妊娠哺乳期乳腺肿块的超声征象及BI-RADS分类价值

Ultrasonographic findings and BI-RADS classification value of breast masses during pregnancy and lactation

目的:探讨妊娠哺乳期乳腺肿块良恶性超声征象及超声乳腺影像报告与数据系统(BI-RADS)分类的诊断价值。方法:回顾性分析2016年1月—2022年6月郑州大学第三附属医院于妊娠期或哺乳期行乳腺彩色多普勒超声检查并发现乳腺肿块的患者109例。根据超声BI-RADS分类对乳腺肿块进行评估。以组织病理学为金标准,比较妊娠哺乳期良恶性肿块超声征象的差异并绘制受试者工作特征(ROC)曲线分析BI-RADS分类诊断妊娠哺乳期肿块良恶性的敏感性及准确性。结果:109例患者共131个乳腺肿块,其中良性71个(54.2%)以纤维腺瘤、腺病和炎性肿块为主(74.6%),恶性60个(45.8%)以非特殊型浸润性癌为主(81.7%)。妊娠哺乳期乳腺恶性肿块与良性肿块相比,在形态、边缘、微钙化、高回声晕、血流方面差异有统计学意义(P<0.05)。根据诊断结果遴选最优诊断节点为4A类,超声BI-RADS诊断妊娠哺乳期肿块良恶性的灵敏度86.7%,特异度80.3%,曲线下面积(AUC)=0.897(P<0.001)。结论:妊娠期和哺乳期女性乳腺恶性肿块常见的超声表现为形态不规则、边缘成角/毛刺、微钙化、高回声晕、血流Ⅱ~Ⅲ级。超声BI-RADS分类对妊娠期或哺乳期乳腺肿块有较高的诊断价值。

Objective:To investigate the ultrasonographic signs and the diagnostic value of ultrasound breast imaging reporting and data system(BI-RADS)classification in the differential diagnosis of benign and malignant breast masses during pregnancy and lactation.Methods:A retrospective analysis was performed on 109 patients with breast masses detected by color Doppler ultrasound during pregnancy or lactation in the Third Affiliated Hospital of Zhengzhou University from January2016 to June 2022.Breast masses were evaluated according to ultrasound BI-RADS classification.Taking histopathological re-sult as the gold standard,the differences of ultrasound signs between benign and malignant masses during pregnancy and lac-tation were compared,and the receiver operating characteristic(ROC)curve was drawn to analyze the sensitivity and accuracy of BI-RADS classification in the diagnosis of benign and malignant masses during pregnancy and lactation.Results:A total of131 breast masses were detected in 109 patients.Among them,71 benign masses(54.2%)were mainly fibroadenoma,adenosis and inflammatory mass(74.6%),and 60 malignant masses(45.8%)were mainly invasive carcinoma of no special type(81.7%).There were significant differences in the shape,margin,microcalcification,hyperechoic halo and blood flow between malignant and benign breast masses during pregnancy and lactation(P0.05).According to the diagnostic results,the optimal diagnostic node was 4A.The sensitivity and specificity of ultrasound BI-RADS in the diagnosis of benign and malignant tumors during pregnancy and lactation were 86.7%and 80.3%,respectively,and the area under the ROC(AUC)was 0.897(P0.001).Conclusion:The ultrasound findings of malignant masses in pregnant and lactating women are irregular shape,angulated/spiculated edges,microcalcifications,hyperechogenic halos,and gradeⅡ~Ⅲblood flow.Ultrasound BI-RADS classification is valuable in the diagnosis of breast masses during pregnancy or lactation.