纵横比大于1乳腺肿块的X线再评估及临床、超声特征分析

X⁃ray reevaluation and clinical and ultrasonic characteristics of breast lesions with depth⁃width ratio>1 in ultrasound

目的分析纵横比(depth⁃width,D/W)大于1乳腺肿块的X线再评估价值,并分析具有D/W>1超声特征乳腺良恶性肿块的临床和超声特征。方法选取具有D/W>1超声特征的乳腺肿块317例,应用X线检查进行再评估,依据病灶的X线表现进行BI⁃RADS分类,按临床处理原则的不同,将BI⁃RADS 1~3类乳腺肿块评估为良性,将具有可疑特征的BI⁃RADS 4~5类乳腺肿块评估为恶性,以手术病理作为金标准,计算X线再评估后的诊断准确率,并分析具有D/W>1超声特征的乳腺良恶性肿块的临床及超声特征。结果317例具有D/W>1超声特征的乳腺肿块中,恶性221例,良性病灶96例,经X线再评估后,诊断的准确率明显提高,与超声比较,差异有统计学意义(P<0.05)。临床资料中,恶性肿块患者的年龄以及肿块的大小均大于良性肿块患者,差异有统计学意义(P<0.05)。同时,在排除了D/W>1的超声特征后,良恶性肿块在形态、边缘、内部回声、后方回声、微钙化、血流、腋窝肿大淋巴结等方面差异均具有统计学意义(P<0.05)。结论超声提示D/W>1的乳腺肿块中仍存在部分良性肿块,这类肿块体积小、合并的其他可疑超声特征少等特点,经X线再评估后,可大大提高诊断的准确率,有效减少穿刺或手术等有创性检查的发生。

Objective To explore the value of X⁃ray reevaluation of breast masses with depth⁃width ratio>1(D/W>1)and further analyze the clinical and ultrasound features of benign and malignant breast masses with D/W>1.Methods A total of 317 breast lesions with D/W>1 by ultrasound were included in the study.These lesions were reevaluated by X⁃ray and classified by BI⁃RADS further.According to different principles of clinical treatment,the lesions with BI⁃RADS 1⁃3 categories were evaluated as benign,and the lesions with BI⁃RADS 4⁃5 categories were evaluated as malignant.The diagnostic accuracy of X⁃ray reevaluation was calculated according to the gold standard of pathological results.The clinical and ultrasonic features of the benign and malignant breast masses were analyzed as well.Results Of the 317 cases,221 were diagnosed as malignant and 96 as benign.The diagnostic accuracy after X⁃ray reevaluation was more significantly improved than that only with ultrasound(P<0.05).In the clinical data,the age of patients with malignant tumors and the size of tumor in them were significantly larger than that with benign tumors(P<0.05).Meanwhile,when the ultrasonic features of D/W>1 were excluded,there were significant differences between the benign and malignant tumors in terms of shape,edge,internal echo,posterior echo,microcalcification,blood flow,axillary lymph node enlargement(P<0.05).Conclusion Some benign lesions with D/W>1 diagnosed as malignant initially by ultrasound are characterized by small volume and few other suspi⁃cious ultrasound features.Combined with X⁃ray examination for reevaluation,the diagnostic accuracy can be greatly improved,and the incidence of invasive examinations such as puncture or operation can be reduced effectively.