Yoon Haesung, Yoon Jung Hyun, Kim Eun-Kyung, Moon Hee Jung, Park Byeong-Woo, Kim Min Jung
Department of Radiology, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Ultrasound Med Biol. 2015 Aug;41(8):2099-107. doi: 10.1016/j.ultrasmedbio.2015.03.029. Epub 2015 May 4.
The aim of this study was to assess the malignancy yield of ultrasound Breast Imaging Reporting and Data System (BI-RADS) classification and the diagnostic value of adding ultrasound to diagnosis of breast cancer in patients with pathologic nipple discharge. Of 267 patients with pathologic nipple discharge seen from February 2003 to March 2011, 198 with histopathologic confirmation and follow-up data were included. Ultrasound images and mammograms were analyzed according to BI-RADS. The malignancy rate for each BI-RADS category and the difference in diagnostic performance resulting from the addition of ultrasound to mammography were calculated. Of the 198 enrolled patients, 34 were diagnosed with a malignancy. The malignancy rates obtained with the addition of ultrasound to mammography were 0.0% (0 of 27) for category 1, 5.9% (1/17) for category 2, 9.4% (5/53) for category 3, 21.5% (20/93) for category 4 and 100% (8/8) for category 5. The malignancy rates for mammography alone were 7.7%-9.0% for categories 1-3, 68.5% (13/19) for category 4 and 100.0% (5/5) for category 5. Adding US to mammography did not significantly increase sensitivity compared with mammography alone. Other diagnostic performance markers such as specificity and positive predictive value were not improved. Among patients for whom mammograms were available, ultrasound detected 5 breast cancers (26.3%) in addition to the 19 breast cancers found by positive mammography. Although it did not increase overall diagnostic performance in patients with pathologic nipple discharge, addition of ultrasound to mammography did detect an additional 26.3% of malignant lesions.
本研究旨在评估超声乳腺影像报告和数据系统（BI-RADS）分类的恶性肿瘤检出率，以及在病理乳头溢液患者的乳腺癌诊断中增加超声检查的诊断价值。在2003年2月至2011年3月期间就诊的267例病理乳头溢液患者中，纳入了198例有组织病理学证实和随访数据的患者。根据BI-RADS对超声图像和乳房X线照片进行分析。计算每个BI-RADS类别的恶性肿瘤发生率，以及在乳房X线摄影基础上增加超声检查后诊断性能的差异。在198例入组患者中，34例被诊断为恶性肿瘤。乳房X线摄影联合超声检查时，1类的恶性肿瘤发生率为0.0%（27例中0例），2类为5.9%（17例中1例），3类为9.4%（53例中5例），4类为21.5%（93例中20例），5类为100%（8例中8例）。仅乳房X线摄影时，1 - 3类的恶性肿瘤发生率为7.7% - 9.0%，4类为68.5%（19例中13例），5类为100.0%（5例中5例）。与单纯乳房X线摄影相比，增加超声检查并未显著提高敏感性。其他诊断性能指标，如特异性和阳性预测值也未得到改善。在有乳房X线照片的患者中，超声检查除了发现19例乳房X线照片阳性的乳腺癌外，还检测出5例乳腺癌（26.3%）。虽然在病理乳头溢液患者中增加超声检查并未提高总体诊断性能，但确实额外检测出了26.3%的恶性病变。
