摘要目的 评价自动乳腺全容积成像(automated breast volume scanner,ABVS)的诊断特点、诊断性能,探讨其诊断价值及临床意义.方法 选取2011至2015年在北京协和医院乳腺外科就诊的288例乳腺肿物患者,收集其术前ABVS检查、手持超声(hand-held breast ultrasound,HHUS)及手术或活检病理的诊断、影像资料,记录病理及影像报告检查结果,统计"纠集征"表现,采用受试者操作特征曲线(receiver operating characteristic curve,ROC)分析计算单一诊断方法及联合诊断方法的诊断性能.结果 (1)288例患者经ABVS检查共发现311个乳腺病灶,组织病理学诊断结果显示恶性病变141个(45.3%),良性病变170个(54.7%);(2)ABVS"纠集征"表现在恶性病变检出率为31.2%(44/141),在良性病变检出率为1.8%(3/170),两者差异有统计学意义(χ2=52.075,P=0.000).ABVS"纠集征"在浸润性导管癌(invasive ductal carcinoma,IDC)检出率为38.5%(40/104),在导管原位癌(ductal carcinoma in situ,DCIS)检出率为10.5%(2/19),在其他类型癌检出率为11.1%(2/18),IDC的检出率与后两者的差异均有统计学意义(χ2=5.575,P=0.018;χ2=5.085,P=0.024);(3)ABVS对恶性病变的敏感性89.4%、特异性80.6%、诊断效率90.1%;HHUS对恶性病变的敏感性91.5%、特异性74.1%、诊断效率91.3%.ABVS和HHUS联合诊断,敏感性93.6%、特异性72.9%、诊断效率93.2%."纠集征"对恶性乳腺肿瘤诊断的敏感性31.2%,特异性98.2%,优势比25.251.结论 ABVS冠状面特有的"纠集征"对乳腺肿瘤的诊断,特别是IDC有较高的临床价值,但ABVS尚不能完全取代HHUS,两者联合检查可提高诊断效率,有助于早期发现乳腺恶性病变.

abstractsObjective To evaluate the diagnostic features, characteristics, value, and clinical significance of the automated breast volume scanner (ABVS) in breast lesions. Methods A total of 288 patients with breast lesions diagnosed at the Breast Surgery Department of Peking Union Medical College Hospital between 2011 and 2015 were selected. Diagnostic and image data of preoperative ABVS examinations, hand-held breast ultrasound (HHUS), and surgery or biopsy pathology were collected. Pathology and imaging report results were recorded, accounting for the retraction phenomenon; receiver operating characteristic(ROC)curve analysis was used to calculate the diagnostic performance of the single and combined diagnostic methods. Results (1) A total of 311 breast lesions were found in 288 patients using the ABVS;histopathological diagnosis showed that there were 141(45.3%)malignant lesions and 170 (54.7%)benign lesions.(2)The detection rates of the retraction phenomenon using the ABVS in malignant and benign lesions were, respectively, 31.2% (44/141) and 1.8% (3/170); the difference was statistically significant (χ2=52.075,P=0.000). The detection rates of the retraction phenomenon using the ABVS in invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS), and other types of carcinomas were, respectively, 38.5% (40/104), 10.5% (2/19), and 11.1% (2/18). There were significant differences between IDC and DCIS and between IDC and other types of carcinomas (χ2=5.575, P=0.018; χ2=5.085, P=0.024, respectively). (3) The sensitivity, specificity, and accuracy rates of single ABVS were 89.4%, 80.6%, and 90.1%,respectively,and those of single HHUS were 91.5%,74.1%,and 91.3%,respectively,for malignant lesion diagnosis. For diagnosis with combined ABVS with HHUS, the sensitivity, specificity, and accuracy rates were 93.6%,72.9%,and 93.2%,respectively.Sensitivity and specificity rates,and the advantage ratio of the retraction phenomenon were, 31.2%, 98.2%, and 25.251, respectively. Conclusions Use of the ABVS for coronary sections with the retraction phenomenon has important clinical value in identifying malignant breast lesions,especially in identifying IDC,but ABVS cannot completely replace HHUS.ABVS combined with HHUS can improve the diagnostic capacity, and is helpful for early diagnosis of malignant breast lesions.