应变弹性成像对BI-RADS 4A级乳腺病变分类诊断的价值

Value of strain elastography in the classification diagnosis of US BI-RADS 4A breast pathologic lesion

目的探讨应变弹性成像技术是否能提高US BI-RADS 4A级乳腺病变分类诊断效能。方法选择2014年5月至2016年3月因乳腺病变在我院就诊的患者中,经常规二维及彩色多普勒诊断为US BI-RADS 4A级的患者75例,乳腺病灶共87个,经二维及彩色多普勒超声评定为BI-RADS 4A级的乳腺病灶,进行应变弹性成像检查,采用改良5分法进行评分,结合二维及彩色超声重新进行BI-RADS分级,≥4分升为4B-C级,=3分级别不变,<3分降至3级,并与病理结果进行对照。结果 87个乳腺病灶中,弹性评分≥4的6个,=3分的11个,<3分的70个。病理结果显示87个乳腺肿瘤中,恶性肿瘤8个,弹性评分≥4的4个,=3分的2个,<3分的2个;以弹性评分≥3分为恶性,弹性评分<3分为良性标准,诊断恶性肿瘤的敏感性、特异性及准确率分别为75.0%、86.1%和85.1%,阴性预测值97.1%,优于常规超声,差异有统计学意义(P<0.05)。结合弹性成像后的再次BI-RADS分级,良性组的恶性率降至2.8%,恶性组的恶性率升至35.3%,差异有统计学意义(P<0.05)。结论弹性成像技术能有效提高BI-RADS 4A级乳腺病变的分级诊断效能,能极大地减少术前活检率,具有较好的临床应用前景。

Objective To explore whether strain elastography could improve the classification diagnosis of US BI-RADS 4Abreast pathologic lesion. Methods Eighty-seven breast foci of the 75 patients diagnosed with the two-dimensional color Doppler ultra-sonography as BI-RADS 4A were selected for the study, and then, strain elastography was performed. The modified 5-point method was used for further evaluation, and BI-RADS classification was performed again with the help of the two-dimensional color Doppler ultra-sonography. The cases with the scores of ^4 were upgraded as the 4B-C grade, the cases with the scores of =3 remained in the same grade, and the cases with the scores of 〈 3 were downgraded to be the third grade. The results were compared with the pathological re-sults. Results Of the 87 breast lesions, 6 were evaluated to have elasticity scores of ≥4, 11 were assessed to have elasticity scores of =3,and 70 were assessed to have elasticity scores of 〈3. There were 8 malignant tumors confirmed by pathological examination in the 87 breast lesions, of which 8 lesions had elasticity scores of ≥4, 3 lesions had elasticity scores of =3,and 2 lesions had elasticity scores of 〈 3. With the elasticity scores of ^3 and 〈 3 as the standards for respectively malignant and benign tumors, the sensitivity, specificity and accuracy of the method for detecting malignant tumors were respectively 75% , 86. 1% and 85. 1% , and the negative predictive value （ NPV） was 97. 1 % , which was superior to that of conventional ultrasonography （ P 〈 0. 05 ） . With further classification of BI-RADS in combined use of elastography, the malignancy rate in the benign group was reduced to 2. 8% and the malignancy rate in the malignant group was increased to 35. 3% , and significant differences could be noted, when compared with those previous figures （P 〈 0. 05）. Conclusion Elastography could effectively promote the classification diagnostic accuracy of BI-RADS 4A breast pathologic lesion and could considerably reduce the rate of biopsy before surgery. With this reason, it promised good clinical application.