声脉冲辐射力弹性成像对超声BI-RADS 4A类微小肿块的再评估

Reevaluation of acoustic impulse radiation force elastography in BI-RADS-US 4A small breast masses

目的探讨声脉冲辐射力弹性成像(ARFI)技术对超声评估为BI-RADS4A类微小肿块的再评估价值。方法回顾性分析2016年4月至2018年6月在江南大学附属医院(无锡市第四人民医院)接受诊治的247例经常规超声评估为BI-RADS4A类的乳腺微小肿块患者的临床资料,共253个病灶,应用ARFI技术对此类肿块进行重新评估,并与手术或穿刺病理对照,根据剪切波速度(SWV)绘制ROC曲线,确定BI-RADS4A类良恶性微小肿块的最佳临界点。将超声评估和ARFI技术再评估的结果与病理对比,分析超声和ARFI技术对恶性微小肿块的敏感度、特异度、阳性预测值、阴性预测值以及准确度,并进行一致性分析。结果253个病灶经病理证实为恶性病灶34个,良性病灶219个,乳腺癌发生率13.44%;根据SWV数据,3.63m/s为BI-RADS4A类良恶性微小肿块的最佳临界点,SWV低于临界值的微小肿块乳腺癌发生率为0.68%,SWV高于临界值的微小肿块乳腺癌发生率达31.13%;根据此临界值,ARFI技术对乳腺恶性微小肿块再评估的敏感度以及阴性预测值高于超声,特异度和准确率低于超声评估,差异均有统计学意义(P<0.05)。结论ARFI技术可定量评估乳腺肿块SWV值,确定良恶性最佳临界点,对BI-RADS4A类乳腺微小肿块的再评估具有一定的价值。

Objective To reevaluate the value of acoustic impulse radiation force elastography(ARFI)in small breast mass es with BI-RADS 4 assessed by ultrasound(US). Methods A total of 247 patients with 253 small breast masses which confirmed by surgery or biopsy were selected.According to the data of shear wave velocity(SWV),ROC curve was drew to determine the cutoff point of benign and malignant small breast mass.The results were compared with the pathology,and the sensitivity,specificity,positive pre dictive value,negative predictive value and accuracy of US and ARFI techniques were analyzed,the consistency analysis was carried out.Meanwhile,the clinical data which beyond the cutoff point were analyzed. Results There were 34 malignant lesions and 219 benign lesions in this study,and the malignant rate were 13.44%. According to the data of SWV in this study,the cutoff value of BI-RADS 4A small breast masses was 3.63 m/s.The ma lignant rate of small breast mass which below the cutoff point was 0.68%,the malignant rate of small breast mass which be yond cutoff point was 31.13%.At the same time,the sensitivity and negative predictive value of ARFI technique were higher than that of US for BI-RADS 4A small breast mass,and the specificity and accuracy were lower than that of US(P<0.05). Conclusion SWV of small breast masses with BI-RADS 4 assessed by ultrasound is measured quantitatively by ARFI technology,the cutoff point of be nign and malignant small breast masses is determined. ARFI technology improves the sensitivity of US,which is of certain value for the reassessment in BI-RADS-US 4A small breast masses.