超声引导下穿刺活检对BI-RADS分级4A至4C乳腺肿物诊断的价值

Diagnosis value of ultrasound-guided core-needle biopsy in breast masses under BI-RADS categories 4A to 4C

目的:探讨超声引导下穿刺活检(ultrasound guided-core needle biopsy,US-CNB)在乳腺癌定性诊断中的临床应用价值。方法:选取2015年3月至2015年10月355例就诊天津医科大学肿瘤医院经乳腺超声检查结果为BI-RADS分级4A^4C的单发肿物患者资料,入选患者均行US-CNB,并与术后病理结果对照。结果:355例乳腺肿物患者的US-CNB病理结果中235例恶性肿物的术后病理均为乳腺癌,120例良性肿物患者中41例术后病理为乳腺癌。US-CNB在BI-RADS分级4A^4C患者中诊断乳腺癌的特异度均为100%,灵敏度分别为62.50%、82.46%、89.73%,准确率分别为84.62%、87.01%、90.74%。41例US-CNB假阴性患者的术后病理为14例导管内癌、5例导管内乳头状癌、3例黏液腺癌、19例浸润性导管癌。结论:US-CNB对BI-RADS分级4B^4C乳腺肿物的定性诊断是一种安全、可靠且较为准确的检查方法,但对于4A患者灵敏度较低,需慎重选择并结合钼靶、MRI等检查。超声诊断提示导管内乳头状肿瘤,不建议行US-CNB。

Objective：To evaluate the clinical value of ultrasound-guided core-needle biopsy （US-CNB） in the diagnosis of breast lesions under categories 4A to 4C of the second edition of the Breast Imaging Reporting and Data System （BI-RADS） ultrasound lexicon. Methods： The pathological characteristics of 355 patients with breast masses who underwent US-CNB in the Tianjin Medical University Cancer Institute and Hospital from March 2015 to October 2015 were retrospectively analyzed. Each patient was subjected to postoperative pathological examination to confirm diagnosis. Results： According to the US-CNB results, of the 355 patients, 235 were diagnosed with breast cancer, and 120 had benign lesions. Through postoperative pathological examination, 41 of the patients with benign lesions were confirmed to have breast cancer. The specificity of the US-CNB was 100% in all the categories of breast masses. The sensibilities of breast masses under BI-RADS categories 4A, 4B, and 4C were 62.50%, 82.46%, and 89.73%, respectively. The accuracies of the US-CNB in 4A, 4B, and 4C were 84.62%, 87.01%, and 90.74%, correspondingly. Of the 41 patients with false-negative results, 14 had intraductal carcinoma, 5 had intraductal papillary carcinoma, 3 had mucinous carcinoma, and 19 had invasive ductal carcinoma. Conclusion： US-CNB is a safe, reliable, and accurate early diagnostic method for breast masses under the 4B and 4C categories. However, the sensibility of US-CNB was extremely low in patients with breast masses under the 4A category. Thus, final diagnosis should be accomplished by combining US-CNB with mammography, MRI, or other testing methods. Meanwhile, US-CNB is not recommended for pa- tients with intraductal papillary neoplasms diagnosed through ultrasonography.