Rahbar G, Sie A C, Hansen G C, Prince J S, Melany M L, Reynolds H E, Jackson V P, Sayre J W, Bassett L W
Iris Cantor Center for Breast Imaging, Department of Radiological Sciences, UCLA School of Medicine 90095-6952, USA.
Radiology. 1999 Dec;213(3):889-94. doi: 10.1148/radiology.213.3.r99dc20889.
To investigate the general applicability and interobserver variability of ultrasonographic (US) features in differentiating benign from malignant solid breast masses.
One hundred sixty-two consecutive solid masses with a tissue diagnosis were reviewed. Three radiologists reviewed the masses without knowledge of clinical history or histologic examination results.
US features that most reliably characterize masses as benign were a round or oval shape (67 of 71 [94%] were benign), circumscribed margins (95 of 104 [91%] were benign), and a width-to-anteroposterior (AP) dimension ratio greater than 1.4 (82 of 92 [89%] were benign). Features that characterize masses as malignant included irregular shape (19 of 31 [61%] were malignant), microlobulated (four of six [67%] were malignant) or spiculated (two of three [67%] were malignant) margins, and width-to-AP dimension ratio of 1.4 or less (28 of 70 [40%] were malignant). If the three most reliable criteria had been strictly applied by each radiologist, the overall cancer biopsy yield would have increased (from 23% to 39%) by 16%. When US images and mammograms were available, the increase in biopsy yield contributed by US was not statistically significant (2%, P = .73). However, in independent reviews, one to three reviewers interpreted four carcinomas as benign at US.
The data confirm that certain US features can help differentiate benign from malignant masses. However, practice and interpreter variability should be further explored before these criteria are generally applied to defer biopsy of solid masses.
探讨超声（US）特征在鉴别乳腺实性肿块良恶性方面的总体适用性及观察者间的变异性。
回顾了162例经组织学诊断的连续性实性肿块。三位放射科医生在不了解临床病史或组织学检查结果的情况下对这些肿块进行了评估。
最可靠地将肿块特征为良性的US特征包括圆形或椭圆形（71例中的67例[94%]为良性）、边界清晰（104例中的95例[91%]为良性）以及宽度与前后径（AP）比值大于1.4（92例中的82例[89%]为良性）。将肿块特征为恶性的特征包括不规则形状（31例中的19例[61%]为恶性）、微叶状（6例中的4例[67%]为恶性）或毛刺状（3例中的2例[67%]为恶性）边界以及宽度与AP比值为1.4或更小（70例中的28例[40%]为恶性）。如果每位放射科医生严格应用这三个最可靠的标准，总体癌症活检率将提高16%（从23%提高到39%）。当有US图像和乳腺X线照片时，US导致的活检率增加无统计学意义（2%，P = 0.73）。然而，在独立评估中，一至三位评估者将4例癌在US检查时判为良性。
数据证实某些US特征有助于鉴别肿块的良恶性。然而，在这些标准普遍应用于推迟实性肿块活检之前，应进一步探讨操作和解释的变异性。
