乳腺BI-RADS 3类病变的超声随访结果

Ultrasonographic follow-up results of breast BI-RADS 3 lesions

目的探讨乳腺BI-RADS 3类病变在超声随访过程中径线增大和形态学变化的具体情况,并分析各变化情况与其良、恶性之间的关系,为该类病变的临床管理提供参考信息。方法超声随访观察2012年1月～2013年12月于本院经乳腺超声检查诊断为BI-RADS 3类病变的女性患者,并选取随访期间径线增大超过20%的130例进行回顾性分析。回顾分析纳入病灶的最大径、前后径、数量和形态学(形状、走形、边缘、内部回声和后方有无衰减)等的变化情况,以及上述各表现与病灶良、恶性之间的关系。结果纳入的130例病灶均有病理结果或随访≥2年,其中7例证实恶变(5.4%)。前后径增量>50%组的恶性率高于前后径增量≤50%组(P=0.015,10.8%vs 3.2%)。乳腺BI-RADS 3类病变在随访期间出现增大但不伴随形态学变化时,其恶性率仅为1.9%,显著低于伴随可疑形态学改变组(P<0.001)。结论本研究可为临床管理乳腺BI-RADS 3类病变提供了重要指导意见,并提示乳腺BI-RADS 3类病变在径线增大>50%但未见相关可疑超声特征的情况下,其恶性肿瘤的风险仅为1.9%,仍推荐继续超声随访。

Objective To investigate the frequency and malignancy rate among growing Breast Imaging Reporting and DataSystem （BI-RADS） category 3 lesions during ultrasound follow-up, and to analyze the relationship between the changes andmalignancy, for providing reference information for clinical management of these lesions. Methods A retrospective analysiswas performed for 130 patients with BI-RADS category 3 breast lesions and lesions showed ≥20% enlargement on follow-upultrasound, who underwent the first ultrasound examination in our hospital between June 2012 and December 2013.Ultrasound features including increase in the maximum diameter and AP dimension, morphological changes, multiplicity andnew mass were evaluated to determine their association with malignancy. Results 130 included lesions had pathologicalfindings or follow-up ≥ 2 years, and 7 of them proved to be malignant （5.4%）. Enlargement without associated suspicioussonographic morphologic abnormalities had only 1.9% （BI-RADS category 3） chance of malignancy, which was significantlylower than the case with suspected morphological changes （p〈0.001）. Conclusion This study can provide important referencefor clinical management of breast BI-RADS type 3 lesions, suggesting that the lesions growing up to 50% enlargement withoutassociated suspicious ultrasound features, carries a risk of malignancy of only 1.9%, and continued recommendation forimaging follow-up rather than biopsy.