超声造影对乳腺BI-RADS4类肿块的诊断价值
Diagnostic value of contrast-enhanced ultrasound in breast lesions of BI-RADS 4
目的 探讨超声造影(CEUS)检查对提高乳腺第5版乳腺影像报告和数据系统(BI-RADS)4类肿块良恶性诊断的价值.方法 收集2016年1月至2017年12月在山西医科大学第一医院就诊患者72例,最终经穿刺活检或手术病理结果确诊的乳腺肿块共79个.根据常规超声对所有肿块行BI-RADS分类,并行CEUS检查.根据CEUS预测模型结果,重新判定乳腺BI-RADS 4类肿块良恶性:(1)常规超声BI-RADS分类+CEUS预测模型:两者均提示恶性时诊断为恶性;(2)利用CEUS预测模型重新调整BI-RADS分类:若为恶性CEUS预测模型,则上调一类,若为良性CEUS预测模型,则下调一类.比较两种方法对乳腺B1-RADS 4类肿块良恶性的诊断效能.结果 (1)79个乳腺肿块中,恶性肿块36个,良性肿块43个;常规超声BI-RADS分类、CEUS预测模型、常规超声BI-RADS分类+CEUS预测模型及调整后BI-RADS分类诊断的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为86.1%、65.1%、74.7%、67.4%、84.8%;88.9%、76.7%、82.3%、76.2%、89.2%;80.6%、86.0%、83.5%、82.9%、84.1%;97.2%、76.7%、86.1%、77.8%、97.1%.(2)以病理结果为金标准,常规超声BI-RADS分类、CEUS预测模型、常规超声BI-RADS分类+CEUS预测模型及调整后BI-RADS分类ROC曲线下面积分别为0.756、0.828、0.833、0.870,调整前、后BI-RADS分类比较差异有统计学意义(Z =2.322,P<0.05).结论 利用CEUS预测模型调整乳腺BI-RADS 4类肿块分类后诊断效能更高,可以减少不必要的穿刺活检.
更多Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of BI-RADS 4 breast masses.Methods A total of 72 patients were collected from the First Hospital of Shanxi Medical University from January 2016 to December 2017.79 breast masses were confirmed by biopsy or surgical pathology.All the masses were classified by BI-RADS according to conventional ultrasound and CEUS was performed in parallel.Based on the results of the CEUS predictive model,the benign and malignant features of the breast BI-RADS type 4 tumors were re-determined:(1)conventional ultrasound BI-RADS classification + CEUS predictive model:both of them were malignant when malignant;(2) re-adjusting BI-RADS classification by CEUS predictive model:if the malignant CEUS predictive model,upgrade a class,if the benign CEUS predictive model,downgrade a class.The diagnostic efficiency of the two methods in breast masses of BI-RADS 4 was compared.Results (1) There were 36malignant masses and 43 benign masses in 79 breast masses.Diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the conventional ultrasound BI-RADS classification,CEUS predictive model,conventional ultrasound BI-RADS classification + CEUS predictive model and the adjusted BI-RADS classification were 86.1%,65.1%,74.7%,67.4%,84.8%;88.9%,76.7%,82.3%,76.2%,89.2%;80.6%,86.0%,83.5%,82.9%,84.1%;97.2%,76.7%,86.1%,77.8%,97.1%,respectively.(2) The area under the receiver operating characteristic (ROC) curve of conventional ultrasound BI-RADS classification,CEUS predictive model,conventional ultrasound BI-RADS classification + CEUS predictive model and the adjusted BI-RADS classification was 0.756,0.828,0.833,0.870,respectively.Before and after the adjustment of BI-RADS classification,the difference was statistically significant (Z =2.322,P < 0.05).Conclusion The diagnostic efficiency that CEUS predictive model adjusted classification of BI-RADS 4 breast masses is better,the method can reduce unnecessary biopsy.
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