Kamal Rasha Mohamed, Hamed Soha Talaat, Salem Dorria Saleh
Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt.
Breast J. 2009 Jul-Aug;15(4):367-80. doi: 10.1111/j.1524-4741.2009.00740.x. Epub 2009 May 22.
In this study, the authors proposed a classification of inflammatory breast disorders based on which a practical systematic scheme in diagnosis was applied aiming to differentiate simple forms of mastitis from more complicated and malignant forms. The study population included 197 female patients who were clinically or pathologically diagnosed as having mastitis. All patients underwent Ultrasound examination. Mammography was performed for 133/197 cases. Cases of simple mastitis and periductal mastitis were followed up to ensure complete resolution. Abscess cavities and postoperative collections were drained. Other cases were biopsied to confirm diagnosis and were managed accordingly by their treating physicians. Statistical analysis was performed by the Statistical Package for Social Science. Nominal Data were expressed as frequency and relative frequencies (percentage). Ultrasound and Mammography categorical results were compared using the Pearson Chi Square and Fisher's exact test. Patients were classified into three groups; infectious, noninfectious and malignant mastitis. Simple and malignant forms of mastitis showed many signs in common. The presence of ill defined collections and abscess cavities on ultrasound favored simple over malignant forms of mastitis while extensive skin thickening and infiltrated malignant nodes favored malignant forms. Interstitial edema, edematous fat lobules, abscess cavities, skin thickening seen on ultrasound examination were significantly lower in noninfectious than simple and malignant mastitis. Mammography signs were less discriminating. Diffuse skin thickening and increased density favored malignant mastitis while dilated retro areolar ducts and characteristic calcification patterns favored noninfectious forms. Simple mastitis showed nonspecific signs. Ultrasound examination in mastitis cases shows more specific signs in differentiating between the three forms of mastitis and is useful in monitoring treatment, excluding complications and guide for interventional procedures. Mammography should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected.
在本研究中，作者提出了一种炎性乳腺疾病的分类方法，并在此基础上应用了一种实用的系统诊断方案，旨在将单纯性乳腺炎与更复杂的恶性形式区分开来。研究人群包括197名临床或病理诊断为患有乳腺炎的女性患者。所有患者均接受了超声检查。197例中有133例进行了乳房X线摄影检查。对单纯性乳腺炎和导管周围乳腺炎病例进行随访，以确保完全消退。脓肿腔和术后积液进行了引流。其他病例进行活检以确诊，并由治疗医生进行相应处理。采用社会科学统计软件包进行统计分析。名义数据以频数和相对频数（百分比）表示。使用Pearson卡方检验和Fisher精确检验比较超声和乳房X线摄影的分类结果。患者被分为三组：感染性、非感染性和恶性乳腺炎。单纯性和恶性乳腺炎形式有许多共同的体征。超声显示边界不清的积液和脓肿腔提示为单纯性而非恶性乳腺炎，而广泛的皮肤增厚和浸润性恶性结节则提示为恶性形式。超声检查发现非感染性乳腺炎的间质水肿、脂肪小叶水肿、脓肿腔、皮肤增厚明显低于单纯性和恶性乳腺炎。乳房X线摄影体征的鉴别性较差。弥漫性皮肤增厚和密度增加提示为恶性乳腺炎，而乳晕后导管扩张和特征性钙化模式提示为非感染性形式。单纯性乳腺炎表现为非特异性体征。乳腺炎病例的超声检查在区分三种乳腺炎形式时显示出更具特异性的体征，有助于监测治疗、排除并发症并指导介入操作。每当怀疑有复杂、恶性和不常见的乳腺炎形式时，都应进行乳房X线摄影检查。
