超声筛查乳腺恶性非肿块型病变的研究现状

doi:10.3877/cma.j.issn.1673-5250.2022.04.002

目前全球乳腺癌发病率位居女性恶性肿瘤首位。早筛查、早诊断可有效提高乳腺癌患者总体生存率，改善其预后。超声检查是目前国内乳腺癌筛查的重要手段之一。乳腺恶性非肿块型病变(NML)因边缘模糊、无明显占位效应，而容易被乳腺超声检查漏诊或误诊。针对乳腺恶性NML的超声诊断，目前临床主要诊断技术包括以下几种。①二维超声可清晰显示乳腺恶性NML低回声区、微钙化、增粗扩张导管及结构扭曲(AD)等；②彩色多普勒血流显像(CDFI)，可见乳腺恶性NML内丰富血流信号；③超声造影(CEUS)不仅可通过造影剂反映乳腺恶性NML的微血管灌注情况，还能与乳腺影像和报告数据系统(BI-RADS)分类结合，提高诊断乳腺恶性NML效能，降低诊断性组织病理学活检率；④超声弹性成像可定性、定量反映乳腺恶性NML与周围组织弹性差异；⑤乳腺超声自动乳腺全容积成像(ABVS)基于独特的冠状面特征图像，可更加敏感地反映乳腺恶性NML与正常乳腺组织的结构差异；⑥对上述5种超声技术进行联合的多模态超声技术，可有效提高对乳腺良、恶性NML患者的鉴别诊断效能，降低对乳腺恶性NML的漏诊与误诊率。笔者拟就乳腺二维超声、CDFI、CEUS、超声弹性成像、ABVS，以及上述5种超声技术联合的多模态超声技术，在乳腺恶性NML筛查中的应用研究最新进展进行阐述。

关键词: 乳腺肿瘤, 超声检查, 彩色多普勒血流显像, 超声造影, 超声弹性成像, 自动乳腺全容积成像, 乳腺影像和报告数据系统, 女(雌)性

Breast cancer is top 1 of malignant tumor of women worldwide now. Early screening and diagnosis can effectively make improvements for overall survival rate of breast cancer patients and improve their prognosis. Ultrasound is a widely used detection method for breast cancer screening in China. Non-mass lesion (NML) is prone to clinical omission or misdiagnosis due to blurred edges without obvious mass effects, which is one of difficulties of breast ultrasound in diagnosis of breast malignant NML. For diagnosis of breast malignant NML, there are a variety of ultrasonic diagnosis techniques as the following. ① Breast two-dimensional ultrasound is used clinically to show low echo area of malignant NML without obvious occupancy effects, micro calcification of lesions tissue, coarse expansion of catheters and architectural distortion (AD). ② Malignant NML often presents as a rich blood flow signal on color doppler flow imaging (CDFI). ③ Contrast-enhanced ultrasound (CEUS) can not only reflect perfusion of malignant NML microvascular through contrast agents, but also can be combined with breast imaging and report data system (BI-RADS) classification to improve diagnostic efficiency of breast malignant NML and reduce diagnostic biopsy ratio. ④ Ultrasonic elastography can show qualitatively and quantitatively reflect elastic differences between breast malignant NML and its surrounding tissue. ⑤ Automated breast volume scanner (ABVS) of unique images of coronal features can more sensitively reflect structural differences between malignant NML of mammary gland and normal breast tissue. ⑥ The combination of a variety of the above five ultrasound technologies to form multimodal ultrasound technology can effectively improve diagnosis efficiency of breast malignant NML. The author intends to expound the latest research progresses of breast two-dimensional ultrasound, CDFI, CEUS, ultrasound elastography, ABVS, and combination of the above five ultrasonic examination techniques to form multimodal ultrasound technology in screening of breast malignant NML of mammary gland.

Key words: Beast neoplasms, Ultrasonography, Color doppler flow imaging, Contrast-enhanced ultrasound, Ultrasonic elastography, Automated breast volume scanner, Breast imaging and report data system, Female

图1 2020年全球女性癌症新发患者与死亡患者数量前10位的癌症类型^[1](图1A：新发患者数量前10位的癌症类型；图1B：死亡患者数量前10位的癌症类型)

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