BI-RADS联合超声弹性成像对麦默通乳腺肿块手术患者的筛选价值

Screening value of BI-RADS combined with ultrasound elastography for guiding Mammotome procedure for resecting breast lumps

目的探讨乳腺超声影像报告与数据系统(BI-RADS)结合超声弹性成像技术对筛选麦默通乳腺肿块手术患者的价值。方法对本院2016年3月至2017年8月需要行麦默通手术的531例患者共653个乳腺肿块在术前利用BI-RADS系统进行分类,同时对肿块行超声弹性成像检查;以病理结果为金标准,分析超声弹性成像在总体及不同BI-RADS 3~4类病灶中的诊断效能,计算灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率。结果 531例患者共653个肿块(良性592个、恶性61个)中3类病灶414个,4A类病灶159个,4B类病灶54个和4C类病灶26例。超声弹性成像诊断乳腺病灶良恶性的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率依次为85.2%、88.0%、42.3%、98.3%和87.7%;结合BI-RADS分类情况,超声弹性成像诊断BI-RADS 3、4A、4B和4C类的灵敏度依次为85.7%、58.3%、91.3%和94.7%,特异度为91.4%、89.8%、41.9%和57.1%,诊断符合率为91.3%、87.4%、63.0%和84.6%。超声弹性成像诊断BI-RADS 3类、4A及4C类病灶符合率的差异无统计学意义(P>0.05),但均优于BI-RADS 4B类病灶(P<0.05)。结论对于BI-RADS 3~4A类病灶,超声弹性成像提示良性可行麦默通手术,提示恶性宜行穿刺活检;对于BI-RADS 4B^4C类病灶不宜行麦默通手术。

Objective To investigate the screening value of breast imaging report and data system （BI-RADS） combined with ultrasound elastography for guiding Mammotome procedure for resecting breast lumps. Methods From March 2016 to August 2017, 653 breast lumps from 531 patients undergoing Mammotome surgery were classified using BI-RADS and detected by elastography. Based on pathological results, the diagnostic efficiencies of ultrasound elastography in general and different BI-RADS 3-4 lesions were ana- lyzed, and the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accordance rate were calculat- ed. Results Six hundred and fifty-three breast lumps （592 benign lesions and 61 malignant lesions） included 414 cases of BI-RADS 3, 159 cases of BI-RADS 4A, 54 cases of BI-RADS 4B and 56 cases of BI-RADS 4C. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accordance rate of ultrasound elastography in diagnosing breast lesions were 85.2%, 88.0%, 42. 3%, 98.3% and 87. 7%, respectively. Combined with BI-RADS classification, the sensitivity of ultrasound elastography were 85.7%, 58.3%, 91.3% and 94. 7%, specificity were 91.4%, 89. 8%, 41.9% and 57.1%, and the diagnostic accordance rates were 91.3%, 87. 4%, 87.4% and 87. 4% for B1-RADS categorization of 3, 4A, 4B and 4C. There was no significant difference in the diagnostic accuracy of ultrasound elastography in diagnosing BI-RADS 3, 4A and 4C lesions （P〉0. 05）, but all were superior to those of BI-RADS 4B lesions （P〈0. 05）. Conclusion For lesions of BI-RADS 3-4A, benign lesions suggested by ultrasound elostography were feasible for Mammotome surgery, while maligant lesions should be punctured for biopsy. Lesions of BI-RADS 4B-4C were not suit- able for Mammotome surgery.