| Background and Objective Granulomatous lobular mastitis is a rare breast inflammation of unknown etiology.Most clinical and ultrasound doctors may misdiagnose as suppurative mastitis,plasma cell mastitis or even breast cancer,which leads to delays in treatment.Because the disease has diverse clinical manifestations,pathogenesis,treatment of refractory recurrent,clinical diagnosis and treatment become difficult.Leading of awareness of the disease.In recent years,there is an increasing trend.In the past,there were some reports about the ultrasonic manifestations of the disease,but many of them lacked specificity.Through the analysis of 16 cases of patients witih different duration of 29 ultrasound images,and combined with the clinical course and pathological characteristics to explore the specific ultrasound image of granulomatous lobular mastitis,and its correlation with the clinical course and pathological in different stages of development.Meterials and methods Review the sonographic features of granulomatous lobular mastitis patients of our hospital in August 2009?February 2016 confirmed by pathologically,then divide them into different types.Clinical features and pathological features were collected.The ultrasonic characteristics,courses of disease and pathological characteristics were compared.At the same time,compared to the other 225 cases ultrasound images of other types of mastitis which confirmed by pathologically in the same period,to explore the specificity of granulomatous lobular mastitis ultrasoung images.Philips iU22 and Mindray color ultrasonic diagnostic instrument,probe frequency 5-12MHz.Patients take supine position,fully exposed bilateral breast and axillary,fan-shaped scanning on the breast of each quadrant,especially scanning edge,the rear of the areola,then axillary exploration.Ultrasound observation lesion morphology,size,boundary,internal echo,color Doppler flow imaging and spectral Doppler lesions observed in and around the blood supply,blood flow velocity and resistance index(Resistence index,RI),<60 degree angle correction.SPSS 21.0 statistical software was used for data analysis.Chi square test was used to compare categorical variables.The<0.05 value of P was significant difference.Results In this study,16 cases of granulomatous lobular mastitis patients 29 cases of ultrasound images can be divided into 4 types.Various types of granulomatous lobular mastitis have corresponding clinical and pathological features.Compared to the sonographic features of plasma cell mastitis and lactation suppurative mastitissame have been checked by ultrasound and diagnosed by pathology in this period,we can see:(1)similar lymph node echo:granulomatous lobular mastitis patients 6 cases(6/29,21%),lactation mastitis patients 9 cases(9/192,0.05%),patients with plasma cell mastitis 0 case(0/33,0%),the image in the patients with granulomatous lobular mastitis showed statistically significant specificity(P<0.05).(2)diffuse mixed echo:Including the type of diffuse medium and low echo mixed and the type of diffuse irregular low and weak echo mixed,the former granulomatous lobular mastitis patients 5 cases(5/29,17.2%),lactation mastitis patients 48 cases(48/192,25%),plasma cell mastitis 0 case(0/33,0%);the latter granulomatous lobular mastitis patients 3 cases(3/29,10.3%),lactation mastitis patients 0 case(0/192,0%),plasma cell mastitis 0 case(0/33,0%).(3)abscess of liquefaction necrosis:According to the shape of different ways can be divided into parallel tubular and longitudinal calabash,The former granulomatous lobular mastitis patients 2 cases(2/29,6.9%),lactation mastitis patients 21 cases(21/192,10.9%),plasma cell mastitis 30 cases(30/33,91%);the latter granulomatous lobular mastitis patients 5 cases(5/29,17.1%),lactation mastitis patients 0 case(0/192,0%),plasma cell mastitis 1 case(1/33,3%).(4)multiple abscess and multiple fistula type:granulomatous lobular mastitis patients 8 cases(8/29,27.6%),lactation mastitis patients 0 case(0/192,0%),plasma cell mastitis 2 cases(2/3 3,6%),the image in the patients with granulomatous lobular mastitis showed statistically significant specificity(P<0.05).Conclusion and significance Different types of ultrasound were found in different stages of development.Mixed echo mass of similar lymph nodes which isolated scattered in the edge of the mammary gland and area of liquid prolonged does not heal and complex sinus,these two kinds of image features can obviously improve the sensitivity of ultrasound diagnosis of the disease.Ultrasound doctors can recognize the disease and master its diagnostic characteristics,which is very important for the clinical treatment and prognosis of the disease. |
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