BI-RADS分类联合超声造影及剪切波弹性成像在乳腺微小癌中的诊断价值研究

The diagnostic value of BI-RADS classification combined with CEUS and SWE in breast microcarcinoma

目的:比较乳腺影像报告和数据系统(BI-RADS)、剪切波弹性成像(SWE)、超声造影(CEUS)以及三者联合应用诊断直径≤1 cm的乳腺癌的诊断价值。方法:回顾性分析经病理结果证实的138例乳腺小结节的BI-RADS分类、SWE及CEUS的图像资料。以病理诊断结果为金标准,分析BI-RADS分类、SWE、CEUS以及三者联合应用诊断乳腺微小癌的灵敏度、特异度、阳性预测值、阴性预测值,并对四种方法做受试者操作曲线(ROC)分析,进行曲线下面积(AUC)比较各种方法的诊断价值。结果:病理诊断恶性结节49个(35.5%),良性结节89个(64.5%)。BI-RADS、SWE、CEUS及联合应用诊断乳腺微小癌的灵敏度、特异性、阳性预测值、阴性预测值和AUC分别为67.3%、65.2%、51.6%、78.4%、66.3%;71.4%、77.5%、63.6%、83.1%、75.2%;67.3%、83.1%、68.8%、82.2%、74.5%和79.6%、85.4%、75.0%、88.4%、82.5%。Z检验示联合应用与BI-RADS分类、SWE、CEUS诊断乳腺微小癌差异有统计学意义(P<0.001、P=0.018及P=0.033),联合应用优于单一技术。结论:BI-RADS分类联合CEUS、SWE能提高乳腺微小癌的诊断准确率,对其临床诊治有重要的意义。

Objective:To compare the diagnostic value of the breast imaging reporting and data system(BI-RADS),contrast-enhanced ultrasound(CEUS),shear wave elastography(SWE),and their combined application to diagnose breast carcinoma with maximum diameter≤1 cm.Methods:The imaging data of 138 cases of breast nodules confirmed by pathological results were analyzed retrospectively.The sensitivity(SEN),specificity(SPE),positive predictive value(PPV)and negative predictive value(NPC)of BI-RADS classification,SWE,CEUS and their combined application in the diagnosis of breast microcarcinoma were statistically analyzed using the pathological results as the gold standard.The receiver operating curve(ROC)analysis was per-formed on the four methods,and the area under the curve(AUC)was performed to compare the diagnostic value of each method.Results:There were 49 malignant nodules(35.5%)and 89 benign nodules(64.5%).The SEN,SPE,PPV,NPV and AUC of BI-RADS,SWE,CEUS and their combination were 67.3%,65.2%,51.6%,78.4%,66.3%;71.4%,77.5%,63.6%,83.1%,75.2%;67.3%,83.1%,68.8%,82.2%,74.5%and 79.6%,85.4%,75.0%,88.4%,82.5%respectively.Z test showed that there were significant differences between combined application and BI-RADS classification,SWE,CEUS in the diagnosis of breast microcarcinoma(P<0.001,P=0.018 and P=0.033),and combined application was superior to single technique.Conclusion:BI-RADS classification combined with CEUS and SWE can improve the diagnostic accuracy of breast microcarcinoma,which is of great significance for clinical diagnosis and treatment.