超声造影联合2019版Bosniak分级对肾脏囊性占位的诊断效能

Diagnostic efficacy of contrast-enhanced ultrasound combined with 2019 Bosniak classification in cystic renal mass

目的探讨超声造影(contrast-enhanced ultrasound,CEUS)联合2019版Bosniak分级(B_(2019))在肾脏囊性占位(cystic renal mass,CRM)诊断中的应用价值。方法分析2011年10月至2021年10月复旦大学附属中山医院收治的经手术病理证实的99例CRM患者共99个病灶的病例资料,所有病灶均分别按照B_(2019)、2005版Bosniak分级(B_(2005))进行评价。采用ROC曲线评价CEUS+B_(2019)和CEUS+B_(2005)对CRM的诊断效能。结果CEUS+B_(2019)及CEUS+B_(2005)诊断CRM的曲线下面积(area under curve,AUC)分别为0.943、0.885,差异有统计学意义(P<0.05)。CEUS+B_(2019)诊断CRM的特异度、准确度分别为97.80%、93.94%,明显高于CEUS+B_(2005)(84.40%、88.89%),灵敏度为90.70%,低于CEUS+B_(2005)(92.60%),差异均有统计学意义(均P<0.05)。CEUS+B_(2019)、CEUS+B_(2005)诊断CRM的Kappa值分别为0.879、0.775。结论在CRM的诊断中,CEUS+B_(2019)较CEUS+B_(2005)有更高的特异度、准确度,有助于避免良性CRM的误诊,减少不必要的随访及过度治疗。

Objective To explore the value of contrast-enhanced ultrasound(CEUS)combined with 2019 Bosniak classification(B_(2019))in the diagnosis of cystic renal mass(CRM).Methods The clinical data of 99 patients with 99 pathologically confirmed CRM in Zhongshan Hospital,Fudan University from October 2011 to October 2021 was analyzed retrospectively.All lesions were evaluated according to B_(2019)and 2005 Bosniak classification(B_(2005)).The ROC curve was constructed to evaluate the diagnostic efficacy of CEUS+B_(2019)and CEUS+B_(2005)for CRM.Results The area under curve(AUC)of CEUS+B_(2019)and CEUS+B_(2005)in evaluating CRM were 0.943 and 0.885 respectively(P<0.05).The specificity and accuracy of CEUS+B_(2019)in CRM were 97.80%and 93.94%,which was significantly higher than that of CEUS+B_(2005)(84.48%,88.89%),while the sensitivity of CEUS+B_(2019)to diagnose CRM was 90.70%,which was lower than that of CEUS+B_(2005)(92.60%,P<0.05).The Kappa values of CEUS+B_(2019)and CEUS+B_(2005)for the diagnostic consistency analysis with the gold standard were 0.879 and 0.775 respectively.Conclusions In the diagnosis of CRM,CEUS+B_(2019)is higher than CEUS+B_(2005)in specificity and accuracy,which maybe help to reduce the misdiagnosis of benign CRM,and avoid unnecessary follow-up together with over-treatment.