多模态超声对于乳腺癌不同BI-RADS分类诊断的价值及与分子分型的关系

The value of multimodal ultrasound in the diagnosis of breast cancer with different BI-RADS classification and its relationship with molecular typing

目的探究多模态超声技术在不同超声BI-RADS分类乳腺良恶性结节诊断中的价值及与乳腺癌分子分型的关系。方法纳入本院2017年12月至2019年12月165例疑似乳腺癌患者,以病理检查结果为金标准,对比多模态超声诊断的准确率、敏感性和特异性;依据超声影像进行BI-RADS分级,对比不同BI-RADS分级的诊断准确率,并分析超声征象与乳腺癌分型的相关性。结果病理诊断结果显示良性104例(63.0%),恶性61例(37.0%)。多模态超声联合诊断的敏感度为93.4%,特异度为94.2%,阳性预测值为90.5%,阴性预测值为96.1%,均显著高于常规超声、超声造影及超声弹性成像(P<0.05)。乳腺癌不同BI-RADS分级患者病灶直径、良恶性比例、恶性诊断准确率比较差异具有统计学意义(P<0.05);不同BI-RADS分级患者病理分型比较差异无统计学意义(P>0.05)。Luminal A型、Luminal B型、HER-2过表达及三阴性病灶直径、高回声晕比较差异无统计学意义(P>0.05);纵横比、内部回声是否均匀、微钙化比比较差异具有统计学意义(P<0.05)。结论联合多模态超声检测并结合BI-RADS分类可显著提升乳腺癌的诊断准确率,通过超声征象可初步判断乳腺癌分子分型,对乳腺癌患者的临床诊疗具有良好价值。

Objective To explore the value of multimodal ultrasound technology in the diagnosis of benign and malignant breast nodules with different ultrasound BI-RADS and its relationship with breast cancer molecular typing. Methods Including 165 patients with suspected breast cancer in our hospital from December 2017 to December 2019. The pathological examination results were used as the gold standard to compare the accuracy,sensitivity and specificity of multimodal ultrasound diagnosis. Based on the ultrasound images,BI-RADS classification was performed,the diagnostic accuracy of different BI-RADS classifications was compared,and the correlation between ultrasound signs and breast cancer classification was analyzed.Results Pathological diagnosis showed that 104 cases were benign(63.0%)and 61 cases were malignant(37.0%). The sensitivity of multimodal ultrasound combined diagnosis was 93.4%,specificity was 94.2%,positive predictive value was 90.5%,negative predictive value was 96.1%,which were significantly higher than conventional ultrasound,ultrasound contrast,and ultrasound elastography(P<0.05). There were statistically significant differences in lesion diameter,benign and malignant ratio,and accuracy of malignant diagnosis among breast cancer patients with different BI-RADS grades(P<0.05);there was no significant difference in pathological classification between patients with different BI-RADS grades(P>0.05). Luminal A type,Luminal B type,HER-2 overexpression and triple-negative lesion diameter,high echo halo were not significantly different(P>0.05);aspect ratio,internal echo are uniform,and microcalcification ratio was statistically different Significance(P<0.05). Conclusion Combined multi-modality ultrasound detection and BI-RADS classification can significantly improve the diagnostic accuracy of breast cancer. The molecular classification of breast cancer can be preliminarily judged by ultrasound signs,which has good value for clinical diagnosis and treatment of breast cancer patients.