辻本 文雄

Fumio TSUJIMOTO

聖マリアンナ医科大学超音波センター

Diagnostic Ultrasound Center, St. Marianna University, School of Medicine

キーワード : breast, ultrasonography, benign disease, borderline lesion

乳房疾患はその種類が多く，特に良性疾患は多岐にわたる．乳腺症は臨床情報を加味せず画像所見のみで診断するのは，超音波検査で嚢胞を検出したとき確定診断できる以外，非常に難しい．良性と診断しやすいものに線維腺腫，腺腫，過誤腫，脂肪腫，脂肪壊死症，血管脂肪腫，乳腺線維症，乳瘤，女性化乳房症がある．悪性との鑑別に注意を要すものに放射状瘢痕，乳管内乳頭腫，嚢胞内乳頭腫，乳管腺腫，乳頭部腺腫がある．良悪の境界病変は，葉状腫瘍，cystic hypersecretory hyperplasia，異型乳管過形成，mucocele-like tumorがある．炎症性疾患を除いた主な乳房の良性疾患と境界病変の臨床像，病理像と対比した超音波診断を個々の疾患について，マンモグラフィやMRIなど他の画像診断も加味しつつ記載した．乳房疾患の良悪性の判定に際して，超音波診断が非常に大きな役割を果たしていることが分かる．

There are many types of breast disease, with benign diseases being particularly diverse. It is very difficult to diagnose mastopathies using imaging findings alone without clinical information, except for definite diagnosis of cysts by ultrasonography. Diseases that are easily diagnosed as benign are fibroadenoma, adenoma, hamartoma, lipoma, fat necrosis, angiolipoma, fibrous breast disease, galactocele, and gynecomastia. On the other hand, care needs to be taken when differentiating the benignancy and malignancy of radial scar, intraductal papilloma, intracystic papilloma, ductal adenoma, and adenoma of the nipple. Borderline benign/malignant lesions are phyllodes tumor, cystic hypersecretory hyperplasia, atypical ductal hyperplasia, and mucocele-like tumor. While other diagnostic imagings, i.e., mammography and MRI, were mentioned for the diagnosis of the main benign breast diseases and borderline lesions with the exception of inflammatory diseases, ultrasonographic findings were described in contrast to histopathology and clinical diagnosis of individual breast diseases. On the occasion of diagnosis for benignancy or malignancy of breast diseases, ultrasonography plays a very large role.