BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the...BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System(BI-RADS).Contrast-enhanced ultrasound(CEUS)can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography(US),color Doppler flow imaging(CDFI)and CEUS,and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019.All lesions were examined by US,CDFI and CEUS,and their features from those examinations were analyzed.With pathology as the gold standard,binary logic regression was used to analyze the independent risk factors for malignant breast NMLs,and a regression equation was established to calculate the efficiency of combined diagnosis.Based on the regression equation,the combined diagnostic efficiency of US combined with CEUS(US+CEUS)was determined.The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS,and the diagnostic efficiency of CEUS combined with BI-RADS(CEUS+BI-RADS)was calculated based on the results.ROC curves were drawn to compare the diagnostic values of the three methods,including US,US+CEUS,and CEUS+BI-RADS,for benign and malignant NMLs.RESULTS Microcalcification,enhancement time,enhancement intensity,lesion scope,and peripheral blood vessels were significantly different between benign and malignant NMLs.Among these features,microcalcification,higher enhancement,and lesion scope were identified as independent risk factors for malignant breast NMLs.When US,US+CEUS,and CEUS+BI-RADS were used to identify the benign and malignant breast NMLs,their sensitivity rates were 82.6%,91.3%,and 87.0%,respectively;their specificity rates were 71.4%,89.2%,and 92.9%,respectively;their positive predictive values were 70.4%,87.5%,and 90.9%,respectively;their negative predictive values were 83.3%,92.6%,and 89.7%,respectively;their accuracy rates were 76.5%,90.2%,and 90.2%,respectively;and their corresponding areas under ROC curves were 0.752,0.877 and 0.903,respectively.Z tests showed that the area under the ROC curve of US was statistically smaller than that of US+CEUS and CEUS+BI-RADS,and there was no statistical difference between US+CEUS and CEUS+BI-RADS.CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs.The adjustment of the BI-RADS classification according to the features of contrastenhanced US of NMLs enables the diagnostic results to be simple and intuitive,facilitates the management of NMLs,and effectively reduces the incidence of unnecessary biopsy.展开更多
[目的]探讨乳腺容积成像(Volume Imaging for Breast Assessment,VIBRANT)技术诊断乳腺肿块性病变的临床价值。[方法]对52例(57灶)经病理证实的女性乳腺患者术前行VIBRANT动态增强检查。分析良恶性病变VIBRANT动态增强形态学特征及时间...[目的]探讨乳腺容积成像(Volume Imaging for Breast Assessment,VIBRANT)技术诊断乳腺肿块性病变的临床价值。[方法]对52例(57灶)经病理证实的女性乳腺患者术前行VIBRANT动态增强检查。分析良恶性病变VIBRANT动态增强形态学特征及时间-信号强度曲线(Time-Signal intensity Curves,TIC)。采用评分法根据积分情况进行综合定性诊断。[结果]利用毛刺征鉴别乳腺良恶性病变的特异度97.1%(33/34)。乳腺恶性病变的TIC类型中III型比例最大,占14/23;乳腺良性病变的TIC类型中Ⅰ型比例最大,占19/34。乳腺良恶性病变的信号增强比率(Signal Enhancement Ratio,SER)差异有显著性意义(t=3.243,P<0.01),以恶性病变的95%CI上界作为SER值的阈值即1.33。通过对乳腺病变VIBRANT动态增强形态学和TIC类型综合的评分诊断乳腺病变的敏感度、特异度和阳性似然比、阴性似然比分别为86.96%(20/23)、85.29%(29/34)和5.913、0.153,诊断符合率为86.0%;通过对乳腺病变SER值的评分诊断乳腺病变的敏感度、特异度和阳性似然比、阴性似然比分别为82.6%(19/23)、82.4%(28/34)和4.681、0.211,诊断符合率为82.5%;联合VIBRANT动态增强形态学、TIC的分型和半定量参数值诊断乳腺病变良恶性的敏感度、特异度和阳性似然比、阴性似然比分别为91.3%(21/23)、88.2%(30/34)和7.761、0.099,诊断符合率为89.5%。[结论]VIBRANT技术对乳腺肿块性病变的诊断可提供更有价值和更接近真实的信息。病灶边缘的毛刺征是VIBRANT动态增强鉴别乳腺良恶性肿块性病变特异度较高的征象。将乳腺MR VIBRANT的形态学与血流动力学表现相结合,可以提高乳腺病变诊断的准确率。当病灶形态学、TIC类型可疑恶性时,SER值能提供更有价值的信息。展开更多
文摘BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System(BI-RADS).Contrast-enhanced ultrasound(CEUS)can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography(US),color Doppler flow imaging(CDFI)and CEUS,and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019.All lesions were examined by US,CDFI and CEUS,and their features from those examinations were analyzed.With pathology as the gold standard,binary logic regression was used to analyze the independent risk factors for malignant breast NMLs,and a regression equation was established to calculate the efficiency of combined diagnosis.Based on the regression equation,the combined diagnostic efficiency of US combined with CEUS(US+CEUS)was determined.The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS,and the diagnostic efficiency of CEUS combined with BI-RADS(CEUS+BI-RADS)was calculated based on the results.ROC curves were drawn to compare the diagnostic values of the three methods,including US,US+CEUS,and CEUS+BI-RADS,for benign and malignant NMLs.RESULTS Microcalcification,enhancement time,enhancement intensity,lesion scope,and peripheral blood vessels were significantly different between benign and malignant NMLs.Among these features,microcalcification,higher enhancement,and lesion scope were identified as independent risk factors for malignant breast NMLs.When US,US+CEUS,and CEUS+BI-RADS were used to identify the benign and malignant breast NMLs,their sensitivity rates were 82.6%,91.3%,and 87.0%,respectively;their specificity rates were 71.4%,89.2%,and 92.9%,respectively;their positive predictive values were 70.4%,87.5%,and 90.9%,respectively;their negative predictive values were 83.3%,92.6%,and 89.7%,respectively;their accuracy rates were 76.5%,90.2%,and 90.2%,respectively;and their corresponding areas under ROC curves were 0.752,0.877 and 0.903,respectively.Z tests showed that the area under the ROC curve of US was statistically smaller than that of US+CEUS and CEUS+BI-RADS,and there was no statistical difference between US+CEUS and CEUS+BI-RADS.CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs.The adjustment of the BI-RADS classification according to the features of contrastenhanced US of NMLs enables the diagnostic results to be simple and intuitive,facilitates the management of NMLs,and effectively reduces the incidence of unnecessary biopsy.
文摘[目的]探讨乳腺容积成像(Volume Imaging for Breast Assessment,VIBRANT)技术诊断乳腺肿块性病变的临床价值。[方法]对52例(57灶)经病理证实的女性乳腺患者术前行VIBRANT动态增强检查。分析良恶性病变VIBRANT动态增强形态学特征及时间-信号强度曲线(Time-Signal intensity Curves,TIC)。采用评分法根据积分情况进行综合定性诊断。[结果]利用毛刺征鉴别乳腺良恶性病变的特异度97.1%(33/34)。乳腺恶性病变的TIC类型中III型比例最大,占14/23;乳腺良性病变的TIC类型中Ⅰ型比例最大,占19/34。乳腺良恶性病变的信号增强比率(Signal Enhancement Ratio,SER)差异有显著性意义(t=3.243,P<0.01),以恶性病变的95%CI上界作为SER值的阈值即1.33。通过对乳腺病变VIBRANT动态增强形态学和TIC类型综合的评分诊断乳腺病变的敏感度、特异度和阳性似然比、阴性似然比分别为86.96%(20/23)、85.29%(29/34)和5.913、0.153,诊断符合率为86.0%;通过对乳腺病变SER值的评分诊断乳腺病变的敏感度、特异度和阳性似然比、阴性似然比分别为82.6%(19/23)、82.4%(28/34)和4.681、0.211,诊断符合率为82.5%;联合VIBRANT动态增强形态学、TIC的分型和半定量参数值诊断乳腺病变良恶性的敏感度、特异度和阳性似然比、阴性似然比分别为91.3%(21/23)、88.2%(30/34)和7.761、0.099,诊断符合率为89.5%。[结论]VIBRANT技术对乳腺肿块性病变的诊断可提供更有价值和更接近真实的信息。病灶边缘的毛刺征是VIBRANT动态增强鉴别乳腺良恶性肿块性病变特异度较高的征象。将乳腺MR VIBRANT的形态学与血流动力学表现相结合,可以提高乳腺病变诊断的准确率。当病灶形态学、TIC类型可疑恶性时,SER值能提供更有价值的信息。
