Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical College, Guang Zhou, China.
Ultraschall Med. 2018 Oct;39(5):526-534. doi: 10.1055/s-0043-115108. Epub 2018 Sep 3.
Breast lesions classified as BI-RADS-US 3 are probably benign and observation was recommended, while a considerable number of BI-RADS-US 4 lesions were benign, resulting in excessive biopsies. We focus exclusively on BI-RADS-US 3 and 4 lesions and hypothesize that improved diagnostic performance can be achieved by integrating real-time elastography (strain ratio) into the BI-RADS-US classification system.
From April 2010 to September 2015, 1071 lesions were included in the final analysis. After the conventional ultrasound examination, the BI-RADS-US (2013) classification was used to evaluate the lesions. Then the strain ratios were calculated, and the final diagnosis was made on the basis of histological results. The sensitivity, specificity, accuracy, PPV and NPV were calculated and the AUCs were compared. Additionally, an analysis of the diagnostic performance expressed by the pretest and posttest probability of disease (POD) was performed in BI-RADS-US 3 and 4A lesions.
With the cutoff point of 2.98, the sensitivity, specificity and accuracy of the strain ratio method were 86.9 %, 86.6 % and 82.6 %, respectively. In BI-RADS-US 3 lesions, a suspicious strain ratio significantly modified the POD from 1.3 % to a posttest POD of 29.8 %. In BI-RADS-US 4A lesions, a suspicious strain ratio significantly modified the POD from 8.5 % to a posttest POD of 48.7 %.
Ultrasonographic elastography (strain ratio) yields additional diagnostic information in the evaluation of BI-RADS-US 3 and 4 breast lesions. The strain ratios should be integrated into the BI-RADS-US classification system and into daily practice.
BI-RADS-US 3 类的乳腺病变可能为良性，推荐观察；但相当一部分 BI-RADS-US 4 类病变为良性，导致过度活检。我们专注于 BI-RADS-US 3 和 4 类病变，并假设通过将实时超声弹性成像（应变比）纳入 BI-RADS-US 分类系统，可以提高诊断性能。
2010 年 4 月至 2015 年 9 月，共纳入 1071 例病变进行最终分析。常规超声检查后，采用 BI-RADS-US（2013）分类评估病变，计算应变比，根据组织学结果作出最终诊断。计算灵敏度、特异度、准确性、PPV 和 NPV，并比较 AUC。另外，还对 BI-RADS-US 3 和 4A 类病变的术前和术后疾病概率（POD）进行了诊断性能分析。
以 2.98 为截断值，应变比法的灵敏度、特异度和准确性分别为 86.9%、86.6%和 82.6%。在 BI-RADS-US 3 类病变中，可疑应变比显著改变了术前 POD（从 1.3%变为术后 POD 29.8%）。在 BI-RADS-US 4A 类病变中，可疑应变比显著改变了术前 POD（从 8.5%变为术后 POD 48.7%）。
超声弹性成像（应变比）为 BI-RADS-US 3 和 4 类乳腺病变的评估提供了额外的诊断信息。应变比应纳入 BI-RADS-US 分类系统，并应用于日常实践。
