探讨血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检的价值

Study on the value of grade of blood flow instructing ultrasound-guided BI-RADS Ⅳ breast lumps puncture

目的探讨彩色多普勒血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检的价值。方法回顾性分析120例超声诊断为BI-RADS4级的乳腺病灶患者,结合彩色多普勒观察乳腺病灶内部及周边的血流分布,形态,数量,按照Adler的半定量方法,对血流进行分级,所有病例均进行了超声引导下穿刺活检。结果 120例超声活检结果,良性62例,恶性58例,BI-RADS4a、4b、4c的阳性预测值(positive predictive value,PPV)分别为10.8%、39.0%、90.5%,各个级别间比较均有统计学意义(P<0.05),2级和3级血流的乳腺病灶PPV(79.7%)与BI-RADS4级的总PPV(48.3%)比较,差异具有统计学意义(P<0.05)。BI-RADS4级乳腺病灶的良恶性在血流分级的分布具有差异性,差异具有统计学意义(P<0.05)。2级和3级血流的BI-RADS4b乳腺病灶的PPV(70.0%)和总体BI-RADS4b乳腺病灶的PPV(39.0%)比较,差异有统计学意义(P<0.05)。结论血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检具有指导价值,4a的PPV较低,可以短期随访观察,但对于伴有2级和3级血流的BI-RADS4a级乳腺病灶,由于其PPV比整体BI-RADS4a级乳腺病灶的PPV高,建议穿刺活检;对于2级和3级血流的4b乳腺病灶,由于其PPV较高,一定要尽早穿刺活检,明确良恶性;对于2级和3级的4c乳腺病灶,由于其PPV很高,不建议穿刺活检,直接手术处理。

Objective To study the value of Color Doppler grade of blood flow instructing uhrasound-guided BI-RADS Ⅳbreast lumps puncture. Methods 120 patients with breast lesions of BI-RADSⅣ diagnosed by ultrasound were analyzed retrospectively. We observed the distribution, shape, number of the internal and peripheral vessels of the breast lesions with Color Doppler to demand the grade of blood flow by the method of Adler half quantitative. All patients underwent ultrasound-guided puncture. Results Of the 120 masses ,there were 62 lesions with benign findings and 58 lesions with malignant findings. The PPV of BI-RADS4a, 4b, 4c were10.8% , 39.0%, 90.5% , respectively, with statistically significant difference between the categories （ P 〈0.05）. The PPV of grade2 and grade3 of blood flow was 79.7%, the difference between it and the PPV of BIRADSⅣ was significant （ P 〈 0.05 ）. The different distribution of benign and malignant breast lesions in the grade of blood flow was significant （ P 〈0.05）. The PPV of grade 2 and grade 3 of blood flow in BI-RADS4b was 70%, the difference between it and the PPV of all BI-RADS4b was significant （ P 〈 0.05）. Conclusion Color Doppler grade of blood flow can instruct ultrasound-guided breast lumps puncture. The PPV of 4a was a little low and it can undergo shout-term follow-up. But the lesions of grade 2 and grade 3 should be suggested to undergo puncture, because of the higher PPV compared with all of 4a＇ s. The PPV of grade 2 and grade 3 of blood flow in BI-RADS4b was a little high, so puncture should be done early to make sure that the lesion is benign or malignant. The PPV of 4c with grade 2 and grade 3 was very high, and instead of puncture, it should be suggested to be operated directly.