超声造影对乳腺影像报告和数据系统4a类肿块的诊断价值

The value of contrast-enhanced ultrasound in the diagnosis of Breast Imaging Reporting and Data System 4a breast lesions

目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)对乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS) 4a类肿块的诊断价值。方法:入组149个常规超声诊断为BI-RADS 4a类的乳腺肿块行CEUS检查,以粗针穿刺或手术病理学检查为对照,比较良恶性肿块的CEUS特征的差异。采用logistic逐步回归分析恶性肿块在CEUS中的优势比征象,并调整肿块的BI-RADS分类。用受试者工作特征(receiver operating characteristic,ROC)曲线比较CEUS调整前后的BI-RADS分类的诊断效能。结果:在149个BI-RADS 4a类乳腺病灶中,良性病灶112个,恶性病灶37个。通过二分类logistic回归分析显示,CEUS增强后病灶形态不规则(OR=4.32)及有滋养血管(OR=15.79)为恶性肿块的优势比征像。CEUS诊断后,BI-RADS分类调整为:3类83个(55.70%),4a类57个(38.25%),4b类9个(6.04%)。以BI-RADS 4a为活检阈值,活检率由造影前的100.00%降低至44.30%,癌症检出率由24.83%升高至51.52%,允许随访患者的恶性风险仅2.01%。以BI-RADS 4a为恶性阈值,常规超声和CEUS的ROC曲线的曲线下面积分别为0.500和0.835(95%CI:0.392~0.680 vs 0.764~0.907,P<0.05)。结论:CEUS有助于常规超声BI-RADS 4a类肿块良恶性的鉴别,可减少不必要的穿刺活检。但对部分BI-RADS 4a类依据CEUS降类的肿块,应综合判断,以降低假阴性率。

Objective: To explore the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of Breast Imaging Reporting and Data System(BI-RADS) 4 a breast lesions. Methods: One hundred and forty-nine breast masses diagnosed by conventional ultrasound as BI-RADS 4 a were enrolled in this study. All patients were evaluated by CEUS before core-needle biopsy or surgical pathology. CEUS characteristics included qualitative characteristics and quantitative characteristics were analyzed and compared with pathological results. Binary logistic regression analysis was used to choose the signs of malignant and revise the classification of BI-RADS. Receiver operating characteristic(ROC) curve was applied to evaluate the diagnostic efficacy of CEUS and conventional ultrasound. Results: Pathological results showed 112 benign and 37 malignant lesions. Irregular lesion shape after enhancement(OR=4.32) and penetrating vessels(OR=15.79) were selected by binary logistic regression analysis as signs of malignant. After CEUS, 83(55.70%) lesions were diagnosed as BI-RADS 3, 57(38.25%) were diagnosed as BI-RADS 4 a and 9(6.04%) were diagnosed as BI-RADS 4 b. The cancer-to-biopsy yield was 51.52% with CEUS-based BI-RADS 4 a selected as the biopsy threshold compared with 24.83% otherwise, while the biopsy rate was only 44.30% compared with 100.00% otherwise. Overall, only 2.01% of malignant lesions were misdiagnosed. The area under curve of ROC curve with thresholds of ultrasound BI-RADS 4 a, CEUS-based BI-RADS 4 a were 0.500 and 0.835, respectively(95% CI: 0.392-0.680 vs 0.764-0.907, P<0.05). Conclusion: CEUS could help to differentiate between malignant and benign breast lesions with ultrasound BI-RADS 4 a, and reduce unnecessary biopsies and increase cancer-to-biopsy yields. However, for some BI-RADS 4 a lesions that are reduced by CEUS, a comprehensive judgment should be made to reduce false negative cases.