超声BI-RADS分类联合声触诊组织量化技术鉴别诊断乳腺良恶性病灶的价值探讨

Value of differential diagnosis for benign and malignant breast lesions using ultrasonic BI-RADS classification and virtual touch tissue quantification

目的探讨2013版超声乳腺影像报告和数据系统(BI-RADS)分类结合声触诊组织量化(VTQ)技术鉴别乳腺良恶性病灶的价值。方法对251例患者共334个乳腺病灶行常规超声检查,采用BI-RADS分类判断其良恶性;然后应用VTQ技术测量病灶的剪切波速度(SWV);以病理结果为金标准,构建受试者工作特征曲线,比较两种方法单独及联合应用对乳腺良恶性病灶的诊断效能。结果 BI-RADS分类鉴别诊断乳腺良恶性病灶的敏感性、特异性、准确率、阳性预测值(PPV)及阴性预测值(NPV)分别为91.82%、79.46%、83.53%、68.71%及95.19%;VTQ技术鉴别诊断乳腺良恶性病灶的敏感率、特异性、准确率、PPV及NPV分别为68.18%、98.21%、88.32%、94.94%及86.27%;BI-RADS分类联合VTQ技术鉴别诊断乳腺良恶性病灶的敏感性、特异性、准确率、PPV及NPV分别为65.45%、99.11%、88.02%、97.30%及85.38%。BI-RADS分类、VTQ技术单独及联合鉴别诊断乳腺良恶性结节的曲线下面积分别为0.901、0.868及0.947,三者两两比较差异均有统计学意义(均P<0.01)。结论 BI-RADS分类联合VTQ技术可以提高乳腺良恶性病灶的诊断准确率和特异性。

Objective To evaluate the differential diagnostic value for benign and malignant breast lesions using breast imaging reporting and data system（BI-RADS）issued in 2013 and virtual touch tissue quantification（VTQ）.Methods Data of 251 patients with 334 lesions were examined by BI-RADS and VTQ were enrolled in this study.The receiver operating characteristic（ROC） curves were constructed to assess the diagnostic efficiency and compared with the histologic results.Results The sensitivity,specificity,accuracy,positive predictive value（PPV）and negative predictive value（NPV）of BI-RADS in differential diagnosis of benign and malignant breast lesions were 91.82%,79.46%,83.53%,68.71% and 95.19%,respectively.The sensitivity,specificity,accuracy,PPV and NPV of VTQ in differential diagnosis of benign and malignant breast lesions were68.18%,98.21%,88.32%,94.94% and 86.27%,respectively.The sensitivity,specificity,accuracy,PPV and NPV of BI-RADS combined with VTQ in differential diagnosis of benign and malignant breast lesions were 65.45%,99.11%,88.02%,97.30% and85.38%,respectively.The area under ROC curve for BI-RADS,VTQ and combination of BI-RADS and VTQ were 0.901,0.868 and0.947,respectively.There were significant differences between any two groups（all P〈0. 01）. Conclusion BI-RADS combined with VTQ is potentially to improve the accuracy and specificity in differential diagnosis of benign and malignant breast lesions.