常规超声与超声弹性成像对乳头溢液病因诊断的价值

Nipple discharge disorders:diagnosis using conventional US and real-time ultrasound elastography

目的探讨常规超声及超声弹性成像在乳头溢液病因诊断中的价值。方法36例乳头溢液患者术前经常规超声及实时超声弹性成像检查,采用平行于乳腺导管的放射状方法扫查,根据乳晕区域扩张导管和（或）占位的常规超声声像图表现,诊断分为BI-RADS 1~5级。实时弹性成像根据病灶弹性成像的特征,将其分为1~5级。全部病变均获得手术病理。结果36例患者病理共发现40个病变,其中良性31个,恶性9个。常规超声对病变导管的显示率为90%（36/40）,对所显示的36个病变良恶性诊断的敏感性100%,特异性54.8%,准确性65%。在常规超声的基础上使用弹性成像,在BI-RADS 4级和5级的23个病变中,以弹性成像评分1级或2级为良性标准,检出良性病变3例,均为导管扩张伴实性占位的病灶,二者联合使用的诊断敏感性100%,特异性64.5%,准确性72.5%。弹性成像评分为1级或2级者14例,病理证实均为良性。结论对部分导管扩张伴有导管内局限性低回声的病变,应用超声弹性成像可提高诊断的特异性。

Objective To investigate the value of conventional ultrasound （US） and real-time ultrasound elastography （USE） in the diagnosis of breast discharge. Methods Both conventional US and real-time USE using a Hitachi EUB-8500 US system were performed in 36 consecutive patients. Each lesion was assigned an elasticity score according to the degree and distribution of strain induced manually by mild compression. The USE scores （1 to 5） were compared to conventional US with the BI-RADS assessment categories （1 to 5）. Sensitivity, specificity, and overall accuracy of each measurement were determined by using surgical pathology as a gold standard. Results There were 31 benign and 9 malignant lesions. Conventional US found 90% of the lesions （36/40）. In these 36 lesions, the sensitivity, specificity and accuracy were 100%, 54.8% and 65% for conventional US. Of 23 lesions with BI-RADS 4-5 categories of malignant on conventional US, three were scored as 1 and 2 categories of benign by USE and proven to be benign, which increase the specificity and accuracy to 64.5% and 72.5%, respectively. Conclusion The addition of USE imaging to conventional US could be helpful to characterize the intraductal masses of breast.