超声弹性成像诊断不同乳腺影像报告和数据系统分级乳腺肿块的临床价值

Clinical significance of ultrasound elastography in the diagnosis of different breast lumps categorized by BI-RADS

目的探讨超声弹性成像诊断不同乳腺影像报告和数据系统(BI-RADS)分级乳腺肿块的临床价值。方法选取2016年12月至2018年2月间上海市嘉定区中医医院收治的122例乳腺肿块患者进行回顾性分析,采用超声弹性成像与BI-RADS分级对患者进行检测,与病理结果进行对照,对超声弹性成像与BI-RADS分级对乳腺肿块良恶性的诊断价值进行探讨另析。结果右乳90个,左乳62个;病理结果证实,恶性72个,良性80个。72个恶性病灶中,浸润性导管癌32个,乳头状癌20个,浸润性小叶癌18个,黏液癌2个。80个良性病灶中,纤维腺瘤48个,乳头状瘤27个,乳腺增生5个。BI-RADS分级:3级42个,4a级32个,4b级28个,4c级41个,5级9个;超声弹性成像评分:1分19个,2分32个,3分30个,4分50个,5分21个。超声弹性成像对BI-RADS进行修正后分级,病灶3级42个,4a级38个,4b级20个,4c级41个,5级11个。152个肿块中,BI-RADS分级诊断为良性74个,恶性78个,超声弹性成像评分显示良性81个,恶性71个,超声弹性成像对BIRADS修正后分级显示良性80个,恶性72个。超声弹性成像对BI-RADS修正后分级敏感度、特异度、阳性预测值、阴性预测值和诊断准确率均高于BI-RADS分级和超声弹性成像评分。结论超声弹性成像可提升BI-RDAS分级对乳腺肿块的诊断敏感性、特异性、阳性预测值、阴性预测值和诊断准确率,达到减少穿刺或手术活检的目的。

Objective To investigate the clinical value of ultrasound elastography in the diagnosis of breast lumps classified by breast imaging reporting and data system(BI-RADS).Methods From December 2016 to February 2018,122 patients with breast masses admitted to Shanghai Jiading District Hospital of Traditional Chinese Medicine were selected for a retrospective analysis.The patients were detected by ultrasound elastic imaging and BI-RADS grading,and were compared with the pathological results.The diagnostic value of ultrasound elastography and BI-RADS grading for breast masses was studied.Results There were 90 lumps in the right breast and 62 lumps in the left breast.A total of 72 malignant lesions and80 benign lesions were confirmed by the the pathological results.Of the 72 malignant lesions,32 were invasive ductal carcinoma,20 were papillary carcinoma,18 were invasive lobular carcinoma,and 2 were mucinous carcinoma;of the 80 benign lesions,48 were fibroadenoma,27 were papilloma,and 5 were hyperplasia.For BI-RADS grading,there were 42 grade 3 breast lumps,32 grade 4 a lumps,28 grade 4 b lumps,41 grade 4 c lumps,and 9 grade 5 lumps;for ultrasonic elastography scale,category 1,19,category 2,32,category 3,30,category 4,50,and category 5,21;for BI-RADS grading modified by ultrasonic elastography,there were 42 grade 3 lumps,38 grade 4 a lumps,20 grade 4 b lumps,41 grade 4 C lumps,and 11 grade 5 lumps.Among the 152 lumps,74 lumps were diagnosed as benign and 78 lumps as malignant according to BI-RADS grading.According to ultrasound elastography,81 lumps were benign and 71 lumps were malignant.According to BI-RADS grading modified by ultrasonic elastography,80 lumps were benign and 72 lumps were malignant.The sensitivity,specificity,positive and negative predictive value and diagnostic accuracy of BI-RADS were higher than BI-RADS.Conclusion Ultrasound elastography can improve the sensitivity,specificity,positive predictive and negative predictive value and diagnostic accuracy of BIRDAS classification for the diagnosis of breast lumps so as to reduce the usage of puncture or surgical biopsy.