超声BI-RADS分级与应变比值对乳腺结节的诊断价值研究

Study on significance of BI-RADS-US and strain ratio of sonoelastrography in differential diagnosis of breast lesions

目的探讨超声乳腺影像报告及数据系统(BI-RADS)和应变比值对于乳腺结节的诊断价值。方法282例乳腺结节,通过超声弹性成像获得周围组织与乳腺结节的应变比值。以病理结果为金标准,应用受试者工作特征曲线,评价常规超声BI-RADS及应变比值(SR)鉴别乳腺结节良恶性的价值。结果 282例乳腺结节包括79例恶性结节及203例良性结节。常规超声BI-RADS诊断的敏感度、特异度及受试者工作特征曲线下面积为100%、16.75%及0.69(95%CI 0.63-0.74);SR诊断的敏感度、特异度及受试者工作特征曲线下面积为73.42%、90.15%及0.874(95%CI 0.83-0.91)。SR的诊断价值优于常规超声BI-RADS(Z=6.357,P<0.001)。以2.97作为SR的诊断阈值鉴别常规超声BI-RADS 4级乳腺结节222例时,170例(170/222,76.58%)可避免活检,但漏诊21例(21/222,9.46%)。结论应变比值鉴别乳腺结节的性质临床价值优于常规超声BI-RADS,两者结合可以减少乳腺活检的需求。

Objectine To explore the diagnostic value of breast imaging reporting and data system with ultrasonology（BI - RADS - US）and strain ratio in differential diagnosis of benign and malignant breast lesions. Methods Ultrasonic elastography had been performed in 282 cases of breast lesions. Strain ratio（SR）was defined as the ratio of strain of normal surrounding tissue to strain of breast lesions. With pathologic results as the gold standard,the diagnostic value of BI - RADS - US and SR in differentiating benign and malignant breast lesions had been compared with re-ceiver - operating characteristic（ROC）curve. Results A total of 79 cases of malignant lesions and 203 cases of benign lesions were included. Di-agnostic sensitivity,specificity and area under the ROC curve of BI - RADS - US were 100% ,16. 75% and 0. 69 respectively（95% CI 0. 63 - 0. 74）. The sensitivity,specificity and area under the ROC curve of SR were 73. 42% ,90. 15% and 0. 874 respectively（95% CI 0. 83 -0. 91）. The area under ROC curve of SR was better than BI - RADS - US（ Z = 6. 357,P ﹤ 0. 001）. If the cut - off point of SR was 2. 97,222（76. 58% ） breast lesions in 170 cases with BI - RADS - US 4 could avoid biopsy,but 21 cases（21 / 222,9. 46% ）were misdiagnosed. Conclusion Strain ra-tio is superior to BI - RADS - US in identification of breast lesions,a combination of these two methods can reduce the demand of breast biopsy.