超声分型在乳腺复合囊肿乳腺影像报告及数据系统4类中的应用价值

The value of ultrasound classification in BI-RADS category 4 of breast complex cystic masses

目的分析乳腺复合囊肿的超声声像图特征并进行超声分型，以病理结果为金标准，将超声分型结果应用于乳腺影像报告及数据系统（BI－RADS）4a～4c分类，为临床提供更明确的诊断意见和处理依据。方法回顾性分析2014年7月至2017年6月在中国医学科学院肿瘤医院行超声检查并经病理证实的78例乳腺复合囊肿患者的临床资料，根据病灶内部囊性、实性成分比例和分布特点将其分为Ⅰ型[厚壁和（或）厚的分隔（〉0.5 mm）]、Ⅱ型（囊内含1个或多个独立实性结节）、Ⅲ型（包含囊性和实性成分，且囊性成分占50%以上）和Ⅳ型（包含囊性和实性成分，实性成分占50%以上），计算每一类型恶性病灶的阳性预测值。采用多元线性回归分析乳腺复合囊肿的超声声像图特征（病灶大小、边界、血流阻力指数、钙化以及腋下淋巴结等）与恶性的关系。结果78例患者共有81个病灶。81个乳腺复合囊肿中，Ⅰ型14个（17.3%），Ⅱ型18个（22.2%），Ⅲ型18个（22.2%），Ⅳ型31个（38.3%），Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型乳腺复合囊肿恶性病灶的阳性预测值分别为7.1%、16.7%、61.1%和48.3%，差异有统计学意义（P＝0.040）。超声BI－RADS评估为4a类病灶14个，4b类病灶18个，4c类病灶49个。病灶≥2.0 cm、边界不清、血流阻力指数≥0.7、腋下淋巴结肿大与恶性复合囊肿有关（P值分别为0.030、0.038、〈0.001和0.025）。结论超声分型有助于乳腺复合囊肿良恶性的鉴别及BI－AIDS 4a～4c分类，进而为临床提供更明确的处理意见。

Objective To analyze the feature of breast complex cystic masses and to classify it at uhrasonography （US）, which applied to the Breast hnaging Reporting and Data System （BI-RADS） categories 4a to 4c with pathological results as the golden standards. Methods The uhrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features ： type 1 [ thick wall and （or） thick septa（ 〉 0.5 ram） ] , type 2 （ one or more intra-cystic masses）, type 3 （ mixed cystic and solid components with cystic components more than 50%） and type 4 （mixed cystic and solid components with solid components more than 50%）. Positive values （PPVs） were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses （lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc. ） with malignant correlation. Results There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 （17.3%） were classified as type Ⅰ , 18 （22.2%） as type Ⅱ, 18 （22.2%） as type Ⅲ, and 31 （38.3%） as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ , type Ⅱ , Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively （ P = 0.040）. In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI ≥0.7 and presence of abnormal axiliary nodes assessment had a high probability of malignancy （P= 0.030,0.038, 〈0.001 and 0.025, respectively）. Conclusion Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.