剪切波弹性成像与彩色多普勒联合诊断乳腺纤维上皮肿瘤的临床实践

doi:10.3969/j.issn.1009-976X.2020.06.02

摘要/Abstract

摘要： 目的探讨剪切波弹性成像（SWE）联合彩色多普勒在诊断乳腺纤维上皮肿瘤中的价值。方法选择2017年8月至2019年5月在我院因乳腺肿块进行超声诊断并接受组织学活检与手术切除的患者。根据纳入标准分纤维腺瘤组和叶状肿瘤组,共59例患者入组,纤维腺瘤组43例,叶状肿瘤组16例。所有患者均获得B超、SWE和彩色多普勒超声检查;平均弹性（E平均）、最大弹性（E最大）和血管信号由SWE和多普勒超声测定。结果两组的临床与超声特征包括：叶状肿瘤组病变的平均体积大于纤维腺瘤组（P<0.05）,叶状肿瘤组的不均匀回声比纤维腺瘤组更多（P<0.05）。叶状肿瘤组BI-RADS分类高于纤维腺瘤组（P<0.05）,叶状肿瘤的组织E平均和E最大显著高于纤维腺瘤组（P<0.05）,叶状肿瘤组有较高的血流信号（与纤维腺瘤组比较,P<0.05）。另一方面,彩超和SWE的平E平均值的特异性和准确性高于B超检查,E最大的特异度高于B超检查,敏感性略低于B超检查。E平均>40.4 kPa或高血流信号或E最大>48.2 kPa或高血流信号为标准的SWE和彩超联合应用可将诊断的敏感性和PPV提高到100%。结论与乳腺叶状肿瘤相比,纤维腺瘤有较低的僵硬度和较少的血管数量的倾向。联合应用SWE和多普勒超声中,平均弹性值和最大弹性值在鉴别可疑病例方面显示更高的诊断价值。

关键词: 剪切波弹性成像, 乳腺纤维上皮瘤

Abstract: Objective To investigate the value of shear wave elastography （SWE） combined with color doppler in the diagnosis of breast fibroepithelial tumors. Methods From August 2017 to May 2019, patients with breast mass who underwent ultrasound diagnosis and histological biopsy and surgical resection in our hospital were selected. According to the inclusion criteria, 59 patients were divided into fibroadenoma group （FA） and phyllodes tumor （PT） group, 43 patients in FA group and 16 patients in PT group.B-ultrasound, SWE and color doppler US were performed for each lesion. Mean elasticity （Emean）, maximum elasticity （Emax）, and vascularity were determined by SWE and Doppler US. Results The lesion size of PT group was significantly larger than that of FA group （P< 0.05）. The heterogeneous echo pattern was more frequently observed with significance in PT group than FA group （P< 0.05）. BI-RADS categories were higher in PT group than FA group （P< 0.05）. Both Emean and Emax were significantly higher in PT group than FA group （Emean, P< 0.05; Emax, P< 0.05）. Low vascularity was more frequent in FA group than in PT group （P< 0.05）. On the other hand, the specificity and accuracy of Emean and SWE were higher than that of B-ultrasound （P< 0.05）, and the specificity of maximum elastic value was higher than that of B-ultrasound （P< 0.05）, and the sensitivity was slightly lower than that of B-ultrasound. The sensitivity and negative predictive value （NPV） of SWE combined with color Doppler ultrasound were increased to 100% with the standard of average elasticity value > 43.9 kPa or high blood flow signal or maximum elasticity value > 46.1 kPa or high blood flow signal. Conclusion Compared with phyllodes tumor, fibroadenoma tends to have lower stiffness and fewer blood vessels. In the combined application of SWE and doppler ultrasound, Emean and Emax showed higher diagnostic value in the identification of suspicious cases.

Key words: color doppler ultrasound, breast fibroepithelial tumor, shear-wave elastography

中图分类号:

R739.7

冯瑞卿, 傅仲带, 曹磊, 欧妍妍, 黄健东. 剪切波弹性成像与彩色多普勒联合诊断乳腺纤维上皮肿瘤的临床实践[J]. 岭南现代临床外科, 2020, 20(06): 694-698.

FENG Rui-qing, FU Zhong-dai, CAO Lei, OU Yan-yan, HUANG Jian-dong. Clinical practice of combination of shear-wave elastography and color doppler in the diagnosis of breast fibroepithelial tumor[J]. Lingnan Modern Clinics in Surgery, 2020, 20(06): 694-698.

参考文献

[1] Jacobs TW, Chen YY, Guinee DG Jr, et al.Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision?[J]. Am J Clin Pathol, 2005, 124(3): 342-354.
[2] Rowell MD, Perry RR, Hsiu JG, Barranco SC.Phyllodes tumors[J]. Am J Surg, 1993, 165(3): 376-379.
[3] Resetkova E, Khazai L, Albarracin CT, Arribas E.Clinical and radiologic data and core needle biopsy findings should dictate management of cellular fibroepithelial tumors of the breast[J]. Breast J, 2010, 16(6): 573-580.
[4] Ben Hassouna J, Damak T, Gamoudi A, et al.Phyllodes tumors of the breast: a case series of 106 patients[J]. Am J Surg, 2006, 192(2): 141-147.
[5] Park HL, Kwon SH, Chang SY, et al.Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy[J]. J Breast Cancer, 2012, 15(2): 224-229.
[6] Chao TC, Lo YF, Chen SC, Chen MF.Phyllodes tumors of the breast[J]. Eur Radiol, 2003, 13(1): 88-93.
[7] Lee AH, Hodi Z, Ellis IO, Elston CW.Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast[J]. Histopathology, 2007, 51(3): 336-344.
[8] Choi J, Koo JS.Comparative study of histological features between core needle biopsy and surgical excision in phyllodes tumor[J]. Pathol Int, 2012, 62(2): 120-126.
[9] Berg WA, Cosgrove DO, Doré CJ, et al.Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses[J]. Radiology, 2012, 262(2): 435-449.
[10] Lee SH, Chang JM, Kim WH, et al.Added value of shear-wave elastography for evaluation of breast masses detected with screening US imaging[J]. Radiology, 2014, 273(1): 61-69.
[11] Kim GR, Choi JS, Han BK, et al.Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy[J]. PLoS One, 2017, 12(5): e0175380.
[12] Li LJ, Zeng H, Ou B, et al.Ultrasonic elastography features of phyllodes tumors of the breast: a clinical research[J]. PLoS One, 2014, 9(1): e85257.
[13] Karim RZ, O′Toole SA, Scolyer RA, et al. Recent insights into the molecular pathogenesis of mammary phyllodes tumours[J]. J Clin Pathol, 2013, 66(6): 496-505.
[14] Tan PH, Ellis IO.Myoepithelial and epithelial-myoepithelial, mesenchymal and fibroepithelial breast lesions: updates from the WHO Classification of Tumours of the Breast 2012[J]. J Clin Pathol, 2013, 66(6): 465-470.
[15] McNicholas MM, Mercer PM, Miller JC, et al. Color Doppler sonography in the evaluation of palpable breast masses[J]. AJR Am J Roentgenol, 1993, 161(4): 765-771.
[16] Wiratkapun C, Piyapan P, Lertsithichai P, Larbcharoensub N.Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy[J]. Diagn Interv Radiol, 2014, 20(1): 27-33.