彩色多普勒血流成像在乳腺较小肿块鉴别诊断中的价值

Color Doppler flow imaging in differential diagnosis of small breast masses

目的评价彩色多普勒超声血流检测在乳腺较小肿块(≤2cm)鉴别诊断中的价值。方法对192个乳腺良、恶性较小肿块的彩色多普勒超声血流数、血流信号的形态特征、多普勒血流参数分别进行统计学分析,并与216个大于2cm的乳腺良、恶性肿块组进行比较。结果彩色多普勒超声对乳腺良、恶性较小肿块的血流检出率具有显著差异,分别为58.1%和83.0%,且其差异较>2cm组更显著;以超声检测的血流数作为乳腺癌诊断依据,虽然敏感性较低,但其特异性明显高于>2cm的肿块,且血流数越多,诊断特异性越高。穿入型血流对乳腺恶性肿块、环绕型血流对良性肿块的诊断分别具有较高的特异性,但其敏感性低,与>2cm组相似。在乳腺较小肿块中,恶性肿块的血流RI、PI、Vmax值均明显高于良性肿块,以RI≥0.72诊断乳腺癌的敏感性、特异性分别为90.9%、84%,较>2cm组更高。结论乳腺较小肿块内的超声血流数显示,尤其是较多的血流数,相对较大的乳腺肿块来说更可能提示恶性病变,血流RI值测定对较小乳腺癌的诊断具有更高的价值。

Objective To evaluate the value of color Doppler flow imaging in differential diagnosis of the small breast masses （≤2 cm）. Methods We analyzed the flow numbers, the flow morphologie characteristics and the spectral Doppler parameters of one hundred and ninety-two small malignant and benign breast masses （≤2 cm） on the color flow imagings retrospectively, and compared them with the larger mass group （〉2 em） respectively. Results The vascular detecting rate of the small breast masses in malignant and benign groups were 83.0% and 58. 1 % respectively, which had more significant difference than that of the larger group. Although the diagnostic sensitivity was low with flow numbers as criteria for malignancy, the specificity was much higer than that used in the larger masses. The more the vessels, the higher the specificity. The penetrating vessel had a high diagnostic specificity for malignant breast masses while the circular vessel was a characteristic of benign masses, but both of them had lower sensitivity, as same as the larger group. In the small breast masses, RI≥0.72 utilized as a criterion for malignancy had a sensitivity of 90.9% and a specificity of 84%, which were higher than those of the larger masses. Conclusion The vessels visualized by color Doppler ultrasonography in small breast masses, especially the more signals, was more likely suggestive of malignancy than that in larger breast masses. RI had greater value in diagnosing small breast cancer.