超声引导穿刺活检与MRI在诊断BI-RADS 4类乳腺肿块中的价值研究

Ultrasound-Guided Needle Biopsy with MRI in the Diagnosis of BI-RADS Class 4 Value Studies in Breast Masses

目的:探讨超声引导穿刺活检与核磁共振成像(Magnetic Resonance Imaging,MRI)在诊断乳腺影像报告和数据系统4类乳腺肿块(Breast Imaging Report And Data System 4,BI-RADS 4)中的诊断效能,为BI-RADS 4类乳腺肿块的诊疗提供临床依据。方法:选取2021年2月至2023年2月安阳市肿瘤医院收治的90例疑似BI-RADS 4类乳腺肿块患者作为研究对象,以超声引导穿刺活检组织最终石蜡病理诊断为金标准,明确肿块病理结果,对比MRI检查结果在BI-RADS 4类乳腺肿块中其亚型病理和诊断效能。结果:所有乳腺肿块经石蜡病理证实,34例良性肿瘤中67.65%为纤维腺瘤,56例恶性肿瘤中80.36%为浸润性导管癌;在MRI检查中,BI-RADS 4a类乳腺肿块病灶中83.33%为良性肿块;BI-RADS 4c类乳腺肿块病灶中92.00%为恶性肿块;超声引导穿刺活检阳性检出共55例,阳性检出率为61.11%;MRI检查阳性检出共53例,阳性检出率为58.89%,两种检查方式阳性检出率比较,差异无统计学意义(P>0.05);经MRI检查后,其准确度、敏感度、特异度、阴性预测值、阳性预测值与超声引导穿刺活检诊断结果比较,差异无统计学意义(P>0.05)。结论:在疑似BI-RADS 4类乳腺肿块中,BI-RADS 4a、BI-RADS 4c肿块病灶性质分别以纤维腺瘤、浸润性导管癌为主,且MRI检查结果与超声引导穿刺活检均具有较高的诊断效能。因此对于MRI检查BI-RADS 4a肿块患者可选择定期复查并观察肿块变化,而对BI-RADS 4c肿块患者强烈建议尽早穿刺活检以明确肿块病理性质。

Objective:To explore the diagnostic efficacy of ultrasound-guided needle biopsy and Magnetic Resonance Imaging(MRI)in the diagnosis of Breast Imaging Report And Data System 4(BI-RADS 4)to provide a clinical basis for the diagnosis and treatment of BI-RADS 4 breast masses.Methods:A total of 90 patients admitted to Anyang cancer hospital from February 2021 to February 2023 were selected as the study subjects.The final paraffin pathological diagnosis of ultrasound-guided needle biopsy tissue was taken as the gold standard,the pathological results of the mass were defined.Contrast MRI findings for their subtype pathology and diagnostic efficacy in BI-RADS 4 breast masses.Results:All breast masses were confirmed by paraffin pathology,and 67.65% of 34 benign tumors had fibroadenomas and 80.36% of 56 malignant tumors had invasive ductal carcinoma.In the MRI examination,83.33% of BI-RADS 4a breast masses were benign,and 92.00% of BI-RADS 4c breast masses were malignant.A total of 55 cases were detected by ultrasound guided needle biopsy,and the positive detection rate was 61.11%,a total of 53 cases were detected in MRI,and the positive detection rate was 58.89%.There was no statistical significance in the difference between the two positive detection methods(P>0.05).After MRI examination,the accuracy,sensitivity,specificity,negative predictive value,positive predictive value and the diagnostic results of ultrasound-guided needle biopsy were not significantly different(P>0.05).Conclusions:In the suspected BI-RADS 4 breast masses,the focal properties of BI-RADS 4a and BI-RADS 4c masses were mainly fibroadenoma and invasive ductal carcinoma,respectively,and MRI results and ultrasound guided needle biopsy have high diagnostic efficacy.Therefore,for patients with MRI for BI-RADS 4a mass,regularly review and observe the changes of the mass,while early puncture biopsy is strongly recommended to clarify the pathological nature of the mass.