Longman C F, Campion T, Butler B, Suaris T D, Khanam A, Kunst H, Tiberi S, O'Keeffe S A
Barts Health NHS Trust, London, United Kingdom.
Barts Health NHS Trust, London, United Kingdom.
Clin Radiol. 2017 Mar;72(3):217-222. doi: 10.1016/j.crad.2016.11.023. Epub 2017 Jan 6.
To outline the pathophysiology, clinical presentation, imaging features, and relevant investigations of the different subtypes of breast tuberculosis (TB).
A review was undertaken of all cases (33 in total) of breast TB presenting to Barts Health NHS Trust within a 10-year period, including patient demographics, imaging features, and route of diagnosis.
Thirty-three cases of proven granulomatous TB of the breast were identified (11 mastitis obliterans, 10 nodular caseous form, five sclerosing form, four disseminated disease, and three abnormal axillary lymph nodes). No cases of miliary breast TB were identified. Fine-needle aspiration cytology aided diagnosis in six patients (<20% of cases); however, the majority of patients required further investigation; namely core biopsy. Over a third of patients (12/33) had multiple clinic attendances prior to diagnosis. Mean delay in diagnosis was 3.7 months (median 0 months, IQR= 3).
Breast TB is a rare challenging diagnosis with a wide range of imaging features. Core biopsy is essential for definitive diagnosis. A multidisciplinary approach involving surgeons, radiologists, TB consultants, and microbiologists is required, coupled with a high index of clinical suspicion in order to aid timely diagnosis, and initiate prompt treatment to reduce complications.
概述乳腺结核（TB）不同亚型的病理生理学、临床表现、影像学特征及相关检查。
回顾了10年间就诊于巴茨健康国民保健服务信托基金的所有乳腺结核病例（共33例），包括患者人口统计学资料、影像学特征及诊断途径。
确诊33例乳腺肉芽肿性结核（11例闭塞性乳腺炎、10例结节干酪样型、5例硬化型、4例播散性病变及3例腋窝淋巴结异常）。未发现粟粒性乳腺结核病例。细针穿刺细胞学检查辅助6例患者诊断（<20%的病例）；然而，大多数患者需要进一步检查，即粗针活检。超过三分之一的患者（12/33）在诊断前多次就诊。诊断的平均延迟时间为3.7个月（中位数0个月，四分位间距=3）。
乳腺结核是一种罕见且具有挑战性的诊断，具有广泛的影像学特征。粗针活检对明确诊断至关重要。需要外科医生、放射科医生、结核顾问及微生物学家采取多学科方法，并保持高度的临床怀疑指数，以帮助及时诊断并及时开始治疗以减少并发症。
