两种不同超声评估方法在BI-RADS 4类乳腺病变良恶性鉴别中的价值比较

Comparison of Two Different Ultrasound Evaluation Methods in the Differential Diagnosis of BI-RADS 4 Breast Lesions

目的:比较改良超声弹性成像评分法与超声弹性应变比在鉴别乳腺影像报告与数据系统(BI-RADS)4类乳腺良恶性病变中的价值。方法:选取本院83例乳腺病变(乳腺肿块96个),均行改良超声弹性成像评分,并检测超声弹性应变比。根据手术病理结果,并通过绘制受试者工作特征(ROC)曲线评价改良超声弹性成像与应变比在鉴别BI-RADS 4类乳腺良恶性病变中的诊断效能。结果:96个乳腺肿块中,术前超声诊断4A类41个,4B类32个,4C类23个;术后病理提示恶性结节56个,良性结节40个。改良超声弹性成像评分法与超声弹性应变比诊断BI-RADS 4类乳腺癌恶性病变的灵敏度分别为69.64%(39/56)、73.21%(41/56),特异度分别为72.50%(29/40)、82.50%(33/40),准确性分别为70.83%(68/96)、77.08%(74/96),约登指数分别为0.42、0.56。经ROC曲线分析显示,超声弹性应变比在鉴别乳腺良恶性病变中的ROC曲线下面积为0.86,高于改良超声弹性成像评分法(0.74)。结论:改良超声弹性成像评分法与超声弹性应变比在鉴别BI-RADS 4类乳腺良恶性病变中均具有重要的指导价值,但超声弹性应变比可能更加可靠、客观性较强,对鉴别BI-RADS 4类乳腺良恶性病变具有良好的诊断价值。

Objective:To compare the value of the modified ultrasound elastography score and the ultrasound elastic strain ratio in the differential diagnosis of four types of breast benign and malignant lesions in breast imaging reporting and data system for ultrasound(BI-RADS).Methods:A total of 83 cases of breast lesions(96 breast masses)in our hospital were selected,who were graded by modified ultrasound elastography,and the elastic strain ratio of ultrasound was measured.According to the results of operation and pathology,and by plotting the receiver operating characteristic(ROC)curve of the subjects,the diagnostic efficacy of the modified ultrasound elastography and strain ratio in the differential diagnosis of BI-RADS 4 types of breast benign and malignant lesions was evaluated.Results:Among the 96 breast masses,41 of 4A,32 of 4B and 23 of 4C were diagnosed by ultrasonography before operation,56 of them were malignant and 40 of them were benign.The sensitivity,specificity,accuracy and yoden index of the two methods were 69.64%(39/56),73.21%(41/56),72.50%(29/40),82.50%(33/40)and 70.83%(68/96),77.08%(74/96)respectively.The ROC curve analysis showed that the area under the ROC curve was 0.86,which was higher than that of the modified elastography(0.74).Conclusion:The modified elasto-sonography score and the elastic-strain ratio of ultrasound have important guiding value in the differentiation of four types of breast benign and malignant lesions in BI-RADS,but the elastic-strain ratio of ultrasound may be more reliable and objective,which has a good diagnostic value in the differentiation of four types of breast benign and malignant lesions in BI-RADS.