摘要目的 探讨不同病理类型乳腺肉芽肿性疾病的超声特征及诊断可行性分析.方法 回顾性分析2008年11月至2012年11月浙江大学邵逸夫医院32例不同病理类型的乳腺肉芽肿性疾病的临床表现、声像图特征和超声诊断信息,为辅助诊断乳腺肉芽肿性疾病提供依据.结果 依据32例乳腺肉芽肿性病例,其超声特征可分为4型:管样型、肿块型、弥漫型和囊肿型.其中12例肉芽肿性乳腺炎和12例未分类的肉芽组织增生以管样型(6、5例)为主,其次为肿块型(4、5例)和弥漫型(各2例);5例黄色肉芽肿、2例脂性肉芽肿和1例异物肉芽肿,除1例脂性肉芽肿为囊肿型外,其余均表现为肿块型.肉芽肿性乳腺炎和炎性肉芽组织增生这两组病例诊断准确率较高,超声下以炎症作为第一诊断的比例分别为10/12和8/12,而诊断为BI-RADS 4b及以上的均只有1例,分别为8.3％.黄色肉芽肿和异物肉芽肿超声下被误诊为癌概率则很高,BI-RADS 4b及以上误诊比例分别为4/5和1/1.结论 超声诊断肉芽肿性乳腺炎和炎性肉芽组织增生具有一定的实用价值,但确诊依靠病理学检查结果.

abstractsObjective To evaluate the sonographic features of different pathological types of breast granulomatous diseases and analyze the feasibility of ultrasonic diagnosis.Methods A total of 32 patients with different pathological types of breast granulomatous diseases were recruited.Their clinical and sonographic findings were retrospectively reviewed.There were granulomatous mastitis (n =12),breast xanthogranuloma (n =5),lipogranuloma (n =2),foreign body granuloma (n =1) and nonspecific granulation hyperplasia (n =12).Results Based on major sonographic appearances,they were divided into 4 patterns of tubular,mass,diffuse and cystic mass.In 12 patients with granulomatous mastitis and 12 patients with nonspecific granulation hyperplasia,the major sonographic appearance was of tubular pattern (n =6,5),followed by mass pattern (n =4,5) and diffuse pattern (n =2,2).Five patients with breast xanthogranuloma and 1 patient with foreign body granuloma all showed mass pattern.In 2 patients with lipogranuloma,one was of mass pattern and abother cystic pattern.In patients with granulomatous mastitis and patients with nonspecific granulation hyperplasia,it showed a high diagnostic reliability of ultrasound.The ratio of inflammatory lesion as the first sonographic diagnosis was 10/12 and 8/12 respectively and ultrasonic BI-RADS 4b or above both only 1/12.However,the ratio of sonographic imaging in patients with xanthogranuloma and Lipogranuloma mimic breast cancer,in which ultrasonic score as breast imaging-reporting and data system (BI-RADS) 4b or above was 4/5 and 1/1 respectively.Conclusions Ultrasound is valuable in evaluating the lesions in patients with granulomatous mastitis and nonspecific granulation hyperplasia.However a definite diagnosis is still dependent on histopathology.