不同年龄段超声检查BI-RADS 4类乳腺肿块的细化分类研究

Study on detailed classification of BI-RADS category 4 breast lesions in different ages by ultrasonography

目的探讨不同年龄段的超声检查BI-RADS 4类乳腺肿块细化分为4A、4B、4C类的阳性预测值(positive predictive value,PPV),以便准确的评估BI-RADS 4类乳腺肿块的良恶性病变,提高超声诊断的准确性。方法应用美国放射学2013年版BI-RADS超声评分方法,选取4类乳腺肿块1000个,按年龄<40岁、年龄40~50岁、年龄>50岁分三组,分别以病灶的形态、纵横比、边缘、微钙化、后方回声及内部回声这些超声征象进行细化对比分析,将各组病变进一步分为4A、4B、4C类,比较分亚类后PPV的差异性。结果1000个肿块中:年龄<40岁组246个,其中恶性64个,良性182个;年龄40~50岁组446个,其中恶性132个,良性314个;年龄>50岁组308个,其中恶性145个,良性163个。良、恶性病变的形态、纵横比、边缘、微钙化,差异均有统计学意义(P<0.05),肿块内部回声及后方回声改变间比较,差异均无统计学意义(P>0.05)。根据差异有统计学意义的超声征象进一步细化分类后三个不同年龄段4A类的PPV分别为5.1%、9.0%、15.4%,4B类的PPV分别为33.3%、40.9%、61.6%,4C类的PPV分别为74.0%、85.2%、94.5%。各年龄段细化分类后组间的阳性预测值比较差异有统计学意义(χ^(2)=6.10,χ^(2)=13.98,χ^(2)=10.33,P<0.05)。结论不同年龄组4类乳腺肿块的各亚类阳性预测值年龄越大阳性预测值越高,年龄分组且细化分类后能更准确地对乳腺肿块良、恶性风险进行评估,对临床诊断和治疗方案有重要意义。

Objective To explore the positive predictive value(positive predictive value,PPV)of 4 kinds of breast lesions at the different ages by ultrasonic Breast Imaging Reporting and Data System(BI-RADS)category 4 lesions that were subcategorized into 4A,4B,and 4C.and to assess the risk of malignancy of lesions with BI-RADS category 4 in order to improve the accuracy of diagnosis.Methods By use of the radiological BI-2013 RADS ultrasonic score method,1000 patients with the category 4 lesions were selected.Those were divided in three groups by age,i.e.,the groups aged<40,aged between 40 and 50 years old,and aged>50,respectively.And then,the ultrasonic signs in terms of shape of lesions,aspect ratio,edge in lesions,microcalcification,rear echo,and internal echo were refined and analyzed.Those lesions were further divided into groups of lesions 4 A,4B,4C,and the differences of PPV were compared after the classification.Results Of those 1000 lesions,246 were found in group aged<40,in which 64 were malignant and 182 were benign;446 were found in group Aged between 40 and 50,in which 132 were malignant and 314 were benign;and 308 were found in group aged>50,among which 145 were malignant and 163 were benign.The differences were statistically significant(P<0.05)in terms of the morphology of benign and malignant lesions,aspect ratio,edge,microcalcification.As for the nodule comparison between internal echo and rear echo change,there was no statistically significant difference(P>0.05).According to the difference showing statistically significant ultrasonic signs after fur-ther refining the classification of three different age groups,PPV in 4A was 5.1%,9.0%and 5.1%respectively,in 4 B was 33.3%,40.9%and 33.3%respectively,and in 4C was 74.0%,85.2%and 94.5%,respectively.The PPV compared between different groups was statistically significant(χ^(2)=6.10,χ^(2)=13.98,χ^(2)=10.33,P<0.05).Conclusion PPA of BI-RADS category 4 lesions at different age groups is higher,which has higher predictive value.The PPA at different age group and after the refining classification can more accurately evaluate the risk of benign and malignant breast lesions,which is important for the clinical diagnosis and treatment of this disorder.