加权评分法在乳腺结节良恶性鉴别诊断中的应用价值研究

Ultrasound Weighted Score in Differentiating Benign and Malignant Breast Nodules

背景乳腺超声美国放射学会乳腺影像报告和数据系统(BI-RADS)临床应用越来越广泛,但其评分细则缺乏统一标准。目的探讨加权评分法在乳腺结节良恶性鉴别诊断中的应用价值。方法选择2012年1月——2016年12月于中日友好医院超声诊断科进行乳腺超声检查的患者185例、共194个结节(恶性结节103个,良性结节91个),参照《中国浅表器官超声检查指南》对结节的形态、方位、边缘、回声模式、后方回声特征、周边高回声晕环、微钙化等进行描述并进行乳腺结节良恶性鉴别诊断。对每个恶性超声征象(形态不规则、非平行方位、边缘不规整、低回声、后方回声衰减、高回声晕环、微小钙化灶)进行特异度研究并对其进行评分,将所有恶性征象评分相加得出加权评分总分。以1.5 cm为界,分为小结节(≤1.5 cm,81个)和大结节(>1.5 cm,113个),研究加权评分对大、小结节良恶性的诊断价值。结果恶性结节加权评分大于良性结节(P<0.05)。加权评分法诊断乳腺结节良恶性的最佳诊断截点是5.5分,灵敏度、特异度、阳性预测值、阴性预测值、正确率分别为87.4%、81.3%、84.1%、85.1%、84.5%;加权评分法诊断小结节良恶性的最佳诊断截点是4.5分,灵敏度、特异度、阳性预测值、阴性预测值、正确率分别为80.5%、65.0%、70.2%、76.5%、72.8%;加权评分法诊断大结节良恶性的最佳诊断截点是5.5分,诊断灵敏度、特异度、阳性预测值、阴性预测值、正确率分别为93.5%、90.2%、92.1%、92.0%、92.0%。加权评分法诊断大结节良恶性的正确率高于小结节(P<0.001)。结论加权评分法在乳腺结节良恶性鉴别诊断方面有较高的应用价值,尤其是对大结节的良恶性鉴别诊断要优于小结节。

Background The clinical application of breast ultrasound BI-RADS grading system is becoming more and more widespread.However,there is no unified standard for scoring rules.Objective To evaluate the diagnostic efficacy of weighted score in differentiating benign and malignant breast nodules.Methods A total of 185 patients,194 nodules(103 malignant nodules and 91 benign nodules) in total underwent breast ultrasonography in the Department of Ultrasound of China- Japan Friendship Hospital were selected from January 2012 to December 2016.The shape,orientation,margin,echo pattern, echo halo,posterior acoustic features,and microcalcification of nodules were described in accordance with the Guidelines for Ultrasound Examination of Superficial Organs in China.Differential diagnosis of benign and malignant breast nodules was carried out.The specificity of each malignant ultrasound sign (irregular shape,non-parallel orientation,irregular margin, low echo,posterior echo attenuation,high echo halo,micro-calcification focus) was studied and the ultrasound signs were scored.The weighted total score was obtained by adding all malignant signs scores.Using 1.5 cm as the standard,the nodules were divided into small nodule(≤ 1.5 cm,81) and large nodule(>1.5 cm,113).The value of ultrasound weighted score in the diagnosis of benign and malignant nodules of different sizes was studied.Results The weighted score of malignant nodules was greater than that of benign nodules (P<0.05).For all nodules,the weighted score of 5.5 was the best diagnostic cutoff point and the diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 87.4%, 81.3%,84.1%,85.1%,84.5%,respectively.For small nodules(≤ 1.5 cm),the best cutoff point was 4.5,and diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 80.5%,65.0%,70.2%, 76.5%,72.8%,respectively.For big nodules(>1.5 cm),the best cutoff point was 5.5,and the diagnostic sensitivity, specificity,positive predictive value,negative predictive value and accuracy were 93.5%,90.2%,92.1%,92.0%,92.0%, respectively.The accuracy of weighted scoring in the diagnosis of large nodules was higher than that of small nodules(P<0.001). Conclusion The weighted score method has high application value in differentiating benign and malignant breast nodules.In particular,the differential diagnosis between benign and malignant nodules is better than that of small nodules.