超声弹性成像技术在BI-RADS 4级乳腺病灶诊断中的价值

Value of ultrasound elastography in BI-RADS 4 in the diagnosis of breast lesions

目的研究超声弹性成像技术在乳腺影像学报告及数据系统(BI-RADS)4级乳腺良恶性病灶诊断中的价值。方法选取莱芜市人民医院2011年6月至2014年9月收治的102例乳腺癌患者,采用常规超声BI-RADS4级病灶进行超声弹性成像技术检测,依据Itoh制定的弹性成像5分法对病灶进行评分,计算病灶在弹性图像与灰阶图像上的面积比、测定病灶整体的弹性指数并进行统计分析,以病理诊断结果作为金标准,对弹性成像技术鉴别诊断BI-RADS4级乳腺良恶性病灶的能力进行评价。结果 102例乳腺疾病患者,经病理学检查证实,其中确诊乳腺癌43例(42.16%),主要包含浸润性导管癌25例(58.14%)、浸润性小叶癌8例(18.60%);确诊乳腺良性病变59例(57.84%),主要包含纤维腺瘤20例(33.90%)、乳腺腺病18例(30.51%);乳腺恶性病变病灶的超声弹性成像评分(4.19±0.44)分、弹性图像与灰阶图像上的面积比(1.95±0.63)、弹性指数(3.58±0.69),均显著高于乳腺良性病变的(2.37±0.85)分、(1.36±0.41)、(2.61±0.54);超声弹性成像技术诊断BI-RADS4级乳腺恶性病变的灵敏度为88.37%、特异度为79.66%、漏诊率为11.63%、误诊率为20.34%、ROC曲线下面积AUC值为0.864。结论超声弹性成像技术在BI-RADS4级乳腺良恶性病灶诊断中具有较高的临床价值。

Objective To study the value of ultrasound in the diagnosis of breast imaging report and data system(BI-RADS) of 4 grade breast benign and malignant lesions. Methods A total of 102 patients of breast cancer in our hospital from June 2011 to September 2014 were selected, and the BI-RADS 4 grade lesions by conventional ultrasound were detected by ultrasound elastography. According to the five-point method, the lesions were scored, the area ratio on the elasticity image and grayscale image were calculated. The overall elasticity index of lesion was measured and statistically analyzed. Taking the pathological results as the gold standard, the ability of ultrasound elastography for differential diagnosis of benign and malignant BI-RADS4 breast lesions was evaluated. Results Among the 102 patients, 43(42.16%) were confirmed as breast cancer by pathology, including 25 patients(58.14%) of invasive ductal carcinoma and 8 patients(18.60%) of invasive lobular carcinoma. Fifty-nine patients(57.84%) were diagnosed as benign breast lesions, including 20cases(33.90%) of fibroadenoma and 18 cases(30.51%) of breast adenosis. The ultrasound elastography score in malignant breast lesions, the area ratio on the elasticity image and grayscale image, elasticity index were significantly higher than those in benign breast lesions [(4.19±0.44) vs(2.37±0.85),(1.95±0.63) vs(1.36±0.41),(3.58±0.69) vs(2.61±0.54)]. For BI-RADS 4 grade malignant breast lesions, the sensitivity, specificity, missed diagnosis rate, misdiagnosis rate were88.37%, 79.66%, 11.63%, 20.34%, respectively, and the area under the ROC curve was 0.864. Conclusion Ultrasound elastography has a high clinical value in the diagnosis of benign and malignant breast lesions of BI-RADS 4 grade.