实时超声弹性成像鉴别诊断BI-RADS-US 4B类乳腺小肿块

The differential diagnosis of small breast mass according to 4B grade of breast imaging reporting and data system ultrasound by ultrasound elastography

目的 探讨实时超声弹性成像对乳腺超声影像学报告及数据系统（breast imaging reporting and data system ultrasound,BI-RADS-US）评分4B类最大直径≤15mm乳腺单发实性小肿块良恶性进一步鉴别诊断的价值。方法 常规二维灰阶及彩色多普勒超声检查的107例乳腺单发实性小肿块患者,所有乳腺实性小肿块均按照BI-RADS-US分类标准评为4B类,然后进行实时超声弹性成像检查,分析弹性成像特征,将病灶硬度弹性图分为Ⅰ～Ⅴ级,与组织病理学结果进行对照研究。结果 实时超声弹性成像弹性图评Ⅰ、Ⅱ级共44例,均为良性;Ⅲ级22例（17例良性,5例恶性）;Ⅳ～Ⅴ级共41例（4例良性,37例恶性）。以弹性分级Ⅳ～Ⅴ级为高度恶性预测指标,其敏感度、特异度和准确度分别为88.1%、93.8%和91.6%,阳性预测值为90.2%,阴性预测值为92.4%。结论实时超声弹性成像对BI-RADS-US评分4B类乳腺单发实性小肿块良恶性的进一步鉴别诊断有较高的准确性。

Objective To evaluated the differential diagnostic value of real-time ultrasound elastography（USE） on single solid breast mass≤15 mm in maximum diameter according to 4B grade of breast imaging reporting and data system ultrasound（BI-RADS-US）. Methods One hundred and seven consecutive patients with small single solid breast mass were conducted two- dimensional and color Doppler ultrasound. All small breast tumors were classified as 4B according to BI-RADS-US classification criteria. Before surgery each patient was then examined by real-time USE, and the findings on elastography were classified into Ⅰ --Ⅴ grades. Ultrasonographic results were compared with histopathologie data. Results Forty-four patients were found with grade Ⅰ and Ⅱ benign lesions; 22 with gradeⅢ （17 benign and 5 carcinoma） ; 41 with grade Ⅳ and Ⅴ （4 benign and 37 carcinoma） lesion at ultrasonographic elastography. Based on the elastic stage IV-V is highly malignant predictive index, the sensitivity, specificity and accuracy were 88.1%, 93.8% and 91.6% respectively. The positive predictive value was 90.2% and the negative predictive value was 92.4%. Conclusion Real-time USE seems to have great accuracy for differential diagnosis of small single solid breast mass≤15 mm in maximum diameter, which is classified as 4B grade fol.lowed the BI-RADS-US criteria.