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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (08) : 854 -859. doi: 10.3877/cma.j.issn.1672-6448.2023.08.012

浅表器官超声影像学

男性乳腺肿块的超声造影特征
张旭(), 徐建平, 苏冬明, 王彩芬, 王大力, 张文智   
  1. 310003 浙江大学医学院附属杭州市胸科医院超声医学科
  • 收稿日期:2021-01-20 出版日期:2023-08-01
  • 通信作者: 张旭

Contrast-enhanced ultrasound features of male breast masses

Xu Zhang(), Jianping Xu, Dongming Su, Caifen Wang, Dali Wang, Wenzhi Zhang   

  1. Department of Ultrasound, Affiliated Hangzhou Chest Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
  • Received:2021-01-20 Published:2023-08-01
  • Corresponding author: Xu Zhang
引用本文:

张旭, 徐建平, 苏冬明, 王彩芬, 王大力, 张文智. 男性乳腺肿块的超声造影特征[J]. 中华医学超声杂志(电子版), 2023, 20(08): 854-859.

Xu Zhang, Jianping Xu, Dongming Su, Caifen Wang, Dali Wang, Wenzhi Zhang. Contrast-enhanced ultrasound features of male breast masses[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 854-859.

目的

探讨男性乳腺肿块的超声造影特征。

方法

收集2014年1月至2020年10月因发现乳腺肿块在浙江大学医学院附属杭州市胸科医院就诊的男性患者6例,所有病例均经病理结果证实。分析男性乳腺肿块的超声及超声造影特征表现。

结果

6例男性乳腺肿块均为单侧发病,病理证实3例为浸润性导管癌,3例为男性乳腺增生。二维超声表现:6例乳腺肿块均呈低回声。3例乳腺癌患者均可探及血流信号,其中2例可见粗大扭曲血管,1例乳腺癌内见多发微钙化。3例乳腺增生中1例可见条状血流信号,均未发现微钙化。超声造影表现:3例男性乳腺癌超声造影均表现不均匀增强及灌注缺损,而乳腺增生无此特征。3例乳腺癌与2例乳腺增生增强后范围均较二维超声范围扩大,1例乳腺增生增强范围不清。

结论

男性乳腺增生与男性乳腺癌具有不同的造影特征,不均匀增强及灌注缺损等超声造影特征在男性乳腺癌中表现出潜在的诊断价值,可为临床提供更多的诊断信息。

Objective

To evaluate the value of contrast-enhanced ultrasonography in the diagnosis of male breast masses.

Methods

A retrospective study was performed on the medical records of 6 male patients with breast masses diagnosed at the Affiliated Hangzhou Chest Hospital of Zhejiang University School of Medicine from January 2014 to October 2020. All patients were finally diagnosed by pathological results.

Results

All 6 cases of male breast masses were unilateral. Pathology confirmed 3 cases of invasive ductal carcinoma and 3 cases of male breast hyperplasia. Convention ultrasound showed that all the 6 breast masses were hypoechoic. Blood flow signals can be detected in 3 cases of breast cancer, including 2 cases with coarse twisted blood vessels and 1 case with multiple microcalcifications in breast cancer. No microcalcification was found in 1 of 3 cases of breast hyperplasia. Contrast-enhanced ultrasonography revealed that 3 cases of male breast cancer showed uneven enhancement and perfusion defect, but breast hyperplasia did not have this characteristic. Three cases of breast cancer and two cases of breast hyperplasia had expanded enhancement range on contrast-enhanced ultrasound compared to the lesion range detected by conventional ultrasound, while the enhancement range of 1 case of breast hyperplasia was unclear.

Conclusion

Male breast hyperplasia and male breast cancer have different contrast characteristics. Contrast-enhanced ultrasound features such as uneven enhancement and perfusion defect show potential diagnostic value for male breast cancer, which can provide more diagnostic information for clinicians.

表1 男性乳腺肿块患者基本资料与二维超声影像特征
图1 浸润性导管癌二维常规超声及超声造影图像(病例1)。图a二维常规超声示左侧乳腺发现类圆形低回声结节,大小约1.9 cm×1.8 cm,内部回声不均匀,边缘清晰;图b为彩色多普勒超声示结节内部可见粗大扭曲血管(白色箭头);图c,d为超声造影呈快速不均匀高增强,灌注缺损,增强范围较二维超声扩大,增强后边界不清,可见粗大滋养血管
图2 浸润性导管癌二维常规超声及超声造影图像(病例2)。图a二维常规超声示左侧乳腺发现椭圆形低回声结节,大小约2.3 cm×1.2 cm,内部回声不均匀,边缘欠清晰,形态不规则,内部可见多发微钙化(白色箭头);图b为彩色多普勒超声示结节周边可见点状血流信号;图c,d示超声造影呈快速不均匀高增强,灌注缺损,增强范围较二维超声扩大,增强后边界不清、形态不规则
图3 浸润性导管癌二维常规超声及超声造影图像(病例3)。图a为二维常规超声示右侧乳腺发现椭圆形低回声结节,大小约3.0 cm×2.2 cm,内部回声均匀,边缘清晰;图b为彩色多普勒超声示结节内部可见粗大扭曲血管;图c,d示超声造影呈快速不均匀高增强,灌注缺损,增强范围较二维超声扩大,增强后边界清,可见粗大滋养血管(白色箭头)
图4 乳腺增生二维常规超声及超声造影图像(病例4)。图a为二维常规超声示右侧乳腺发现椭圆形低回声结节,大小约1.8 cm×0.8 cm,内部回声均匀,边缘不清晰;图b为彩色多普勒超声示结节内部未见血流信号;图c,d示超声造影呈快速均匀高增强,可见粗大滋养血管(白色箭头),未见灌注缺损,增强范围较二维超声扩大,增强后边界清晰
图5 乳腺增生二维常规超声及超声造影图像(病例5)。图a为二维常规超声示左侧乳腺发现椭圆形低回声结节,大小约1.2 cm×0.5 cm,内部回声均匀,边缘清晰;图b为彩色多普勒超声示结节内部未见血流信号;图c,d示超声造影呈快速均匀等增强,未见粗大滋养血管,未见灌注缺损
图6 乳腺增生二维常规超声及超声造影图像(病例6)。图a为二维常规超声示右侧乳腺发现类圆形低回声结节,大小约1.1 cm×1.1 cm,内部回声不均匀,边缘不清晰,形态不规则;图b为彩色多普勒超声示结节内部可见条状血流信号;图c,d示超声造影呈快速均匀高增强,未见灌注缺损,增强范围较二维超声扩大,增强后边界不清晰,有蟹足样增强(白色箭头)
表2 男性乳腺癌与男性乳腺增生超声造影特征
1
Iuanow E, Kettler M, Slanetz PJ. Spectrum of disease in the male breast [J]. AJR Am J Roentgenol, 2011, 196(3): W247-W259.
2
Cardoso F, Bartlett J, Slaets L, et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program [J]. Ann Oncol, 2018, 29(2): 405-417.
3
Hassett MJ, Somerfield MR, Baker ER, et al. Management of male breast cancer: ASCO guideline [J]. J Clin Oncol, 2020, 38(16): 1849-1863.
4
Elezaby M, Li G, Bhargavan-Chatfield M, et al. ACR BI-RADS assessment category 4 subdivisions in diagnostic mammography: utilization and outcomes in the national mammography database [J]. Radiology, 2018, 287(2): 416-422.
5
Fentiman IS. Male breast cancer is not congruent with the female disease [J]. Crit Rev Oncol Hematol, 2016: S441787775.
6
Jesinger RA. Breast anatomy for the interventionalist [J]. Tech Vasc Interv Radiol, 2014, 17(1): 3-9.
7
Vinod SK, Pendlebury SC. Carcinoma of the male breast: a review of adjuvant therapy [J]. Australas Radiol, 1999, 43(1): 69-72.
8
Ricci P, Cantisani V, Ballesio L, et al. Benign and malignant breast lesions: efficacy of real time contrast-enhanced ultrasound vs. magnetic resonance imaging [J]. Ultraschall Med, 2007, 28(1): 57-62.
9
康佳, 吴桐, 张蕾, 等. 不同分子分型乳腺癌的多模态超声特征和临床病理对照研究 [J]. 中华超声影像学杂志, 2020, 29(4): 330-336.
10
Adler DD, Carson PL, Rubin JM, et al. Doppler ultrasound color flow imaging in the study of breast cancer: Preliminary findings [J]. Ultrasound Med Biol, 1990, 16(6): 553-559.
11
张剑, 陈卉, 徐斌, 等. 超微血管成像、高级动态血流显像、彩色多普勒血流显像对乳腺微小癌的诊断价值及其与病理肿瘤微血管密度的相关性研究 [J]. 中华超声影像学杂志, 2019, 28(9): 787-793.
12
Tang L, Chen Y, Du Z, et al. A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions [J]. Cancer Manag Res, 2019, 11: 2163-2170.
13
Luo J, Chen J, Chen Q, et al. Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions? [J]. World J Radiol, 2016, 8(6): 600-609.
14
王琳琳, 方建强, 李尔清. 超声造影在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值[J/OL]. 中华医学超声杂志(电子版), 2020, 17(1): 29-32.
15
Pellini F, Granuzzo E, Urbani S, et al. Male breast cancer: surgical and genetic features and a multidisciplinary management strategy [J]. Breast Care(Basel), 2020, 15(1): 14-21.
16
Morakkabati-Spitz N, Schild HH, Leutner CC, et al. Dynamic contrast-enhanced breast MR imaging in men: preliminary results [J]. Radiology, 2006, 238(2): 438-445.
17
Muñoz Carrasco R, Álvarez Benito M, Muñoz Gomariz E, et al. Mammography and ultrasound in the evaluation of male breast disease [J]. Eur Radiol, 2010, 20(12): 2797-2805.
18
施惠芬, 马艳, 顾俊毅, 等. BI-RADS分级在男性乳房疾病超声检查中的应用 [J]. 医学影像学杂志, 2013, 23(3): 412-415.
19
赵佳琦, 何金, 章建全. 男性乳腺癌多模式超声影像学特征分析 [J]. 第二军医大学学报, 2009, 30(8): 917-920.
20
Nowak A, Grzegrzolka J, Paprocka M, et al. Nestin-positive microvessel density is an independent prognostic factor in breast cancer [J]. Int J Oncol, 2017, 51(2): 668-676.
21
Lehotska V, Rauova K, Vanovcanova L. Pitfalls of Contrast Enhanced Ultrasound (CEUS) in determination of breast tumor biological dignity [J]. Neoplasma, 2018, 65(1): 124-131.
22
Nowak A, Grzegrzolka J, Paprocka M, et al. Nestin-positive microvessel density is an independent prognostic factor in breast cancer [J]. Int J Oncol, 2017, 51(2): 668-676.
23
Liu H, Jiang Y, Dai Q, et al. Differentiation of benign and malignant sub-1-cm breast lesions using contrast-enhanced sonography [J]. J Ultrasound Med, 2015, 34(1): 117-123.
24
Liu H, Jiang Y, Dai Q, et al. Peripheral enhancement of breast cancers on contrast-enhanced ultrasound: correlation with microvessel density and vascular endothelial growth factor expression [J]. Ultrasound Med Biol, 2014, 40(2): 293-299.
25
Zhao LX, Liu H, Wei Q, et al. Contrast-enhanced ultrasonography features of breast malignancies with different sizes: correlation with prognostic factors [J]. Biomed Res Int, 2015, 2015: 613831.
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