乳腺超声影像报告与数据系统征象术语在乳腺小结节良恶性鉴别诊断中的应用  

Differentiation of small breast nodules using breast imaging reporting and data system-ultrasound

作　　者：周帅[1] 胡敏霞[1] 朱强[1] 黄慧莲[1] 荣雪余[1] 赵汉学[1] 陈宇[2] 

机构地区：[1]首都医科大学附属北京同仁医院超声诊断科,100073 [2]中国医学科学院北京协和医学院肿瘤医院影像诊断科

出　　处：《中华医学超声杂志（电子版）》2013年第8期662-668,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家科技部十二五国家科技支撑计划课题(2012BAI13B02)

摘　　要：目的采用乳腺超声影像报告与数据系统(BI-RADS-US)征象术语分析≤2cm的乳腺小结节,探讨其诊断一致性和在乳腺良恶性结节鉴别诊断中的应用价值。方法收集2009年1月至2011年12月首都医科大学附属北京同仁医院289例患者共317个经手术及穿刺病理证实、≤2cm的乳腺结节。其中0～1cm结节160个(146例),>1～2cm结节157个(143例)。按照BI-RADS-US征象术语描述乳腺结节超声征象。采用Kappa检验分析3位医师评价超声征象的一致性。采用χ2检验分别比较0～1cm、>1～2cm乳腺良恶性结节BI-RADS-US征象术语差异。以病理诊断结果作为金标准,计算恶性超声征象诊断乳腺恶性结节的敏感度、特异度、准确性、阳性预测值(PPV)和阴性预测值(NPV)。结果 160个0～1cm的乳腺结节中,良性95个,恶性65个。157个>1～2cm的乳腺结节中,良性91个,恶性66个。(1)对于0～1cm的乳腺结节,3位评价者对形状、方位、边缘、内部回声、周围情况、钙化等6类BI-RADS-US征象术语评价的一致性为中等(κ值分别为0.44、0.57、0.48、0.43、0.51、0.57)。对于>1～2cm的乳腺结节,3位评价者对形状、方位、边缘、内部回声等4类BI-RADS-US征象术语评价的一致性较好(κ值分别为0.65、0.61、0.64、0.63)。(2)0～1cm的乳腺结节,恶性结节多表现为不规则形、非平行方位、边缘不光整、高回声晕及微钙化,与良性结节比较差异均有统计学意义[52.3%(34/65) vs 20.0%(19/95),38.5%(25/65) vs 13.7%(13/95),75.4%(49/65) vs 32.6%(31/95),18.6%(12/65) vs 0(0/95),10.8%(7/65) vs 2.1%(2/95);χ2值分别为18.19、13.08、28.22、16.39、3.95,P均<0.05],>1～2cm的乳腺结节,恶性结节多表现为不规则形、非平行方位、边缘不光整、高回声晕、后方回声衰减、Cooper韧带改变及微钙化,与良性结节比较差异均有统计学意义[74.2%(49/66) vs 12.1%(11/91),36.4%(24/66) vs 5.5%(5/91),93.9%(62/66) vs 22.0%(20/91),37.9%(25/66) vs 3.3%(3/91),30.3%(20Objective To study the interobserver variabilities and the differential diagnosis value of Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon for small (≤ 2 cm) breast nodules.Methods Between January 2009 and December 2011,289 patients with small (≤ 2 cm) breast nodules (n=317) were included.According to sizes,the lesions were divided into two groups,i.e.,0-1 cm (n=160) group and 1-2 cm (n=157)group.Each lesion was described independently by 3 radiologists using BI-RADS-US lexicon.Interobserver variabilities were assessed by Kappa test.Chi-square test was used to compare the frequency difference of the descriptors between malignant and benign lesions.Sensitivity,specificity,accuracy,positive predictive value and negtive predictive value were calculated.Results (1)Moderate agreements were obtained for lesion shape,orientation,margin,echo pattern,surrounding tissue and calcifications (κ=0.44,0.57,0.48,0.43,0.51 and 0.57) in 0-1 cm group.Substantial agreements were obtained for lesion shape,orientation,margin and echo pattern (κ=0.65,0.61,0.64 and 0.63) in 1-2 cm group.(2)Irregular shape,non-parallel orientation,non-circumscribed margin,echogenic halo and microcalcifications were more frequently found in malignant nodules than in benign nodules in 0-1 cm group [52.3% (34/65) vs 20.0% (19/95),38.5% (25/65) vs 13.7% (13/95),75.4%(49/65) vs 32.6% (31/95),18.6% (12/65) vs 0 (0/95) and 10.8% (7/65) vs 2.1% (2/95);χ2 =18.19,13.08,28.22,16.39 and 3.95;P=0.000,0.000,0.000,0.000 and 0.047].Similarly,irregular shape,non-parallel orientation,non-circumscribed margin,echogenic halo,shadowing,changes of Cooperí s ligament and microcalcifications were significantly more frequent found in malignant nodules than in benign nodules in 1-2 cm group [74.2% (49/66) vs 12.1% (11/91),36.3% (24/66) vs 5.5% (5/91),93.9% (62/66) vs 22.0% (20/91),37.9% (25/66) vs 3.3% (3/91),30.3% (20/66) vs 7.7% (7/91),15.2% (10/66) vs 0 (0/91) and 16.7% (11/66) vs 4.4% (4/91);χ2 =62.59,24.21,79.40,31.22,13.73,12.30 and 6.67;P=

关 键 词：乳腺肿瘤 超声检查 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]