超声应变弹性成像通过重新分类BI-RADS 3类和4a类病变提高乳腺病变的诊断性能：一项多中心诊断研究
Ultrasound strain elastography to improve diagnostic performance of breast lesions by reclassifying BI-RADS 3 and 4a lesions: a multicentre diagnostic study.
作者信息
Gu Yang, Tian Jiawei, Ran Haitao, Ren Weidong, Chang Cai, Yuan Jianjun, Kang Chunsong, Deng Youbin, Wang Hui, Luo Baoming, Guo Shenglan, Zhou Qi, Xue Ensheng, Zhan Weiwei, Zhou Qing, Li Jie, Zhou Ping, Zhang Chunquan, Chen Man, Gu Ying, Xu Jinfeng, Chen Wu, Zhang Yuhong, Li Jianchu, Wang Hongyan, Jiang Yuxin
机构信息
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou 215000, China.
出版信息
Br J Radiol. 2025 Jan 1;98(1165):89-99. doi: 10.1093/bjr/tqae197.
OBJECTIVES
To investigate the added value of strain elastography (SE) by recategorizing ultrasound (US) breast imaging reporting and data system (BI-RADS) 3 and 4a lesions.
METHODS
A total of 4371 patients underwent US and SE with BI-RADS 2-5 categories solid breast lesions were included from 32 hospitals. We evaluated the elastographic images according to elasticity scores (ES) and strain ratios (SR). Three combined methods (BI-RADS + ES, BI-RADS + SR, BI-RADS + ES + SR) and two reclassified methods were used (method one: upgrading BI-RADS 3 and downgrading BI-RADS 4a, method two: downgrading BI-RADS 4a alone). The diagnostic performance and the potential reduction of unnecessary biopsies were evaluated.
RESULTS
Combining BI-RADS with SE had a higher area under the curve (AUC) than BI-RADS alone (0.822-0.898 vs 0.794, P < .01). For reclassified method one, the sensitivity, specificity, and accuracy were 99.36%, 66.70%, 78.36% for BI-RADS + ES and 98.01%, 66.45%, 77.72% for BI-RADS + SR, and 99.42%, 66.70%, 78.38% for BI-RADS + ES + SR, respectively. For reclassified method two, the sensitivity, specificity, and accuracy were 99.17%, 70.72%, 80.87% for BI-RADS + ES and 97.76%, 81.75%, 87.46% for BI-RADS + SR, and 99.23%, 69.83%, 80.32% for BI-RADS + ES + SR, respectively. Downgrading BI-RADS 4a alone had higher AUC, specificity, and accuracy (P < .01) and similar sensitivity (P > .05) to upgrading BI-RADS 3 and downgrading BI-RADS 4a. Combining SE with BI-RADS could help reduce unnecessary biopsies by 17.64%-55.20%.
CONCLUSIONS
Combining BI-RADS with SE improved the diagnostic performance in distinguishing benign from malignant lesions and could decrease false-positive breast biopsy rates. Downgrading BI-RADS 4a lesions alone might be sufficient for achieving good diagnostic performance.
ADVANCES IN KNOWLEDGE
Downgrading BI-RADS category 4a lesions alone had higher AUC, specificity, and accuracy, and similar sensitivity to upgrading or downgrading BI-RADS category 3 and 4a lesions.
目的
通过对超声（US）乳腺影像报告和数据系统（BI-RADS）3类和4a类病变进行重新分类，探讨应变弹性成像（SE）的附加价值。
方法
来自32家医院的4371例接受了US和SE检查且患有BI-RADS 2 - 5类乳腺实性病变的患者被纳入研究。我们根据弹性评分（ES）和应变率（SR）评估弹性成像图像。使用了三种联合方法（BI-RADS + ES、BI-RADS + SR、BI-RADS + ES + SR）和两种重新分类方法（方法一：将BI-RADS 3类升级并将BI-RADS 4a类降级，方法二：仅将BI-RADS 4a类降级）。评估了诊断性能以及不必要活检潜在的减少情况。
结果
将BI-RADS与SE相结合时的曲线下面积（AUC）高于单独使用BI-RADS（0.822 - 0.898对0.794，P <.01）。对于重新分类方法一，BI-RADS + ES的灵敏度、特异度和准确度分别为99.36%、66.70%、78.36%，BI-RADS + SR的分别为98.01%、66.45%、77.72%，BI-RADS + ES + SR的分别为99.42%、66.70%、78.38%。对于重新分类方法二，BI-RADS + ES的灵敏度、特异度和准确度分别为99.17%、70.72%、80.87%，BI-RADS + SR的分别为97.76%、81.75%、87.46%，BI-RADS + ES + SR的分别为99.23%、69.83%、80.32%。仅将BI-RADS 4a类降级具有更高的AUC、特异度和准确度（P <.01）以及与将BI-RADS 3类升级并将BI-RADS 4a类降级相似的灵敏度（P >.05）。将SE与BI-RADS相结合可帮助将不必要的活检减少17.64% - 55.20%。
结论
将BI-RADS与SE相结合可提高鉴别良性与恶性病变的诊断性能，并可降低乳腺活检的假阳性率。仅将BI-RADS 4a类病变降级可能足以实现良好的诊断性能。
知识进展
仅将BI-RADS 4a类病变降级具有更高的AUC、特异度和准确度，并且与升级或降级BI-RADS 3类和4a类病变具有相似的灵敏度。
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