6) 8(80.0) ? ?
? 2(6.5) 4(15.4) 2(20.0) ? ?
形状 ? ? ? - 0.045a
? 椭圆或圆 14(45.2) 6(23.1) 8(80.0) ? ?
? 不规则或分叶 10(32.2) 10(38.5) 1(10.0) ? ?
? 分叶或毛刺 7(22.6) 10(38.5) 1(10.0) ? ?
边界 ? ? ? 14.012 0.001b
? 22(71.0) 7(26.9) 8(80.0) ? ?
? 不清 9(29.0) 19(73.1) 2(20.0) ? ?
回声 ? ? ? - 0.520
? 低回声 8(25.8) 5(19.2) 5(50.0) ? ?
? 实性混合回声 11(35.5) 10(38.5) 2(20.0) ? ?
? 包含无回声 12(38.7) 11(42.3) 3(30.0) ? ?
钙化 ? ? ? 0.041 0.980
? 24(77.4) 20(76.9) 8(80.0) ? ?
? 7(22.6) 6(23.1) 2(20.0) ? ?
后方回声 ? ? ? - 0.186
? 增强 6(19.4) 4(15.4) 3(30.0) ? ?
? 不变 18(58.1) 10(38.5) 6(60.0) ? ?
? 衰减 7(22.6) 12(46.2) 1(10.0) ? ?
血流 ? ? ? - 0.025c
? 无或有少量血流信号 30(96.8) 19(73.1) 9(90.0) ? ?
? 内部血流丰富或伴周边环绕血流 1(3.2) 7(26.9) 1(10.0) ? ?
与皮肤关系 ? ? ? - 0.001d
? 无关 22(71.0) 10(38.5) 10(100.0) ? ?
? 紧贴或粘连 9(29.0) 16(61.5) 0(0) ? ?
同侧腋窝淋巴结 ? ? ? - 0.019e
? 无异常 31(100.0) 21(80.8) 8(80.0) ? ?
? 肿大 0(0) 5(19.2) 2(20.0) ? ?
与周围组织分界 ? ? ? 13.84 0.001f
? 26(83.9) 11(42.3) 9(90.0) ? ?
? 欠清 5(16.1) 15(57.7) 1(10.0) ? ?
病灶数目 ? ? ? - 0.431
? 单发 17(54.8) 13(50.0) 3(30.0) ? ?
? 多发 14(45.2) 13(50.0) 7(70.0) ? ?
表2 不同类型乳腺脂肪坏死病灶超声诊断结果(个)
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