超声血流定量参数联合弹性成像鉴别诊断BI-RADS 3~4类乳腺良恶性肿块的诊断价值

Ability of ultrasound blood flow quantitative parameters combined with elastography in differential diagnosis of benign and malignant BI-RADS 3~4 breast masses

目的探究血流相关参数联合超声弹性成像(ultrasonic elastography,UE)鉴别诊断乳腺影像报告和数据系统分级(breast imaging reporting and data system,BI-RADS)3~4类乳腺良恶性肿块的诊断价值。方法回顾性分析2021年1月-2022年8月以“乳腺肿块”就诊于淮南市第一人民医院并通过常规超声证实为BI-RADS 3~4类肿块的104例患者的资料,患者均行彩色多普勒超声与超声弹性成像检查,根据病理结果分为良性组41例和恶性组63例,比较两组超声血流分级情况、超声血流参数值[搏动指数(pulsatility index,PI)、收缩期峰值血流速度(peak systolic velocity,PSV)、阻力指数(resistance index,RI)]、UE相关参数(长径、长径变化率、面积、面积比值)、通过受试者特征曲线(receiver operating characteristic curve,ROC)评估超声血流参数值联合UE相关参数值鉴别诊断BIRADS 3~4类乳腺良恶性肿块的价值。结果恶性组患者超声血流0级、Ⅰ级比率低于良性组,差异有统计学意义(P<0.05),Ⅱ级、Ⅲ级比率高于良性组,差异有统计学意义(P<0.05)。恶性组患者PI、RI、PSV高于良性组,差异有统计学意义(P<0.05)。恶性组患者长径、长径变化率和面积、面积比值均高于良性组,差异有统计学意义(P<0.05)。绘制ROC曲线发现,当超声血流参数值联合UE相关参数值时,其鉴别诊断BI-RADS3~4类乳腺良恶性肿块的AUC为0.920(95%CI:0.864~0.957,P<0.001),灵敏度为84.38%,特异度为87.50%。结论血流相关参数联合超声弹性成像鉴别诊断BI-RADS3~4类乳腺良恶性肿块的价值较高,两项技术联合应用更具优越性。

Objective To explore the ability of blood flow related parameters combined with ultrasonic elastography(UE)in differential diagnosis of benign and malignant breast masses of 3~4 categories in breast imaging report and data system(BI-RADS).Methods Retrospective analysis was performed on the data of 104 patients admitted to our hospital from January 2021 to August 2022 with"breast masses"and confirmed as BI-RADS Class 3-4 masses by routine ultrasound.All patients underwent color Doppler ultrasound and ultrasound elastic imaging.According to the pathological results,41 cases were divided into benign group and 63 cases were malignant group.The ultrasonic blood flow classification,ultrasonic blood flow parameters(Pulsatility index(PI),peak systolic velocity(PSV)and resistance index(RI)),UE related parameters(length diameter,change rate of length diameter,area,area ratio)between the two groups were compared.Receiver Operating Characteristic(ROC)Curve was used to evaluate the ability of ultrasonic blood flow parameters combined with UE-related parameters in the differential diagnosis of benign and malignant breast masses of BI-RADS 3~4.Results Compared with the benign group,the ratio of grade 0 and grade I ultrasonic blood flow in malignant group was lower(P<0.05),and the ratio of gradeⅡand gradeⅢultrasonic blood flow was higher(P<0.05).Compared with the benign group,PI,RI,and PSV in the malignant group were significantly higher(P<0.05).Compared with the benign group,the long diameter,the change rate of long diameter,and the ratio of area to area in the malignant group were significantly higher(P<0.05).The Via ROC,we found that the ultrasonic blood flow parameter value combined with the UE related parameter value got good performance in differential diagnosis BI-RADS3~4 breast benign and malignant tumors with AUC 0.920(95%CI:0.864~0.957,P<0.001),sensitivity 84.38%,and specificity 87.50%.Conclusion Blood flow related parameters combined with ultrasonic elastography has the ability in differential diagnosis of benign and malignant BI-RADS3~4 breast masses,which is more superior than the single application of the two technologiess.