超声造影对不同大小BI-RADS 4类乳腺结节的良恶性定性诊断研究

The contrast enhanced ultrasound qualitative diagnosis of benign and malignant in BI-RADS 4 breast nodules with different sizes

目的:探讨超声造影对不同大小BI-RADS 4类乳腺结节的定性诊断价值。方法:收集2017年10月至2019年5月上海交通大学附属第一人民医院的467例患者506个常规超声定性为BI-RADS 4类乳腺结节,分为大结节组(最大径线>20 mm,198个)和小结节组(最大径线≤20 mm,308个),采用χ2检验比较两组乳腺结节良恶性超声造影特征的差异,依据超声造影特征对病灶赋值评分,构建ROC曲线评价超声造影特征评分对两组病灶良恶性的诊断效能。结果:两组乳腺良恶性结节在增强程度、增强后病灶大小改变、病灶与周围组织显影早晚、是否放射状增强、增强均匀性及有无穿入性血流灌注的差异性方面有统计学意义(均P<0.001)。当小结节组良恶性鉴别评分临界值为2.5分时,ROC曲线下面积(AUC)、敏感性、特异性、准确性分别为0.793、82.67%、60.22%、69.48%;当大结节组良恶性鉴别评分临界值为3.5分时,AUC、敏感性、特异性、准确性分别为0.901、85.42%、80.00%、82.65%。结论:超声造影定性分析不同大小BI-RADS 4类乳腺结节良恶性均有意义,20 mm以上结节可避免不必要的穿刺,20 mm及以下结节仍需穿刺活检除外良性病灶。

Objective To evaluate the qualitative diagnosis of contrast enhanced ultrasound(CEUS)in different sizes′benign and malignant breast nodules(BNs)of BI-RADS 4.Methods A total of 506 BNs in 467 patients from Shanghai General Hospital between October 2017 and May 2019 classified as BI-RADS 4 were divided into large size group(>20 mm,n=198)and small size group(≤20 mm,n=308)according to their largest diameter lines.The CEUS characteristics of benign and malignant BNs in two groups were analyzed by Chi-square test.The CEUS characteristics of BNs were assigned scores for diagnosis of benign and malignant BNs with different sizes,the diagnostic efficacy of these scores was evaluated by ROC curve.Results There were statistic differences in the degree,size change of the enhanced lesions,enhancement time of lesions compared with surrounding tissues,radial enhancement or not,homogeneity of enhancement,with or without penetrating of perfusion between benign and malignant BNs in both groups(all P<0.001).In small size group,with the critical value of 2.5 points,area under curve(AUC)of ROC curve was 0.793,and the sensitivity,specificity,accuracy of CEUS was 82.67%,60.22%and 69.48%,respectively.In large size group,with the critical value of 3.5 points,AUC of ROC curve was 0.901,and the sensitivity,specificity,accuracy of CEUS was 85.42%,80.00%and 82.65%,respectively.Conclusions CEUS has great significance in qualitative diagnosis of benign and malignant in BI-RADS 4 BNs with different sizes.The biopsy could be avoided in BNs greater than 20 mm,while biopsy is still needed in BNs less than or equal to 20 mm.