超声引导下穿刺活检联合弹性成像对乳腺肿块的诊断价值

Diagnostic Value of Ultrasound-guided Biopsy Combined with Elastography for Breast Masses

目的 探讨BI-RADS4级肿块4a、4b、4c级常规超声诊断与穿刺病理活检诊断符合率,应变力弹性成像重新评估后与穿刺活检病理诊断符合率改善情况。方法 回顾性分析2015年12月21日-2019年1月17日131枚乳腺BI-RADS 4级肿块,将常规超声诊断结果与超声引导下穿刺活检病理结果对照分析,另对所有病例行应变力弹性成像重新评估后与超声引导下穿刺活检结果重新对照分析。结果 131例肿块中良性88例,恶性43例,BI-RADS4a级44例,4b级65例,4c级22例,阳性预测值分别为6.82%、33.85%、81.82%,应变力弹性成像重新评估后,37例降为3级,总计94例肿块为BI-RADS 4级,其中4a级45例,4b级15例,4c级20例,5级14例,阳性预测值分别为28.89%、53.33%、45.00%、92.86%。结论 超声引导下穿刺活检对乳腺肿块的诊断方便、安全、可靠,并发症少,应变力弹性成像对BI-RADS4级乳腺肿块的再评估可以提高肿块穿刺的阳性率并可以在一定程度上减少患者不必要的创伤操作。

Objectives This study aims to investigate the diagnostic coineidence rate of the four subtypes of BI-RADS type 4 mass(4a,4b,4c)and biopsy,and explore the improvement of the coincidence rate between strain elastography and biopsy pathological diagnosis after re--evaluation.Methods 131 cases of breast BI--RADS 4 masses from December 21,2015 to January 17,2019 were retrospectively analyzed.Routine ultrasonographic diagnosis results and pathological results of the ultrasound-guided biopsy were comparatively analyzed.In addition,all cases were compared with the pathological results after being reclassified by elasticity imaging technology.Results There were 88 benign lesions and 43 malignant lesions.44 masses were in BI-RADS 4a group,65 masses in BI-RADS 4b group,and 22 masses in BI-RADS 4c group.The positive predictive values were 6.82%,33.85%,and 81.82%respectively.37 masses were changed to BI-RADS 3 from BI-RADS 4a after being reclassified by elasticity imaging technology.A total of 94 masses were classified as BI-RADS grade 4,including 45 masses of grade 4a,15 masses of grade 4b,20 masses of grade 4c,and 14 masses of grade 5.The positive predictive values were 28.89%,53.33%,45.00%,92.86%respectively.Conclusions Ultrasound-guided biopsy is convenient,safe,and reliable for the diagnosis of breast masses,with few complications.Reassessment of BI-RADS grade 4 breast masses by strain elastography can increase the positive rate of mass puncture and reduce unnecessary traumatic operations in patients to a certain extent.