源新 めぐみ¹, 角田 博子², 向井 理枝¹, 鈴木 咲子¹, 平山 美以子², 河内 伸江², 菊池 真理², 小野田 結², 鈴木 高祐³

Megumi GENSHIN¹, Hiroko TSUNODA-SHIMIZU², Rie MUKAI¹, Sakiko SUZUKI¹, Miiko HIRAYAMA², Nobue KAWAUCHI², Mari KIKUCHI², Yui ONODA², Koyu SUZUKI³

¹聖路加国際病院臨床検査科, ²聖路加国際病院放射線科, ³聖路加国際病院病理診断科

¹Department of Clinical Labolatory, St. Lukes International Hosipital, ²Department of Radiology, St. Lukes International Hosipital, ³Department of Pathology, St. Lukes International Hosipital

キーワード : breast ultrasound, breast cancer, elastography, color Doppler method

目的：エラストグラフィ技術が普及し，乳房疾患の良悪性の診断に寄与している．一方，血流が多い病変は悪性の可能性を考えてアプローチする必要があることが多い．日常臨床においてhypervasucularであるにも関わらず，エラストグラフィでは良性の可能性が示される病変が経験されている．そのような症例をretrospectiveに検討し，今後どのような点に留意して検査を行うべきかを知ることを目的とした．対象と方法：2007年4‐6月の間に超音波検査を施行され，Bモードでカテゴリー3以上かつカラードプラ法で血流が多い症例のうち，エラストグラフィでスコア3以下を示した17例を対象とし，これらの超音波所見と病理組織所見について検討した．結果：17例中乳癌は12例，良性疾患は5例であった．エラストグラフィにてスコア1または2を示した症例は8例で，非浸潤性乳管癌4例，乳頭腺管癌1例，乳腺症，乳管内乳頭腫，葉状腫瘍が各1例ずつであった．スコア3を示した症例は9例で，非浸潤性乳管癌4例，硬癌，充実腺管癌，乳頭腺管癌が1例ずつ，乳腺症と葉状腫瘍が1例ずつであった．乳癌12例中非浸潤性乳管癌が8例であり，残り浸潤癌4例中3例は浸潤部分がかなり小さく乳管内成分優位なものであった．結論：Bモードおよびカラードプラ法で悪性と考えた症例で，elasticity score3以下の病変は，非浸潤癌を示すか良性病変であるということが示された．

Purpose: To diagnose benign and malignant breast lesions using elastography, which has proven useful and found increasing use in tumor diagnosis. Lesions with heavy blood flow must often be approached as possibly malignant. Elastography has also been used to evaluate potentially benign lesions, which are usually hypervascular. In this study, we examined such cases retrospectively to determine what points should be kept in mind during examination and testing. Subjects and Methods: Of patients who had undergone ultrasound evaluation from April to June 2007, whose B-mode ultrasound evaluation was category 3 or higher, and whose color Doppler ultrasound findings indicated heavy blood flow, those with an elastography score of 3 or lower served as subjects, and their ultrasound and histologic findings were studied. Results: Twelve of the 17 subjects had breast cancer; the remaining 5 had benign lesions. Eight of the subjects had an elastography score of 1 or 2: 4 had ductal carcinoma in situ; 1, papillotubular carcinoma; 1, fibrocystic breast disease; 1, intraductal papilloma; and 1, a phyllodes tumor. Of 9 subjects with an elastography score of three, 4 had ductal carcinoma in situ; 1, scirrhous carcinoma; 1, solid-tubular carcinoma; 1, papillotubular carcinoma; 1, fibrocystic breast disease; and 1, a phyllodes tumor. Of the 12 cases of breast cancer, 8 were cases of ductal carcinoma in situ and 4 were cases of invasive cancer. In 3 of the 4 cases, the invasive portion was relatively small and accounted for the image. Conclusion: Further study seems warranted by the fact that in cases that were potentially malignant according to B-mode and color Doppler ultrasound findings, lesions with an elastography score of 3 or lower were either non-invasive cancer or benign lesions.