Ultrasonographic and pathological features of phyllodes tumor of breast
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摘要: 目的 探讨乳腺叶状肿瘤的超声图像特征及病理特征。 方法 选取本院2018年6月—2020年4月术后病理检查确诊的51例乳腺叶状肿瘤患者作为研究对象,收集患者一般资料(包括肿瘤单侧单发位置、病理分级、肿瘤大小、腋窝淋巴结转移)。根据病理学分级将乳腺叶状肿瘤患者分为良性组、交界性组及恶性组,比较3组超声特征的差异。 结果 51例乳腺叶状肿瘤中,良性33例(64.7%), 交界性13例(25.5%), 恶性5例(9.8%); 肿瘤最小体积7.6 mm×3.6 mm×6.7 mm, 最大体积168.0 mm×135.0 mm×120.0 mm; 无1例出现腋窝淋巴结转移。乳腺叶状肿瘤的超声声像图表现为实性或囊实性病灶,其中形态呈椭圆形者占13.7%, 分叶状者占86.3%, 边界清晰者占58.8%, 局部不清或模糊者占41.2%, 边缘光滑整齐者占54.9%, 边缘不光滑整齐者占45.1%, 内部回声均质者占33.3%, 不均质者占66.7%, 血流信号0~I级者占31.4%, Ⅱ~Ⅲ级者占68.6%, 阻力指数(RI)<0.7者占66.7%, RI>0.7者占33.3%。良性组、交界性组及恶性组叶状肿瘤的形态、血流分级比较,差异无统计学意义(P>0.05); 3组病灶边界、边缘、内部回声、血流RI比较,差异有统计学意义(P<0.05)。结果提示病灶边界局部不清或模糊,边缘不光整,内部回声不均质,出现不同程度片状不规则无回声区,恶性组和交界性组血流RI>0.7患者比率高于良性组,差异有统计学意义(P<0.05)。 结论 不同病理类型的乳腺叶状肿瘤声像图具有不同的特征性表现,肿瘤边界、边缘、内部回声、血流RI对判断肿瘤的良性、恶性分型具有一定的参考价值。Abstract: Objective To investigate the ultrasonographic and pathological features of phyllodes tumor of breast. Methods A total of 51 patients with phyllodes tumor of breast diagnosed by pathology in our hospital from June 2018 to April 2020 were selected as the research objects, and the general materials such as unilateral single tumor location, pathological grading, tumor size, axillary lymph node metastasis were collected. According to the pathological grading, the patients were divided into benign group, borderline group and malignant group, and the differences of ultrasonic characteristics were compared among the three groups. Results Out of 51 cases with phyllodes tumor of breast, 33 cases(64.7%)were benign, 13 cases(25.5%)were borderline, and 5 cases(9.8%)were malignant. The minimum tumor volume was 7.6 mm×3.6 mm×6.7 mm, and the maximum tumor volume was 168 mm×135 mm×120 mm. No case was found axillary lymph node metastasis. The sonographic appearance of the breast phyllode tumor presented as solid or cystic solid lesions, among which oval-shaped tumor accounted for 13.7%, lobulation-shaped for 86.3%, clear boundary for 58.8%, - local ambiguity or ambiguity for 41.2%, smooth and neat edges for 54.9%, rough edges for 45.1%, homogeneity of internal echo for 33.3%, and heterogeneity for 66.7%. Besides, tumor with blood flow signal level of 0 to I accounted for 31.4%, level of Ⅱ to Ⅲ for 68.6%, resistance index(RI)<0.7 for 66.7%, and RI >0.7 for 33.3%. The morphology of lobar tumors and blood flow grading in the benign group, the borderline group and the malignant group showed no significant differences(P>0.05). Lesion boundary, edge, internal echo and blood flow RI among the three groups showed significant differences(P<0.05). The results showed that the tumor had the characteristics of local unclear or fuzzy boundary, rough edges, heterogeneity of internal echo, patchy irregular anechoic region in varying degrees. The malignant group and the borderline group had significantly higher ratio of patients with blood flow RI>0.7 than that of the benign group(P<0.05). Conclusion Different pathological types of breast phyllodes tumors have different characteristics, and tumor boundary, edge, internal echo and blood flow RI show certain reference values in judging benign and malignant types of tumors.
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