摘要
目的:术前超声结合术后病理学检查结果,分析乳腺癌漏诊或低估的原因,提高对不典型乳癌影像学的认识,以期作出合理的诊断决策。方法:分析2014年1月1日—2018年12月30日中日友好医院收治的43例超声漏诊或低估的患者资料,25例为乳腺影像报告和数据系统(Breast Image Report And Data System,BI-RADS)3级,18例未见目标病变,伴可疑临床症状或乳腺X线摄影异常。通过术前术者超声结合临床、影像、肉眼观察标本及病理学检查报告,总结超声漏诊或低估的原因及不同原因对应的病理学特征。结果:43例漏诊或低估:5例病变边界清楚,病理学诊断为实性乳头状癌、浸润性导管癌、浸润性微乳头状癌;11例病变微小,病理学诊断为导管内癌、乳头状瘤癌变;3例病变回声接近周围腺体,病理学诊断为导管内癌、浸润性导管癌;4例占位感弱,病理学诊断为浸润性小叶癌;18例病变沿导管分布,病理学诊断为导管内癌;2例病变弥漫分布于整个腺体,无背景对比,病理学诊断为导管内癌。结论:某些乳腺癌的病理学特征加上超声的局限性,使其易漏诊或者低估。临床医师需要结合临床、其他影像学资料综合判断,降低漏诊或低估率。
Objective:To analyze the causes of missed diagnosis or underdiagnosis of breast cancer combined with the characteristics of preoperative ultrasound and postoperative pathology,improve the understanding of atypical breast cancer imaging and make accurate diagnosis decisions.Methods:From January 1st 2014 to December 30th 2018,the data of 43 cases that had been missed by ultrasound or evaluated as low-risk cases was analyzed,of which 25 cases were Breast Image Report and Data System(BI-RADS)grade 3.No target lesion was found in other cases,but suspicious clinical symptoms or abnormal mammography were found.Through preoperative ultrasound combined with signs,X-ray films,specimens and pathological reports,the causes of missed diagnosis and underestimation of breast cancer by ultrasound were summarized.Results:The distribution of ultrasound findings and corresponding pathological results of 43 cases were as follows:5 cases had clear boundary of lesions,including solid papillary carcinoma,invasive ductal carcinoma and invasive micropapillary carcinoma;11 cases had micro lesions,including intraductal carcinoma and papilloma canceration;3 cases had echo close to surrounding glands,including intraductal carcinoma and invasive ductal carcinoma;4 lesions had weak mass effect,were invasive lobular carcinoma;18 lesions distributing along the catheter with unclear boundary were all intraductal carcinoma;2 lesions diffusing among the whole gland without contrast background were intraductal carcinoma.Conclusion:Breast cancer with specific pathological features is easy to display as low-level image under ultrasound images.Preoperative ultrasound combined with clinical and other imaging data can reduce the rate of missed diagnosis.
作者
王宁
王铁柱
刘健
陈平
WANG Ning;WANG Tiezhu;LIU Jian;CHEN Ping(Department of Breast and Thyroid Surgery,China Japan Friendship Hospital,Beijing 100029,China;Department of Ultrasound,Hospital of Chinses Renmin University,Beijing 100872,China;Department of Ultrasound,China Japan Friendship Hospital,Beijing 100029,China)
出处
《肿瘤影像学》
2022年第1期43-49,共7页
Oncoradiology
关键词
乳腺癌
漏诊
低估
超声
病理学
Breast cancer
Missed diagnosis
Ultrasound
Pathology
