目的 评价乳腺黏液癌的超声、X线等影像学特征及其与病理组织类型的相关性.方法 回顾性分析21例经手术病理证实的乳腺黏液癌患者(22个病灶)的超声、X线特征及与病理组织类型之间的关系.结果 病理组织学分类包括14个单纯型(6个富细胞型,8个少细胞型)和8个混合型病灶.超声:所有病例均存在实性肿块,85.71％(12/14)的单纯型肿块境界清晰,回声等或略低于皮下脂肪,92.86％(13/14)的单纯型病灶后方回声增强；75.00％(6/8)的混合型和14.29％(2/14)的单纯型肿块边界较模糊并细小毛刺,内部回声较脂肪回声低.超声和X线片术前怀疑恶性的比例均为63.64％(14/22).恶性X线表现包括肿块(10个)、局限性不对称致密影(2个)、结构扭曲并恶性钙化和单纯不定性钙化(各1个).肿块主要为高密度,单纯型边界清楚或呈浅分叶状,混合型边界不规则和毛刺改变.81.82％(18/22)的病灶被超声或X线之一疑诊恶性,45.45％(10/22)的病灶术前超声和X线均疑为恶性.结论 乳腺黏液癌尤其单纯型影像学特征不典型,超声和X线诊断均可能诊断为良性病变；肿块边缘特征是鉴别良恶性的重要依据,混合型肿块较单纯型更具有浸润性特征；超声和X线联合诊断有利于避免误诊,两者之一怀疑恶性时,即应行穿刺活检以明确诊断.%Objective To evaluate the correlation between ultrasonic and X-ray features and pathological types of breast mucinous carcinoma. Methods Twenty-one patients with 22 focuses of breast mucinous carcinoma confirmed pathologically were enrolled. The correlation between the ultrasonic and mammogram findings and histological features were analyzed retrospectively. Results These 22 focuses of breast mucinous carcinoma included pure type (n= 14) and mixed type (n=8), the former included 6 cellular type and 8 hypocellular type. On US examination, all patients had solid mass. The pure type masses showed well-defined margins without pseudocapsule and isoechogenic or hypoechoic internal echo pattern relative to that of subcutaneous fat in 85. 71% (12/14) focuses, 92. 86% (13/14) pure type focuses had posterior enhancement, while 75. 00% (6/8) of mixed type lumps and 14. 29% (2/14) of pure type lumps demonstrated as ill-defined and/or spiculated margins with hypoechogenic structure. There were 63. 64% (14/22) of lesions classified as BI-RADS 4 or 5 suspected as malignancy by ultrasonography and mammograms, respectively. These mammograms features contained 10 masses, 2 focal asymmetries, 1 architectural distortion with malignant calcification and 1 isolated indifferent calcification. The main mammographic appearances of masses were well-defined margins with microlobulation for pure type, poorly differentiated or speculated margins for mixed type. There was 81. 82% (18/22) of focuses suspected as malignancy by mammogra-phy or ultrasonography. There was 45. 45% (10/22) of focuses suspected as malignancy by both mammogram and ultrasonography. Conclusion Mucinous breast carcinomas, especially pure type ones do not have typical image features, which might be diagnosed as benign focuses by mammography and/or ultrasound. Margins of the masses are very important for differential diagnosis. Mixed type mucinous carcinomas have more aggressive imaging characteristics, which demonstrate ill-defined and/or speculated margins. Combination of mammogram with ultrasonography is helpful to avoiding miss. Biopsy should be performed when malignancy is suspected by mammogram or ultrasonography.
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