自动乳腺全容积成像结合超声乳腺影像报告和数据系统分类诊断常规超声征象不典型的乳腺癌

Automated breast volume scanner combined with breast imaging reporting and data system for diagnosing atypical breast cancer with untypical features of conventional ultrasonography

目的探讨自动乳腺全容积成像(ABVS)联合乳腺影像报告和数据系统(BI-RADS)分类对常规超声恶性征象不典型(BI-RADS分类3类及4A类)乳腺癌的诊断价值。方法对常规超声BI-RADS分类3类及4A类的832例患者共876个乳腺肿块行ABVS。结合ABVS冠状位图像特点对乳腺肿块重新进行BI-RADS分类。与术后病理结果对照,比较常规超声BI-RADS分类与ABVS结合BI-RADS分类为3类、4A类肿块中恶性率的差异;并以BI-RADS分类≥4B类为恶性肿块诊断标准,评价ABVS结合BI-RADS分类诊断乳腺恶性肿块的效能。结果常规超声BI-RADS分类为3类肿块558个,恶性率4.30%(24/558),4A类肿块318个,恶性率11.01%(35/318)。结合ABVS冠状位图像特点重新分类后,3类肿块455个,恶性率0.66%(3/455);4A类肿块176个,恶性率4.55%(8/176);4B类肿块218个,恶性率14.22%(31/218);4C类肿块27个,恶性率62.96%(17/27)。ABVS结合BI-RADS分类为3类、4A类肿块的恶性率明显低于常规超声分类为3类、4A类肿块(χ~2=11.447、5.951,P=0.001、0.015)。ABVS结合BI-RADS分类对恶性肿块的诊断敏感度、特异度及准确率分别为81.36%(48/59)、75.89%(620/817)及76.26%(668/876)。结论 ABVS结合BI-RADS分类对常规超声恶性征象不典型的乳腺癌具有重要诊断价值。

Objective To explore the value of automated breast volume scanner（ABVS）combined with breast imaging reporting and data system（BI-RADS）for diagnosing atypical breast cancer with untypical features diagnosed as BI-RADS 3 and 4 Atypes with conventional ultrasonography.Methods A total of 832 patients with 876 breast lesions of conventional ultrasonography classified as BI-RADS 3 and 4 A types were reexamined using ABVS.BI-RADS classification was reclassified considering the performances of coronal ABVS image and conventional ultrasonic findings.Taking pathology results as the gold standards,the malignant rates of lesions with conventional ultrasonic BI-RADS of 3 and 4 Atypes were compared with those of lesions with routine BI-RADS considering ABVS of 3 and 4 Atypes.Taken BI-RADS classification≥4 Bas the diagnostic criteria for malignant lesions,the efficacy of routine BI-RADS considering ABVS for diagnosing malignant breast mass was evaluated.Results There were 558 lesions classified as BI-RADS 3（malignant rate 4.30%[24/558]）and 318 lesions classified as BI-RADS 4 A（malignant rate 11.01% [35/318]） with conventional ultrasonography.Considering with the performances of coronal ABVS image,the classifications were reclassified as 455 lesions of BI-RADS 3（malignant rate 0.66% [3/455]）,176 lesions of BI-RADS 4 A（malignant rate 4.55% [8/176]）,218 lesions of BI-RADS 4 B（malignant rate 14.22% [31/218]）and 27 lesions of BI-RADS 4 C（malignant rate 62.96%[17/27]）.The malignant rate of lesions classified as BI-RADS 3 and 4 A with routine BI-RADS considering ABVS was significantly lower than that of lesions classified as BI-RADS 3 and 4 A with conventional ultrasonography（χ2=11.447,5.951;P=0.001,0.015）.The sensitivity,specificity and accuracy of routine BI-RADS considering ABVS for diagnosing malignant breast mass was 81.36%（48/59）,75.89%（620/817）and 76.26%（668/876）,respectively.Conclusion Routine BI-RADS considering ABVS has great importance in diagnosis of atypical breast cancer with untypical features of conventional ultrasonography.