利用多模态超声提高乳腺BI-RADS 4类结节诊断准确率的临床应用研究

Clinical application of multi-modality ultrasound to improve the diagnostic accuracy of breast BI-RADS class 4 nodules

目的:探讨多模态超声检查对乳腺BI-RADS 4类结节诊断的应用价值。方法:选取2020年9月—2022年9月在我院完成乳腺常规二维超声检查(2D-US)、声脉冲辐射力弹性成像(ARFI)及超声造影(CEUS)检查的共271例BI-RADS 4类患者,将其中100例有病理结果者纳入本研究。对患者的CEUS、ARFI结果进行分析,探讨2D-US、CEUS、ARFI及联合诊断在乳腺疾病诊断中的诊断效能。结果:100个结节,研究发现良恶性组之间患者年龄、结节大小、结节形态、超声造影增强模式、造影后肿块范围较二维有无扩大比较差异具有统计学意义(P<0.05)。声触诊组织成像(VTI)中选取应变率比值(SR)作为诊断的敏感指标,以6.50作为SR截断值,诊断的特异度,敏感度,阳性预测值(PPV),阴性预测值(NPV)分别为79.6%、80.4%、80.4%、79.6%;声触诊组织定量成像(VTIQ)中选取横向剪切波速度(SWV)作为诊断的敏感指标,以3.45 m/s作为截断值,诊断的灵敏性、特异性、PPV、NPV分别为74.0%、71.4%、72.6%、72.9%。综合分析,多模态超声对BI-RADS 4类结节诊断的敏感度、特异度、准确性、PPV、NPV较高,分别为82.4%、91.8%、87%、91.3%、83.3%。与2D-US相比,曲线下面积(AUC)从0.69提高到0.92(P<0.05),所以联合超声诊断效能优于单独使用常规超声。结论:联合应用2D-US、CEUS、SR、SWV检查可有效提高乳腺结节的诊断效能,减少对乳腺良性结节不必要的穿刺活检,值得临床推广。

Objective:To explore the application value of multimodal ultrasound in the diagnosis of breast BI-RADS class 4 nodules.Methods:A total of 271 patients with BI-RADS class 4 nodules who underwent conventional two-dimensional ultrasound(2D-US),acoustic radiation force impulse elastography(ARFI)and contrast-enhanced ultrasound(CEUS)in our hospital from September 2020 to September 2022 were selected.Among them,100 patients with pathological results were included in this study.The results of CEUS and ARFI were analyzed to explore the diagnostic efficacy of 2D-US,CEUS,ARFI and combined diagnosis in the diagnosis of breast diseases.Results:With 100 nodules,the study found statistically significant differences in patient age,nodule size,nodule morphology,ultrasound contrast enhancement pattern,and the extent of the mass after contrast with or without enlargement between the benign and malignant groups(P<0.05).The strain rate ratio(SR)was selected as the sensitive index of diagnosis in virtual touch tissue imaging(VTI),and 6.50 was used as the cutoff value of SR.The specificity,sensitivity,positive predictive value(PPV)and negative predictive value(NPV)of diagnosis were 79.6%,80.4%,80.4%and 79.6%,respectively.The transverse shear wave velocity(SWV)was selected as the sensitive index of diagnosis in virtual touch tissue quantification(VTIQ).The sensitivity,specificity,PPV and NPV of diagnosis were 74.0%,71.4%,72.6%and 72.9%respectively,with 3.45 m/s as the cutoff value.The sensitivity,specificity,accuracy,PPV and NPV of multimodal ultrasound in the diagnosis of BI-RADS class 4 nodules were 82.4%,91.8%,87%,91.3%and 83.3%,respectively.The area under the curve(AUC)was 0.92.Compared with 2D-US,AUC increased from 0.69 to 0.92(P<0.05),so the combined diagnostic efficiency was better than that of conventional ultrasound alone.Conclusion:The combined application of 2D-US,CEUS,SRand SWV can improve the ultrasonic diagnostic efficiency of breast nodules and reduce unnecessary invasive biopsy of benign breast nodules,which has certain clinical application value.