超声与MRI对乳腺BI-RADS 3~5类肿物的诊断分类一致性比较

Comparison of Diagnostic Classification Consistency Between Ultrasound and MRI in Breast BI-RADS 3-5 Nodules

目的比较超声与MRI对乳腺影像报告和数据系统(BI-RADS)3~5类肿物的诊断一致性及诊断价值。资料与方法回顾性分析2019年6月—2020年7月宁夏医科大学总医院收治的BI-RADS 3~5类乳腺肿物患者152例共161个肿物,所有患者均行超声和MRI检查,并确定影像学定位和不同分类,以穿刺或术后病理结果为“金标准”,比较敏感度、特异度和阳性似然比,分析两种检查方法诊断分类的一致性和临床价值。结果161个乳腺肿物中,良性75个(其中炎性病灶25个),恶性86个,两种检查方法对乳腺肿物定位一致性较强(Kappa=0.917,P<0.01)。两种检查方法诊断分类的一致性较强(Kappa=0.629,P<0.01)。超声诊断乳腺肿物良恶性的敏感度、特异度、符合率分别为84.88%、84.00%、84.47%,MRI诊断的敏感度、特异度、符合率分别为91.86%、78.67%、85.71%,超声联合MRI诊断的敏感度、特异度、符合率分别为84.88%、90.67%、87.58%,联合诊断的敏感度低于MRI组,但特异度明显高于超声和MRI,差异均有统计学意义(P均<0.05);联合诊断的阳性似然比明显高于单独诊断(P<0.05)。超声诊断炎性病灶的准确性高于MRI(χ2=4.62,P=0.031)。结论超声与MRI在乳腺BI-RADS 3~5类肿物的定位和分类诊断中具有较强的一致性,MRI整体诊断效能高于超声,但超声诊断炎性病灶的准确性更高。

Purpose To compare the consistency and diagnostic value of ultrasound and MRI in the diagnosis of breast imaging reporting and data system(BI-RADS)3-5 tumors.Materials and Methods A total of 161 nodules in 152 patients with BI-RADS 3 to 5 breast tumors treated in the General Hospital of Ningxia Medical University from June 2019 to July 2020 were analyzed retrospectively.All patients were examined by ultrasound and MRI,the imaging localization and different classification were determined.According to the results of puncture or postoperative pathology as the gold standard,the diagnostic classification consistency and clinical value of the two methods were analyzed by comparing sensitivity,specificity and likelihood ratio.Results Among 161 breast nodules,75 were benign(including 25 inflammatory lesions)and 86 were malignant.The two methods showed strong consistency in the location of breast nodules(Kappa=0.917,P<0.01).The diagnostic classification of the two examination methods had a strong consistency(Kappa=0.629,P<0.01).The sensitivity,specificity and coincidence rates of benign and malignant breast tumors diagnosed by ultrasound were 84.88%,84.00%and 84.47%,respectively.Those of benign and malignant breast tumors diagnosed by MRI were 91.86%,78.67%and 85.71%,respectively.Those of benign and malignant breast tumors diagnosed by ultrasound combined with MRI were 84.88%,90.67%and 87.58%,respectively.The sensitivity of combined diagnosis was lower than that of MRI,but the diagnostic specificity was significantly higher than that of ultrasound and MRI,with statistically significant(P<0.05).The accuracy of ultrasound in the diagnosis of inflammatory lesions was higher than that of MRI(χ2=4.62,P=0.031).Conclusion Ultrasound and MRI have a strong consistency in the localization and classification of breast tumors from BI-RADS 3-5.The overall diagnostic efficiency of MRI is higher than that of ultrasound,but the accuracy of ultrasound is higher in the diagnosis of inflammatory lesions.