超微血流成像和彩色多谱勒血流显像在乳腺BI-RADS 4类微小结节中的临床应用

The value of combined superb microvascular imaging and color Doppler flow imaging in breast BI-RADS class 4 micronodules

目的探讨联合超微血流成像(superb microvascular imaging,SMI)和彩色多普勒血流显像(color Doppler flow imaging,CDFI)在乳腺影像学报告和数据系统(breast imaging reporting and data system,BI-RADS)分级为4类的微小结节诊断中的应用,并与超声造影(contrast-enhanced ultrasound,CEUS)结果比较。方法前瞻性纳入乳腺BI-RADS分级4类、最大径≤1 cm,并经术后病理检查证实的165例乳腺微小结节患者共165例病灶,其中良性病灶125例、恶性病灶40例,每例病灶均进行CDFI、SMI及CEUS检查,分析其声像图资料。采用Adler半定量法进行血流分级评价,比较CDFI和SMI显示微小结节内血流情况的差异。制定了CDFI、CDFI+SMI联合两种方式预测结节性质的诊断标准,分析了CDFI、CDFI和SMI联合及CEUS三种血流显像方法对乳腺微小结节性质的诊断价值。结果恶性乳腺微小结节患者患病年龄大于良性患者,CDFI及SMI对乳腺微小结节血流检出能力不同,CDFI血流显示率为47.3%(78/165)、SMI为83.6%(138/165)。以病理结果为金标准,CDFI、联合CDFI和SMI、CEUS三种方法诊断乳腺微小结节的灵敏度分别为72.5%、87.5%、72.5%,特异度分别为60.8%、59.2%、82.4%,准确性分别为63.6%、66.1%、80.0%,曲线下面积(area under the curve,AUC)分别为0.665、0.771、0.772,且三种方式对微小结节诊断的差异有统计学意义,表明联合应用CDFI和SMI的方式优于单独使用CDFI。结论对于诊断为BI-RADS 4类的乳腺微小结节,联合应用CDFI和SMI,可有助于提高判断结节性质的灵敏度,并减少有创性检查超声造影的使用。

Objective To investigate the role of superb microvascular imaging(SMI)and color Doppler flow imaging(CDFI)in the diagnosis of breast imaging reporting and data system(BI-RADS)type 4 micro nodules,and to compare it with contrast-enhanced ultrasound(CEUS).Methods A total of 165 patients was enrolled,with 165 breast micro nodules rated as BI-RADS class 4,with the maximum diameter≤1 cm and confirmed by postoperative pathology.It included 125 benign lesions and 40 malignant lesions,and each lesion was examined by CDFI,SMI and CEUS,and the sonogram data were analyzed.Adler semi-quantitative method was used to evaluate blood flow grading,and CDFI and SMI showed the difference in blood flow in micro nodules.The diagnostic criteria for predicting the nature of nodules by CDFI,combined CDFI and SMI were developed,and the diagnostic value of CDFI,combined CDFI,SMI and CEUS in the nature of micro nodules in the breast was analyzed.Results Patients with malignant breast micro nodules were older than benign patients,and CDFI and SMI had different ability to detect breast micro nodules,and the CDFI blood flow rate was 47.3%(78/165)and SMI was 83.6%(138/165).Taking pathological results as the gold standard,the sensitivity of CDFI,combined CDFI,SMI and CEUS for the diagnosis of breast micro nodules is 72.5%,87.5%,72.5%,respectively,and the specificity is 60.8%,59.2%and 82.4%,respectively.The accuracy was 63.6%,66.1%and 80.0%,respectively,and the area under the curve(AUC)was 0.665,0.771 and 0.772,respectively.The difference in the diagnosis of small nodules was statistically significant,so the combined application was better than CDFI alone.Conclusion For micro nodules of the breast diagnosed with BI-RADS class 4,the combined application of SMI techniques can help improve the sensitivity to determine the nature of nodules and reduce the use of ultrasonography for invasive examinations.