超声弹性成像定量分析诊断BI-RADS 4类乳腺肿块良恶性

Ultrasound elastography imaging quantitative analysis techniques for diagnosing benign and malignant breast neoplasms of BI-RADS 4

目的 探讨超声弹性成像（UE）定量分析鉴别乳腺影像和报告数据系统（BI-RADS）4类乳腺肿块良恶性的应用价值。方法 对86例经超声诊断为BI-RADS 4类乳腺肿块的患者行UE检查,检测弹性指数（EI）和弹性指数差（EID）。以病理结果为金标准,绘制ROC曲线,评价EI、EID判断乳腺肿块良恶性的效能。结果 86例肿块经病理证实良性44例,恶性42例。ROC曲线分析显示,EI、EID鉴别BI-RADS 4类乳腺肿块良恶性的曲线下面积（AUC）分别为0.81、0.95。以EID≥2.5为临界值,敏感度、特异度、准确率、阳性预测值、阴性预测值分别为92.86%（39/42）、90.91%（40/44）、91.86%（79/86）、90.70%（39/43）、93.02%（40/43）;以EI≥3.6为临界值,敏感度、特异度、准确率、阳性预测值、阴性预测值分别为61.90%（26/42）、86.36%（38/44）、74.42%（64/86）、81.25%（26/32）、70.37%（38/54）。EID的诊断准确率、敏感度及阴性预测值均高于EI（χ~2=9.33、11.50、7.80,P均〈0.05）,二者特异度及阳性预测值差异无统计学意义（χ~2=0.45、1.42,P均〉0.05）。结论 UE定量分析参数EI、EID均有助于鉴别乳腺BI-RADS 4类肿块的良恶性,且EID诊断准确率更高。

Objective To explore the application value of quantitative analysis with ultrasound elastography （UE） to identify benign and malignant breast masses of breast imaging reporting and data system （BI-RADS） 4. Methods UE examinations were performed on 86 patients with BI-RADS 4 breast masses. The elastic index （EI） and elastic index difference （EID） were measured and calculated. Taking pathological results as the gold standard, the ROC curve was obtained. The efficacities of EI and EID in determining benign and malignant breast masses were evaluated. Results Among 86 cases, there were 44 cases of pathologically proved benign masses and 42 cases of pathologically proved malignant masses. ROC curve showed that the areas under the curve （AUC） of EI and EID for identifying benign and malignant BI-RADS 4 breast masses was 0.81 and 0.95, respectively. With the threshold of EID≥2.5, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 92.86% （39/42）, 90.91% （40/44）, 91.86% （79/86）, 90.70%//00 （39/43） and 93.02% （40/43）, respectively. With the threshold of EI≥3.6, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 61.90% （26/42）, 86.36% （38/44）, 74.42% （64/86）, 81.25% （26/32） and 70. 37% （38/54）, respectively. The accuracy, sensitivity and negative predictive value of EID were higher than those of EI （X2 = 9.33, 11.50, 7.80, all P〈0.05）. No statistical differences of specificity and positive predic- tive value between EID and EI （2 20. 45, 1.42, both P〉0.05）. Conclusion EI and EID in the quantitative analysis with UE are beneficial for identifying benign and malignant BI-RADS 4 breast masses, and the accuracy of EID is higher.