超声造影在BI-RADS 4类乳腺病变中的诊断价值
[Diagnostic value of contrast-enhanced ultrasound in breast lesions of BI-RADS 4].
作者信息
Liang Y C, Jia C M, Xue Y, Lü Q, Chen F, Wang J J
机构信息
Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan 030001, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2018 May 22;98(19):1498-1502. doi: 10.3760/cma.j.issn.0376-2491.2018.19.009.
To investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of BI-RADS 4 breast masses. A total of 72 patients were collected from the First Hospital of Shanxi Medical University from January 2016 to December 2017.79 breast masses were confirmed by biopsy or surgical pathology.All the masses were classified by BI-RADS according to conventional ultrasound and CEUS was performed in parallel.Based on the results of the CEUS predictive model, the benign and malignant features of the breast BI-RADS type 4 tumors were re-determined: (1) conventional ultrasound BI-RADS classification+ CEUS predictive model: both of them were malignant when malignant; (2) re-adjusting BI-RADS classification by CEUS predictive model: if the malignant CEUS predictive model, upgrade a class, if the benign CEUS predictive model, downgrade a class.The diagnostic efficiency of the two methods in breast masses of BI-RADS 4 was compared. (1) There were 36 malignant masses and 43 benign masses in 79 breast masses.Diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the conventional ultrasound BI-RADS classification, CEUS predictive model, conventional ultrasound BI-RADS classification+ CEUS predictive model and the adjusted BI-RADS classification were 86.1%, 65.1%, 74.7%, 67.4%, 84.8%; 88.9%, 76.7%, 82.3%, 76.2%, 89.2%; 80.6%, 86.0%, 83.5%, 82.9%, 84.1%; 97.2%, 76.7%, 86.1%, 77.8%, 97.1%, respectively.(2) The area under the receiver operating characteristic (ROC) curve of conventional ultrasound BI-RADS classification, CEUS predictive model, conventional ultrasound BI-RADS classification+ CEUS predictive model and the adjusted BI-RADS classification was 0.756, 0.828, 0.833, 0.870, respectively.Before and after the adjustment of BI-RADS classification, the difference was statistically significant (=2.322, <0.05). The diagnostic efficiency that CEUS predictive model adjusted classification of BI-RADS 4 breast masses is better, the method can reduce unnecessary biopsy.
探讨超声造影（CEUS）在乳腺影像报告和数据系统（BI-RADS）4类乳腺肿块鉴别诊断中的价值。收集2016年1月至2017年12月山西医科大学第一医院的72例患者。经活检或手术病理确诊79个乳腺肿块。所有肿块均根据常规超声按BI-RADS分类，并同时进行CEUS检查。根据CEUS预测模型的结果，重新确定乳腺BI-RADS 4类肿瘤的良恶性特征：（1）常规超声BI-RADS分类+CEUS预测模型：两者均为恶性时判定为恶性；（2）根据CEUS预测模型重新调整BI-RADS分类：若CEUS预测模型为恶性，则升级一级；若CEUS预测模型为良性，则降级一级。比较两种方法对BI-RADS 4类乳腺肿块的诊断效能。（1）79个乳腺肿块中，恶性肿块36个，良性肿块43个。常规超声BI-RADS分类、CEUS预测模型、常规超声BI-RADS分类+CEUS预测模型及调整后的BI-RADS分类的诊断敏感性、特异性、准确性、阳性预测值和阴性预测值分别为86.1%、65.1%、74.7%、67.4%、84.8%；88.9%、76.7%、82.3%、76.2%、89.2%；80.6%、86.0%、83.5%、82.9%、84.1%；97.2%、76.7%、86.1%、77.8%、97.1%。（2）常规超声BI-RADS分类、CEUS预测模型、常规超声BI-RADS分类+CEUS预测模型及调整后的BI-RADS分类的受试者操作特征（ROC）曲线下面积分别为0.756、0.828、0.833、0.870。BI-RADS分类调整前后差异有统计学意义（=2.322，<0.05）。CEUS预测模型调整BI-RADS 4类乳腺肿块分类的诊断效能较好，该方法可减少不必要的活检。
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