超声造影边缘增强特征对BI-RADS 4类乳腺肿块良、恶性鉴别的诊断价值

The diagnostic value of marginal zone enhancement features of contrast-enhanced ultrasound in the benign and malignant breast masses identification of BI-RADS 4

目的探讨二维超声(2D-US)及超声造影边缘相关特征对BI-RADS 4类良、恶性乳腺肿块的诊断价值。方法选取2016年1月~2018年7月就诊于山西医科大学附属第一医院超声科并获得明确病理结果的乳腺病例76例(共77个病灶)。按良、恶性肿块分为两组,对比良、恶性肿块边缘2D-US及超声造影增强特征,对比良性组、恶性组边缘区与中央区时间强度曲线(TIC)参数,包括基础强度(BI)、峰值强度(PI)、曲线下面积(AUC)、达峰时间(TTP)、梯度(Grad)。共分析3次,取平均值。结果与良性组比较,恶性组2D-US多表现为边界不清晰、多有毛刺、高回声晕、有分叶,差异有统计学意义(P<0.05);超声造影表现为边缘增强、放射状增强、环状增强、穿支增强、造影后边界不清、造影后范围扩大,差异有统计学意义(P<0.05)。恶性组边缘区BI、PI、AUC、Grad均大于中央区,TTP快于中央区,差异有统计学意义(P<0.05);而良性组边缘区与中央区相关参数比较,差异无统计学意义(P>0.05)。结论良、恶性肿块边缘2D-US及超声造影征象存在明显差异,在诊断乳腺癌的贡献中,恶性肿块边缘区超声征象大于中央区,因此对超声造影边缘征象重点关注可提高良、恶性乳腺肿块的鉴别诊断能力。

Objective To explore the diagnostic value of two-dimensional ultrasound(2D-US)and contrast-enhanced ultrasound features in marginal zone for benign and malignant breast masses in BI-RADS 4.Methods From January 2016 to July 2018,76 patients were collected from the Department of Ultrasound,the First Affiliated Hospital of Shanxi Medical University.A total of 77 breast masses were confirmed by biopsy or surgical pathology.Benign and malignant tumors were divided into two groups.2D-US and contrast-enhanced ultrasound characteristics of marginal zone in benign and malignant tumors were compared.And the marginal zone and the inside of the masses time-intensity curve(TIC)parameters of the benign and malignant groups were analyzed.Base strength(BI),peak intensity(PI),area under the curve(AUC),peak time(TTP),and gradient(Grad)were observed.They were analyzed for 3 times and the average value was taken.Results Compared with benign group,2D-US of malignant group showed more irregular edge,spiculate margin,acoustic halo and lobulated edge,the differences were statistically significant(P<0.05).Contrast-enhanced ultrasound showed radial enhancement,perforator enhancement and circular enhancement,perforation enhancement,unclear boundary,enlarged range after angiography were more common in malignant group,the differences were statistically significant(P<0.05).In malignant group,BI,PI,AUC and Grad were bigger in marginal zone than the inside of the masses,and TTP was faster than the inside of the mass,the differences were statistically significant(P<0.05).In benign group,the marginal zone of lesion was not significantly different from the internal mass in the above parameters(P>0.05).Conclusion There are significant differences between the benign and malignant masses in the 2D-US and contrast-enhanced ultrasound of the marginal zone.The ultrasound signs of the marginal zone of the malignant masses contribute more to the diagnosis of breast cancer than the internal,therefore,focusing on the marginal zone ultrasound characteristics can improve the ability of differential diagnosis between benign and malignant breast mass.