超声BI-RADS分类对特殊类型乳腺癌的诊断价值

Application of Breast Ultrasound Imaging Report and Data System classification in diagnosis of special types of breast cancer

目的探讨超声乳腺影像报告与数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类在特殊类型乳腺癌中的诊断价值。方法回顾性分析2009年8月至2020年8月于浙江大学医学院附属第二医院诊治并经手术病理证实的特殊类型乳腺癌患者112例(112个病灶),患者均行术前超声检查。分别由高年资主治医师及低年资住院医师依据超声BI-RADS分类对乳腺病灶进行评估。以组织病理学为金标准,分析BI-RADS分类诊断特殊类型乳腺癌的敏感性及准确性,比较不同特殊类型乳腺癌的BI-RADS分类及超声恶性征象之间的差异。对两名医师的评估结果进行Kappa检验,判断一致性是否良好。结果112例患者中,化生性癌20例,伴有髓样特征的浸润性癌19例,大汗腺分化的癌16例,黏液癌12例,浸润性微乳头状癌12例,浸润性乳头状癌10例,浸润性小叶癌6例,其他特殊类型癌17例;BI-RADS 3类4例(3.5%),BI-RADS 4a类13例(11.6%),BI-RADS 4b类42例(37.5%),BI-RADS 4c类47例(42.0%),BI-RADS 5类6例(5.4%)。BI-RADS分类诊断特殊类型乳腺癌的敏感性为96.43%,准确性为96.43%。不同特殊类型乳腺癌的BI-RADS分类差异有统计学意义(P<0.05)。特殊类型乳腺癌病灶常表现为低回声、不规则形、边界成角或微分叶。不同特殊类型乳腺癌病灶的最大径、边界、内部回声及后方回声差异有统计学意义(均P<0.05)。两名医师诊断结果一致性良好,Kappa值为0.789。结论不同特殊类型乳腺癌超声征象有差异,超声BI-RADS分类对特殊类型乳腺癌诊断准确性较高。

Objective To investigate the value of Breast Ultrasound Report and Data System(BI-RADS)classification in diagnosis of special types of breast cancer.Methods A total of 112 patients with special type of breast cancer(112 breast lesions)confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital,Zhejiang University School of Medicine from August 2009 to August 2020.All patients underwent ultrasound before surgery.The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively.Taking histopathological result as the gold standard,the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed.Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results In the 112 patients,pathological results showed that there were 20 cases of metaplastic carcinoma,19 cases of invasive carcinoma with medullary features,16 cases of differentiated carcinoma of apocrine gland,12 cases of mucinous carcinoma,12 cases of invasive micropapillary carcinoma,10 cases of invasive papillary carcinoma,6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma.Among them,4 cases(3.5%)were BI-RADS 3,13 cases(11.6%)were BI-RADS 4a,42 cases(37.5%)were BI-RADS 4b,47 cases(42.0%)were BI-RADS 4c and 6 cases(5.4%)were BI-RADS 5.The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43%and 96.43%,respectively.There was significant difference in BI-RADS grade among different special types of breast cancer(P<0.05).Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin.The nodule size,boundary,echo and posterior echo in breast cancer with different special types showed significant differences(all P<0.05).There was a good consistency between the two physicians(Kappa=0.789).Conclusions The ultrasonography features of different special types of breast cancer are different.BI-RADS classification has great value in diagnosis of special types of breast cancer.