超声自动全容积扫描与弹性成像对乳腺病变的鉴别诊断

Value of automated breast volume scanner and elastography in differential diagnosis of breast lesions

目的评价观察者间超声自动全容积扫描(ABVS)和弹性成像鉴别乳腺病变的可信度,以及ABVS、弹性成像及两者结合在乳腺病变鉴别诊断中的价值。方法 41例患者分别接受ABVS和弹性成像检查,分析ABVS和弹性成像在两位医师中的诊断一致性,ABVS、弹性成像及ABVS结合弹性成像与病理结果的一致性,比较三种方法的诊断价值。结果两位医师的ABVS诊断结果(K=0.620)和弹性成像诊断结果(K=0.654)均具有良好的一致性;ABVS诊断结果(K=0.810)、弹性成像诊断结果(K=0.765)、ABVS与弹性成像结合的诊断结果(K=0.901)均与病理结果具有良好或极好的一致性,其对乳腺病变的诊断准确率分别为91.30%、89.13%及95.65%,敏感性分别为100%、96.42%及100%,特异性分别为77.78%、77.78%及87.50%,阳性预测值分别为87.50%、87.10%及93.75%,阴性预测值分别为100%、93.33%及100%。结论 ABVS和弹性成像在观察者间具有良好的一致性,与病理结果有良好的一致性,在乳腺病变的鉴别诊断中具有较高的应用价值,ABVS和弹性成像结合更有助于提高诊断准确率。

Objective To investigate the inter-observer reliability of automated breast volume scanner（ABVS） and elastography interpretation in differential diagnosis of breast lesions,and compare the diagnostic value among ABVS,elastography and the combination of these two methods. Methods Forty- one patients received ABVS and elastography examination.Kappa statistics was used to interpret concordance between examiners with ABVS and elastography,and concordance between pathology and ABVS,elastography,and the combination of these two methods. χ^2 test was used to compare diagnostic value among these three methods. Results Inter-observer reliability of examiners with ABVS（K=0.620）and elastography（K=0.654）were consistent. ABVS（K =0.810）,elastography（K =0.765）and the combination of ABVS and elastography（K =0.901）were very consistent with pathology diagnosis. The diagnostic accuracy of ABVS, elastography,and the combination of ABVS and elastography were 91.30%,89.13%,95.65%,the sensitivity were 100%,96.42%,100%, the specificity were 77.78%,77.78%,87.50%,the postive predictive value were 87.50%,87.10%,93.75%,and the negative predictive value were 100%,93.33%,100%,respectively. Conclusion The ABVS and elastography are reliable imaging methods for the differentiation of the breast lesions with high diagnostic value and a good inter-observer and inter-rater reliability. A combination of ABVS and elastography would be favorable to improve diagnostic accuracy.