超声造影在BI–RADS 4类乳腺囊实性病灶中的诊断价值

The Diagnostic Value of Contrast Enhanced Ultrasound in BI-RADS Class 4 Breast Cystic and Solid Lesions

目的:探讨常规超声(US)与US联合超声造影(CEUS)对超声乳腺影像报告与数据系统(BI–RADS)4类乳腺囊实性病灶的诊断价值。方法:回顾性分析2017年8月至2024年1月收治于深圳市第二人民医院进行US与CEUS且为BI–RADS 4类的乳腺囊实性病灶患者116名,116个病灶。采用盲法分析US与CEUS的静态图片、动态视频,以穿刺活检或手术获得的病理为金标准,比较良性、恶性组临床资料、US与CEUS指标的差异。构建受试者工作特征(ROC)曲线,CEUS后调整BI–RADS分类,比较US与US联合CEUS的诊断效能。结果:116例乳腺病灶中,良性90例,恶性26例。两组乳腺囊实性病灶在年龄、病灶最大径、形态、边界、囊实性成分的分界、钙化、血流、实性成分增强的边缘、实性成分增强后范围是否扩大、实性成分增强范围是否超出基底部、实性成分与瘤壁的夹角、增强后壁和/或分隔是否增厚差异具有统计学意义(P <0.05)。US与US联合CEUS诊断乳腺囊实性病灶的ROC曲线下面积、灵敏度、特异度、准确度分别为(0.682、34.62%、65.56%、58.62%)、(0.898、88.46%、86.67%、87.07%)。CEUS检查后重新调整BI–RADS分类,以BI–RADS 4B类为活检阈值,活检率由100%下降至30.17%。结论:CEUS对鉴别诊断乳腺囊实性病灶的良恶性具有重要价值,能够为临床提供重要的影像学依据。

Objective To explore the diagnostic value of conventional ultrasound(US)and US combined with contrast-enhanced ultrasound(CEUS)for breast imaging reporting and data system(BI–RADS)class 4 breast cystic and solid lesions.Methods A retrospective analysis was conducted on 116 patients with breast cystic solid lesions classified as BI–RADS 4 who underwent US and CEUS at Shenzhen Second People’s Hospital from August 2017 to January 2024.Blind analysis of static images and dynamic videos of US and CEUS was used,with pathology obtained through puncture biopsy or surgery as the gold standard.Clinical data and differences in US and CEUS indicators were compared between benign and malignant groups.The receiver operating characteristic(ROC)curve was constructed,and the BI–RADS classification was adjusted after CEUS to compare the diagnostic efficacy of US and US combined CEUS.Results Among 116 cases of breast lesions,90 cases were benign and 26 cases were malignant.There were statistically significant differences between two groups of breast cystic and solid lesions in terms of age,maximum diameter,shape,boundary,boundary of cystic and solid components,calcification,blood flow,edge of solid component enhancement,expansion of solid part enhancement,extension of solid part enhancement beyond the base,angle between solid part and tumor wall,and thickening of enhanced wall and/or partition(P<0.05).The area under the ROC curve,sensitivity,specificity,and accuracy of US and US combined with CEUS in diagnosing breast cystic and solid lesions were(0.682,34.62%,65.56%,and 58.62%),(0.898,88.46%,86.67%,87.07%)respectively.After CEUS,the BI-RADS classification was readjusted to BI-RADS 4B as the biopsy threshold,and the biopsy rate decreased from 100%to 30.17%.Conclusion CEUS has important value in distinguishing between benign and malignant breast cystic lesions,and can provide important imaging evidence for clinical practice.