乳腺BI-RADS分类4类病变的超声特征与病理分析

Ultrasonographic characteristics and pathological analysis of four types of breast lesions classified by BI-RADS

目的 分析乳腺BI-RADS分类4类(≤1 cm)病变的超声特征和病理分析,评价超声BI-RADS分类4类在乳腺微小病变(≤1 cm)中的应用,分析恶性病变的超声特征,提高诊断准确率。方法 收集2017-2021年因乳腺疾病于吉林省肿瘤医院就诊的患者,筛选病变≤1 cm且BI-RADS分类4类的患者共计114例,均为女性,年龄18~70岁,穿刺或手术病理结果作为金标准,对比分析超声特征和病理结果,计算BI-RADS分类4类诊断乳腺微小病变(≤1 cm)的灵敏度、特异度、阳性预测值及阴性预测值。结果 符合入选条件的114例患者中良性病变66例,包括纤维腺瘤27例、导管内乳头状瘤21例、腺病12例、非典型增生4例及硬化性腺病2例;恶性病变48例,包括浸润性导管癌34例、导管内癌7例、小叶癌5例及髓样癌2例。超声BI-RADS分类4A类57例,4B类33例,4C类24例。其中形状、方向和边缘的特征与病理结果比较,差异有统计学意义(P<0.05),内部回声差异无统计学意义(P>0.05)。BI-RADS分类4B类为临界点,超声BI-RADS分类4类诊断微小病变的灵敏度为87.5%,特异度为70.0%,阳性预测值为0.44,阴性预测值为0.95。结论 超声BI-RADS分类4类在乳腺微小病变(≤1 cm)中的诊断价值较高,对于形状不规则、边缘模糊、纵横比>1及内可见钙化的微小病变要高度考虑恶性的可能。

Objective To analyze the ultrasonic characteristics and pathological analysis of four types(≤ 1 cm) of BI-RADS classification of breast lesions, evaluate the application of four types of BI-RADS classification of breast lesions(≤ 1 cm), analyze the ultrasonic characteristics of malignant lesions, and improve the diagnostic accuracy.Methods Collect the patients from 2017 to 2021 who went to Jilin Provincial Cancer Hospital for breast diseases, and select 114 patients with lesions ≤ 1 cm and BI-RADS classification 4, all of whom are female, aged 18 to 70 years old. The pathological results of puncture or surgery are taken as the gold standard. Compare and analyze the ultrasonic characteristics and pathological results, and calculate the sensitivity, specificity, positive predictive value and negative predictive value of BI-RADS classification 4 in diagnosing breast micro lesions(≤ 1 cm).Results Among 114 patients eligible for inclusion, 66 patients had benign lesions, including 27 fibroadenoma, 21 intraductal papilloma, 12 adenopathy, 4 atypical hyperplasia, and 2 sclerosing adenosis;There were 48 cases of malignant lesions, including 34 cases of invasive ductal carcinoma, 7 cases of intraductal carcinoma, 5 cases of lobular carcinoma, and 2 cases of medullary carcinoma. Ultrasound BI-RADS classified 57 cases as Category 4 A, 33 cases as Category 4 B, and 24 cases as Category 4 C. The shape, direction, margin and calcification were statistically significant compared with pathological results(P<0.05), while the internal echo was not statistically significant(P>0.05). Class 4 B of BI-RADS classification is the critical point. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound BI-RADS classification in the diagnosis of small lesions are 87.5%, 70.0%, 0.44 and 0.95 respectively.Conclusion The four categories of ultrasound BI-RADS classification have high diagnostic value in breast micro lesions(≤ 1 cm), and the possibility of malignancy should be highly considered for micro lesions with irregular shape, blurred edges, aspect ratio>1 and calcification visible inside.