超声造影BI-RADS分类诊断乳腺非肿块型病变良恶性的应用研究

Application of contrast-enhanced ultrasound with BI-RADS in the diagnosis of benign and malignant breast non-mass-like lesions

目的:探讨采用超声造影乳腺影像报告和数据系统(Breast Imaging Reporting and Date System,BI-RADS)分类对乳腺非肿块型病变(non-mass-like lesion,NML)良恶性的诊断价值。方法:收集2017年10月—2019年5月就诊经超声诊断为乳腺NML的患者182例。行常规超声对所有病灶进行BI-RADS分类,并行超声造影检查。分析超声造影特征并以穿刺或手术后病理学检查结果为金标准,建立以超声造影特征为变量的logistic回归方程。依据超声造影特征对所有病灶进行BI-RADS分类。比较常规超声和超声造影的BI-RADS分类结果及诊断效能。结果:乳腺良恶性NML的超声造影特征在增强强度、增强后病灶大小、病灶显影时间、病灶周围放射状增强、有无穿支血管方面差异有统计学意义(P<0.05)。常规超声与超声造影的分类结果差异有统计学意义(P<0.05)。常规超声BI-RADS分类诊断恶性病变的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为75.28%、56.98%、65.93%、62.62%、70.67%,曲线下面积为0.661(95%CI:0.582~0.741);超声造影BI-RADS分类诊断恶性病变的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为93.26%、74.19%、83.52%、76.15%、92.00%,曲线下面积为0.837(95%CI:0.775~0.899)。结论:超声造影BI-RADS分类能够提高对乳腺NML良恶性的诊断效能,减少穿刺,有助于临床决策。

Objective:To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)with Breast Imaging Reporting and Date System(BI-RADS)classification in the diagnosis of benign and malignant breast non-mass-like lesion(NML).Methods:A total of 182 cases of NML diagnosed by ultrasound were included.After classified by BI-RADS,all the lesions underwent CEUS.Multivariate logistic regression models were established for CEUS to diagnose breast malignancy.And then classified by BI-RADS according to the characteristics of CEUS thus compared with conventional ultrasound BI-RADS.The diagnostic performance of BI-RADS were compared between conventional ultrasound and CEUS.Results:The CEUS features of benign and malignant NML were significantly different in terms of enhancement intensity,lesions sizes after enhancement,enhancement time,peripheral radial enhancement,and visualization of penetrating vessel(P<0.05).The BI-RADS classification between conventional ultrasound and CEUS were different significantly(P<0.05).The sensitivity,specificity,accuracy,positive predictive value(PPV),and negative predictive value(NPV)of the conventional ultrasound BI-RADS in diagnosis of malignant lesions were 75.28%,56.98%,65.93%,62.62%and 70.67%,respectively(area under curve=0.661;95%CI:0.582-0.741).The sensitivity,specificity,accuracy,PPV,and NPV of CEUS BI-RADS in diagnosis of malignant lesions were 93.26%,74.19%,83.52%,76.15%and 92.00%,respectively(area under curve=0.837;95%CI:0.775-0.899).Conclusion:CEUS with BI-RADS classification can remarkably improve the diagnosis efficacy of benign and malignant breast NML,reduce biopsy and contribute to clinical management.