超声弹性成像对乳腺BI-RADS 4a类微小结节选择性降级的诊断价值研究

Study on diagnostic value of ultrasound elastography for selective downgrading of breast BI-RADS class 4a micronodules

目的探讨超声弹性成像对乳腺BI-RADS 4a类微小结节选择性降级的诊断价值研究。方法选择2021年5月—2022年9月本院收治的行乳腺手术的102例患者作为研究对象,共收集到107例BI-RADS 4类乳腺结节(其中4a类63例,4b类30例,4c类14例),结节最大径均不超过10 mm,以病理结果作为金标准,对患者依次进行BI-RADS分类诊断、应变弹性成像(Strain Elastography,SE)检查、剪切波弹性成像(Shear Wave Elastography,SWE)检查,比较单独及联合使用SWE及SE参数的最佳截断值,对BI-RADS 4a类结节选择性降级的诊断价值。不同方法AUC值的比较使用de-long检验。结果应用SWE、SE的截断值,分别单独与联合对BI-RADS 4a类结节选择性降级,得到BI-RADSα、BI-RADSβ、BI-RADSγ。BI-RADSα、BI-RADSβ、BI-RADSγ的AUC均较BI-RADS(0.877 vs 0.820,P=0.008)、(0.862 vs 0.820,P=0.029)、(0.860 vs 0.820,P=0.019)明显改善,BI-RADSα的AUC明显高于BI-RADSγ(0.877 vs 0.860,P=0.024),稍高于BI-RADSβ(0.877 vs 0.862,P=0.244),但无统计学差异。其中BI-RADSα将73.02%(46/63)BI-RADS 4a类的病灶降为3类,降为3类的病灶中,有2.17%(1/46)恶性病灶被漏诊。BI-RADSβ将69.84%(44/63)BI-RADS 4a类的病灶降为3类,降为3类的病灶中,有4.55%(2/44)恶性病灶被漏诊。BI-RADSγ将55.56%(35/63)BI-RADS 4a类的病灶降为3类,降为3类的病灶中,有2.86%(1/35)恶性病灶被漏诊。BI-RADSα4类结节恶性率为45.90%(28/61),BI-RADSβ4类结节恶性率为42.86%(27/63),BI-RADSγ4类结节恶性率为38.89%(28/72)。三个方法中BI-RADSα在保持AUC最高的前提下,使保留的4类结节恶性率最高,降低了最多的不必要活检,且降为3类的病灶漏诊率最低。结论应用SWE、SE辅助BI-RADS 4a类结节降级,可以减少乳腺4a类结节不必要的活检,其中Emax辅助减少了最多的不必要活检,并保持了最小的漏诊率。

Objective To investigate the diagnostic value of ultrasound elastography for selective downgrading of breast BI-RADS category 4a micronodules.Methods The 102 patients who underwent breast surgery in our hospital from May 2021 to September 2022 were included in this study.A total of 107 cases of BI-RADS category 4 breast nodules(63 cases of category 4a,30 cases of category 4b,and 14 cases of category 4c)were collected.The maximum diameter of the nodules was not more than 10 mm,and the pathological results were used as the gold standard.The patients were diagnosed with the BI-RADS classification,Strain Elastography(SE)examination,Shear Wave Elastography(SWE)examination in sequence.The optimal cut-off values of SWE and SE parameters alone and in combination,and the diagnostic value of selective downgrading of BI-RADS class 4a nodules was compared.The comparison of AUC values of different methods uses a de-long test.Results The cut-off values of SWE and SE were applied to selective downgrading of BI-RADS class 4a nodules individually and in combination to obtain BI-RADSα,BI-RADSβ,and BI-RADSγ.The AUCs of BI-RADSα,BI-RADSβ,and BI-RADSγwere all were significantly improved compared to those of BI-RADS(0.877 vs 0.820,P=0.008),(0.862 vs 0.820,P=0.029),(0.860 vs 0.820,P=0.019),and the AUC of BI-RADSαwas significantly higher than that of BI-RADSγ(0.877 vs 0.860,P=0.024)and slightly higher than that of BI-RADSβ(0.877 vs 0.862,P=0.244).In particular,BI-RADSαdowngraded 73.02%(46/63)of the BI-RADS category 4a lesions to category 3,and 2.17%(1/46)of the lesions downgraded to category 3 were missed.BI-RADSβdowngraded 69.84%(44/63)of the BI-RADS category 4a lesions to category 3,and 4.55%(2/44)malignant lesions were missed.BI-RADSγdowngraded 55.56%(35/63)of BI-RADS category 4a lesions to category 3,and 2.86%(1/35)of malignant lesions downgraded to category 3 were missed.The malignancy rate of BI-RADS categoryα4 nodules was 45.90%(28/61),and the malignancy rate of BI-RADS categoryβ4 nodules was 42.86%(27/63),and the malignancy rate of BI-RADSγcategory 4 nodules was 38.89%(28/72).Of the three methods BI-RADSαresulted in the highest malignancy rate of retained category 4 nodules while maintaining the highest AUC,reduced the greatest number of unnecessary biopsies,and had the lowest leakage rate of lesions downgraded to category 3.Conclusions Application of SWE and SE-assisted BI-RADS category 4a nodal downgrading can reduce unnecessary biopsies of breast category 4a nodules,with Emax-assisted reduction of the most unnecessary biopsies and maintaining the lowest leakage rate.