超声造影在诊断恶性非肿块型乳腺病变中的作用及诊断标准探讨。
The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria.
机构信息
Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.
Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Br J Radiol. 2021 Apr 1;94(1120):20200880. doi: 10.1259/bjr.20200880. Epub 2021 Feb 9.
OBJECTIVES
To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria.
METHODS
A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared.
RESULTS
Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, = 0.003), enhancement area (OR = 4.25, = 0.005), and radial or penetrating vessels (OR = 7.54, = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively.
CONCLUSIONS
CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs.
ADVANCES IN KNOWLEDGE
In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.
目的
评估超声造影（CEUS）诊断恶性非肿块型乳腺病变（NML）的价值，并探讨 CEUS 诊断标准。
方法
共纳入 116 例经常规超声检出的 119 个 NML 患者。以病理结果为参照标准，对比分析良、恶性 NML 的 CEUS 增强特征。采用二元逻辑回归分析确定独立诊断指标，建立恶性 NML 的 CEUS 诊断标准。评估并比较乳腺影像报告和数据系统-US（BI-RADS-US）、CEUS 及 BI-RADS-US 联合 CEUS 的诊断效能。
结果
病理结果显示良性和恶性 NML 分别为 63 个和 56 个。增强程度（OR=5.75， =0.003）、增强面积（OR=4.25， =0.005）和放射状或穿透状血管（OR=7.54， =0.003）是建立 CEUS 诊断标准的独立诊断指标。BI-RADS-US、CEUS 和 BI-RADS-US 联合 CEUS 的敏感度和特异度分别为 100%和 30.2%、80.4%和 74.6%、94.6%和 77.8%，相应的受试者工作特征曲线（AUC）下面积分别为 0.819、0.775 和 0.885。
结论
根据增强程度、增强面积和放射状或穿透状血管等诊断标准，CEUS 对恶性 NML 诊断具有较高的特异性，但敏感度低于 BI-RADS-US。CEUS 联合 BI-RADS-US 是一种有效的诊断工具，对恶性 NML 诊断具有较高的敏感度和特异度。
知识进展
本研究评估了 CEUS 对恶性 NML 的诊断价值，并构建了一种可行的诊断标准。进一步揭示了 CEUS 联合 BI-RADS-US 对恶性 NML 具有较高的诊断价值。
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