乳腺影像报告和数据系统分级4和5级的触诊不清乳腺肿块的超声特征  

Sonographic Features of Breast Imaging Reporting and Data System Assessment Category 4 and 5 Non-palpable Breast Lesions

作　　者：朱庆莉[1] 姜玉新[1] 张璟[1] 刘赫[1] 戴晴[1] 孙强[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院超声科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院外科,北京100730

出　　处：《中国医学科学院学报》2010年第4期456-460,484,共6页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(30570529)~~

摘　　要：目的探讨超声征象对超声诊断为乳腺影像报告和数据系统(BI-RADS)4和5级的触诊不清乳腺病灶的诊断价值。方法 1998年1月至2008年5月术前超声诊断为BI-RADS4或5级触诊不清的213个乳腺病灶为本研究对象,对照病理结果,评价各超声征象的诊断价值。结果 213个病变中,病理证实为良性128个(60.1%)、恶性85个(39.9%),恶性病变的平均大小差异无统计学意义(P=0.09)。"形态不规则"对乳腺癌的诊断敏感性为89.9%,其余超声征象的诊断敏感性均较低(7.6%～42.4%);边缘成角、小分叶、毛刺及血流丰富对乳腺癌的诊断特异性高(89.0%～95.6%)。BI-RADS4和5级中良性病变的常见超声表现为:形态不规则(66.7%)、边界不清(35.1%)、后方回声衰减(27.2%)、纵横比>1(26.3%)。结论形态不规则是诊断乳腺癌敏感性最高的超声征象,超声可准确识别乳腺癌的浸润性边界征象,对于诊断BI-RADS5级有较大帮助。Objective To evaluate the diagnostic value of the sonographic features of Breast Imaging Reporting and Data System(BI-RADS)assessment category 4 and 5 non-palpable breast lesions.Methods A total of 213 non-palpable breast lesions that were pre-operatively assessed to be BI-RADS category 4 and 5 lesions by ultrasound were enrolled in this study.The diagnostic value of their sonographic features were assessed by using pathologic results as the golden standards.Results Of these 213 lesions,128(60.1%)were pathologically confirmed to be benign and 85(39.9%)to be malignant.The mean size was not significantly different between the benign and the malignant lesions(P = 0.09).The sensitivity of'irregular shape'for diagnosing breast cancer was 89.9%,while the sensitivities of other sonographic features ranged from 7.6% to 42.4%.The diagnostic specificities were high for'angular margin','microlobular','spiculation'and'abundant flow'(89.0%-95.6%).The common sonographic findings of benign lesions included 'irregular shape'(66.7%),'obscure margin'(35.1%),'shadowing'(27.2%),and 'taller-than-wider'(26.3%).Conclusions 'Irregular shape'is the most sensitive sonographic feature in the diagnosis of malignant BI-RADS category 4 and 5 non-palpable breast lesions.Ultrasound can accurately identify the invasive margin features of breast cancers,which is especially useful for the diagnosis of BI-RADS category 5 lesions.

关 键 词：临床触诊不清的乳腺病变 乳腺影像报告和数据系统 超声 

分 类 号：R737.9[医药卫生—肿瘤]