多中心乳腺癌筛查中乳光超诊断BI-RADS3和4级结节的价值

Value of ultrasound diffusion breast imaging system in the diagnosis of BI-RADS grade 3 and 4 nodules in multicenter breast cancer screening

目的探讨超声光散射乳腺诊断系统(简称乳光超)在多中心乳腺癌筛查中对乳房影像报告及数据系统(BI-RADS)3、4级乳腺结节的诊断价值。方法纳入2017-10-01-2018-05-316家妇幼保健院(广东省妇幼保健院、北京市海淀妇幼保健院、广州市妇女儿童医疗中心、安阳市妇幼保健院、长沙市妇幼保健院、北京市延庆妇幼保健院)36706名女性体检筛查及门诊筛查者,均进行乳光超和超声2种检查,部分进行乳腺X射线检查,均进行BI-RADS分级。任意一种检查方法BI-RADS 4级者进行活检(空芯针、真空辅助微创旋切或手术活检),BI-RADS 3级者至少随机选取20%进行活检。分析乳光超和超声筛查乳腺癌的灵敏度和特异度,探讨2种检查方法区分BI-RADS 3和4级肿块及≤1 cm肿块的能力。采用SPSS 22.0对数据进行统计学分析,构成比比较采用χ^(2)检验。结果6家研究单位共采集36706名患者数据,有肿块病例为6237例,肿块检出率为16.99%,活检病例为1056例,活检率为2.88%。乳光超灵敏度大于超声(0.932 vs 0.915),差异无统计学意义,P=0.942。乳光超特异度大于超声(0.809 vs 0.737),差异有统计学意义,P<0.001。乳光超与超声检查的BI-RADS 3级恶性率分别为3.39%和6.78%,差异无统计学意义,P=0.316;乳光超与超声BI-RADS 4级良性率分别为17.25%和25.38%,差异有统计学意义,P<0.001。结论乳光超在乳腺筛查中对BI-RADS 3、4级结节的诊断准确性优于超声,可作为早期乳腺癌筛查的有效方法之一。

Objective To investigate the diagnostic value of ultrasound diffusion breast imaging system in multicenter breast cancer screening for breast imaging reporting and data system(BI-RADS) grade 3 and 4 breast nodules.Methods From 2017-10-01 to 2018-05-31 6 Maternal and Child Health Hospitals(Guangdong Maternal and Child Health Hospital, Beijing Haidian Maternal and Child Health Hospital, Guangzhou Women and Children’s Medical Center, Anyang Maternal and Child Health Hospital, Changsha Maternal and Child Health Hospital, Beijing Yanqing Maternal and Child Health Hospital) 36 706 people who underwent physical examination screening and outpatient screening were included, all underwent two types of examinations, ultrasound diffusion breast imaging system and ultrasonography, some underwent mammography, and all underwent BI-RADS classification.Biopsy(core needle, vacuum-assisted minimally invasive rotary incision, or surgical biopsy) was performed for any one of the BI-RADS grade 4 examination methods, and at least 20% of the BI-RADS grade 3 were randomly selected for biopsy.Analyzed the sensitivity and specificity of ultrasound diffusion breast imaging system and ultrasonography for breast cancer screening, and explored the ability of the two examination methods to distinguish BI-RADS grade 3 and 4 masses and ≤1 cm masses.SPSS 22.0 was used for statistical analysis of the data, and the χ^(2) test was used to compare the constituent ratios.Results A total of 36 706 cases of data were collected from 6 research units.There were 6 237 cases with mass, the mass detection rate was 16.99%,and the biopsy cases were 1 056,with a biopsy rate of 2.88%.The sensitivity of ultrasound diffusion breast imaging system was higher than the ultrasound(0.932 vs 0.915),the difference was not statistically significant(P=0.942).The specificity of ultrasound diffusion breast imaging system was greater than ultrasound(0.809 vs 0.737),and the difference was statistically significant(P<0.001).The malignant rates of BI-RADS grade 3 by ultrasound diffusion breast imaging system and ultrasonography were 3.39% and 6.78%,respectively, and the difference was not statistically significant(P=0.316).The diagnostic coincidence rates of ultrasound diffusion breast imaging system and ultrasound BI-RADS grade 4 were 17.25% and 25.38%,respectively, and the difference was statistically significant(P<0.001).Conclusion The diagnostic accuracy of ultrasound diffusion breast imaging system for BI-RADS grade 3 and 4 nodules in breast screening is better than that of ultrasound, and it can be used as one of the effective methods for early breast cancer screening.