超声造影比弹性成像更准确诊断乳腺BI-RADS 4a类结节

Contrast-enhanced ultrasound is more accurate in diagnosing breast BI-RADS 4a nodules than elastography

目的分析超声造影和弹性成像在乳腺BI-RADS 4a类结节中的诊断价值。方法纳入我院2019年1月~2023年2月经常规超声检测诊断为BI-RADS 4a类的患者115例,对每个病灶进行分析,以病理结果为金标准,构建超声造影评分和弹性成像两种诊断方法的ROC曲线,比较两种方法对乳腺BI-RADS 4a类结节良恶性诊断的价值。结果115例患者中,良性病灶87例,恶性病灶28例。超声造影评分和弹性成像两种诊断方法Kappa值小,一致性较差(P=0.258)。以病理结果作为金标准,造影评分的诊断价值更高(敏感度、特异性及准确度分别为0.812、0.976、0.956),与金标准之间的一致性较弹性成像更高。超声造影评分的诊断曲线下面积为0.976,高于弹性成像数值(0.784)。两种不同诊断方法显示恶性结节患者的年龄较良性患者偏高,结节最大直径偏大。结论超声造影方法较弹性成像能明显提高乳腺BI-RADS 4a类结节良恶性诊断的准确率,降低术前活检的风险,值得临床推广。

Objective To compare the diagnostic value of ultrasonic elastography and contrast-enhanced ultrasound in the diagnosis of breast BI-RADS 4a nodules.Method A total of 115 patients diagnosed as BI-RADS category 4a by routine ultrasonic detection in our hospital from January 2019 to February 2023 were included.Each lesion was analyzed,and pathological diagnosis were taken as the gold standard to construct diagnostic ROC curves of the two detection methods.The value of the two methods in the diagnosis of benign and malignant breast BI-RADS 4a nodules of BI-RADS was compared.Results Among 115 patients,there were 87 benign lesions and 28 malignant lesions.The Kappa values of ultrasonic elastography and contrast-enhanced ultrasound scores were small and inconsistent(P=0.258).Using pathological results as the gold standard,contrast score had higher diagnostic value(sensitivity,specificity and accuracy were 0.812,0.976 and 0.956,respectively),and was more consistent with the gold standard than elastic imaging.The area under the diagnostic curve of contrast-enhanced ultrasound score was 0.976,higher than the value of elastic imaging(0.784).Three different diagnostic methods showed that the age of patients with malignant nodules was higher than that of patients with benign nodules,and the maximum diameter of nodules was larger.Conclusion Compared with ultrasonic elastography,contrast-enhanced ultrasound can significantly improve the accuracy of benign and malignant diagnosis of breast BI-RADS 4a nodules of BI-RADS,reduce the risk of preoperative biopsy,and is worthy of clinical promotion.