Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC.
Eur J Radiol. 2011 Jul;79(1):73-9. doi: 10.1016/j.ejrad.2009.12.037. Epub 2010 Feb 8.
To analyze the features of breast complex cystic lesions at ultrasonography (US) and to determine appropriate Breast Imaging Reporting and Data System (BI-RADS) categories and management recommendations for these lesions based on US findings with pathologic correlation.
From July 2001 to June 2007, 152 consecutive pathologically proven complex cystic lesions on US were retrospectively reviewed. All lesions at US were evaluated for size, lesion characteristics, margins, and presence of abnormal axillary nodes. US features of lesions were classified into four types, and positive predictive values (PPVs) were calculated for each type. Clinical, imaging, and histopathological findings were reviewed.
Of the 152 lesions based on US appearance, 36 (24%) were classified as type I, 49 (32%) as type II, 28 (18%) as type III, and 39 (26%) as type IV. The PPVs for malignancy in each type were 14% for type I, 16% for type II, 14% for type III, and 41% for type IV. There was a significantly higher frequency of malignancy among lesions of type IV compared with the other three types (16/39=41% vs 5/36=14%, p=0.0089; 16/39=41% vs 8/49=16%, p=0.0098; and 16/39=41% vs 4/28=14%, p=0.018 [Chi-squared test]). Lesions with maximum diameter equal to or larger than 20mm, not circumscribed margins, or a mammographic finding of suspected malignancy had a high probability of malignancy (p<0.05 for each).
US is useful in evaluating the complex cystic lesions and in clarifying the indication for biopsy of these lesions. The four types of US classifications used in our study establish accepted benchmarks for these breast abnormalities when stratified according to BI-RADS categories.
分析超声（US）下乳腺复杂囊性病变的特征，并根据与病理相关性的 US 检查结果，确定适当的乳腺影像报告和数据系统（BI-RADS）类别和管理建议。
回顾性分析 2001 年 7 月至 2007 年 6 月期间经病理证实的 152 例连续的超声下的复杂囊性病变。所有 US 下的病变均评估大小、病变特征、边界和异常腋窝淋巴结的存在。将 US 下的病变特征分为四种类型，并计算每种类型的阳性预测值（PPV）。回顾性分析临床、影像学和组织病理学发现。
根据 US 表现，152 例病变中 36 例（24%）为 I 型，49 例（32%）为 II 型，28 例（18%）为 III 型，39 例（26%）为 IV 型。每种类型的恶性肿瘤的 PPV 分别为 I 型 14%，II 型 16%，III 型 14%，IV 型 41%。与其他三种类型相比，IV 型病变的恶性肿瘤发生率明显更高（16/39=41%比 5/36=14%，p=0.0089；16/39=41%比 8/49=16%，p=0.0098；16/39=41%比 4/28=14%，p=0.018[卡方检验]）。最大直径等于或大于 20mm、边界不清晰或乳腺 X 线摄影显示可疑恶性的病变恶性肿瘤的可能性较高（p<0.05）。
US 有助于评估复杂囊性病变，并阐明对这些病变进行活检的指征。我们研究中使用的四种 US 分类方法为这些乳腺异常根据 BI-RADS 类别进行分层时建立了公认的基准。
