超声直接及间接征象的乳腺图像和报告数据体系评分对乳腺实性肿块的诊断价值

Value of BI-RADS ultrasonic scores of direct and indirect ultrasonographic signs in diagnosis of solid breast lesions

目的探讨超声直接及间接征象乳腺图像和报告数据体系（BI-RADS）评分对乳腺实性肿块良恶性诊断的价值。方法应用二维以及彩色多普勒技术检查并详细记录132个乳腺肿块的超声直接及间接征象，参照BI—RADS评分标准予以赋值评分，并与病理结果进行对照。结果由乳腺肿块直接征象（肿块纵横比、形态、边界、内部回声、后方回声、血流分级、微小钙化）以及间接征象（局部皮肤厚度改变、Cooper韧带改变、腋窝淋巴结肿大、深浅筋膜改变、肿块周边毛刺改变）综合而成的总积分在良恶性乳腺肿块组之间的差异有统计学意义，恶性肿块总积分为（8．94±2．85）分，高于良性肿块[（3．09±1．97）分，P〈0．05]；除皮肤厚度改变外，其余各征象的积分在乳腺良恶性肿块组之间的差异均有统计学意义（均P〈0．05）。依据受试者工作特性曲线（ROC曲线），直接征象中，总积分≥4分为最佳临界值，其诊断乳腺良恶性肿块的灵敏度和特异度分别为0．84和0．93；间接征象中，总积分≥1分为最佳临界值，其诊断乳腺良恶性肿块的灵敏度和特异度分别为0．82和0．74；二者联合后，总积分≥5分为最佳临界值，其诊断乳腺良恶性肿块的灵敏度和特异度分别为0．88和0．90。结论对乳腺实性肿块的超声直接和间接征象特征进行赋值评分，可使诊断更加客观，是一种简便、有效的半定量、全面分析方法。

Objective To explore the value of BI-RADS ultrasonic scores of direct and indirect ultrasonographic signs in diagnosis of solid breast lesions. Methods Reference to the standard BI-RADS score, ultrasonic scores of direct and indirect ultrasonographic signs of 132 solid breast lesions were assigned, and were compared with pathological results. Results By the direct signs of breast lesions （ aspect ratio, shape, border, internal echo, posterior echo, flow grade, sand-like calcification） and indirect signs （changes in local skin thickness, Cooper ligament changes, axillary lymph nodes, depth of reinforcement membrane changes, mass changes in the surrounding burr） , the integral from the total scores in benign and malignant breast masses showed a statistically significant difference. The total score of malignant lesions （8.94 ± 2.85） was significantly higher than that of benign tumors （3.09 ±1.97, P 〈 0.05）. Except skin thickness, all the remaining scores of the signs of benign and malignant breast tumors showed a significant difference between the two groups （P 〈 0.05）. By receiver operating curve （ROC） analysis, the best critical value of the total score of direct signs was 〉~4, with a sensitivity and specificity of 0.84 and 0.93, respectively, in distinguishing breast carcinoma from benign lesions. The best critical value of the total score of indirect signs was ≥ 1, with a sensitivity and specificity of 0.82 and 0.74, respectively. The critical value of the combination of the direct and indirect signs was ≥5 in differential diagnosis of malignant and benign lesions, with a sensitivity and specificity value of 0.88 and 0.90, respectively. Conclusion The assignment score to the ultrasound characteristics of the direct and indirect signs of solid breast lesions can make a more objective diagnosis, yet it is a simple, effective, comprehensive and semi-quantitative analysis method.