超声造影5分法与超声造影预测模型鉴别诊断不同大小BI-RADS 4类乳腺病灶良恶性的对比研究

Contrast-enhanced ultrasonography 5-point method and contrast-ultrasonography predictive model in the differential diagnosis of benign and malignant BI-RADS 4 lesions with different sizes:a comparative study

目的比较超声造影(CEUS)5分法与CEUS预测模型对不同大小BI-RADS 4类乳腺病灶良恶性的鉴别诊断价值。方法收集我院经穿刺活检或手术病理结果证实的乳腺病变患者165例(166个病灶,均为BI-RADS 4类),均行常规超声和CEUS检查,根据病灶大小分为直径≤2.0 cm组101个和直径>2.0 cm组65个,分析并比较两组良恶性病灶的10项CEUS特征(包括增强强度、增强时相、增强方式、增强形态、增强边界、增强均匀性、灌注缺损、增强范围、蟹足征及滋养血管)。应用CEUS 5分法和CEUS预测模型判断病灶良恶性,绘制受试者工作特征(ROC)曲线比较两种方法鉴别诊断不同大小乳腺病灶良恶性的效能。结果直径≤2.0 cm组中良恶性病灶的10项CEUS特征比较差异均有统计学意义(均P<0.05);直径>2.0 cm组中良恶性病灶的CEUS特征除增强强度、增强方式及灌注缺损外,其余7项特征比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,CEUS 5分法、CEUS预测模型鉴别诊断直径≤2.0 cm病灶良恶性的曲线下面积(AUC)分别为0.884、0.861,二者比较差异无统计学意义;CEUS 5分法、CEUS预测模型鉴别诊断直径>2.0 cm病灶良恶性的AUC分别为0.932、0.864,二者比较差异有统计学意义(P<0.01)。CEUS 5分法中评分为2、3、5分病灶的诊断准确率较高,评分为1、4分病灶的诊断准确率偏低;CEUS预测模型中A、D、E、F模型的预测效能较好,B模型次之,C模型较差。结论对于直径≤2.0 cm的BI-RADS 4类乳腺病灶的良恶性鉴别,CEUS 5分法与CEUS预测模型的诊断价值相当;对于直径>2.0 cm的BI-RADS 4类乳腺病灶的良恶性鉴别,CEUS 5分法具有更高的诊断价值。

Objective To compare the value of contrast-enhanced ultrasonography(CEUS)5-point method and CEUS predictive models in the differential diagnosis of benign and malignant BI-RADS 4 lesions with different sizes.Methods A total of 165 patients with breast lesions(166 lesions in total,all were BI-RADS 4)confirmed by biopsy or surgical pathology in our hospital were collected,all underwent conventional ultrasound and CEUS examination.According to the lesion size,all lesions were divided into the diameter≤2.0 cm group(n=101)and 65 lesions in the diameter>2.0 cm group(n=65).The 10 CEUS characteristics of the lesions were analyzed,including enhanced intensity,enhanced phase,enhanced mode,enhanced morphology,enhanced boundary,enhanced homogeneity,perfusion defect,enhanced range,crab foot sign and nourishing vessels.The CEUS 5-point method and CEUS predictive models were used to determine the benign and malignant lesions,and receiver operating characteristic(ROC)curve was drawn to compare the diagnostic efficacy of the two methods for the benign and malignant BI-RADS 4 breast lesions with different sizes.Results The 10 CEUS characteristics of benign and malignant lesionswith diameter≤2.0 cm had statistically significant differences(all P<0.05).Except enhanced intensity,enhanced mode and perfusion defect,there were statistically significant differences of the rest 7 CEUS characteristics between benign and malignant lesions with diameter>2.0 cm(all P<0.05).ROC curve analysis showed that for lesions with diameter≤2.0 cm,the area under the curve(AUC)of CEUS 5-point method and CEUS predictive models in diagnosing benign and malignant lesions were 0.884 and 0.861,respectively,with no statistical significance.For lesions with diameter>2.0 cm,the AUC of CEUS 5-point method and CEUS predictive models in diagnosing benign and malignant lesions were 0.932 and 0.864,respectively,with statistically significant difference(P<0.01).The diagnostic coincidence rate of lesions with 2,3 and 5 scores in CEUS 5-point method were high,while the diagnostic coincidence rate of lesions with 1 and 4 scores were low.Among CEUS predictive models,A,D,E and F models had better predictive performance,followed by B model and C model.Conclusion For BI-RADS 4 breast lesions with diameter≤2.0 cm,the CEUS 5-point method is equivalent to the diagnostic value of the CEUS predictive models,for BI-RADS 4 breast lesions with diameter>2.0 cm,the CEUS 5-point method has higher diagnostic value.