超声弹性成像在BI-RADS 4类乳腺病变中的诊断价值研究  

Evaluation of Elastography in the Differential Diagnosis of Benign and Malignant Breast Lesions of BI-RADS 4 Diagnosed via Conventional Ultrasound

作　　者：张宇[1] 刘雪静[1] 刘佩芳[1] 朱鹰[1] 徐熠琳[1] 李小康[1] 张淑平[1] 

机构地区：[1]天津医科大学附属肿瘤医院乳腺影像诊断科,乳腺癌防治教育部重点实验室,天津市肿瘤防治重点实验室,天津市300060

出　　处：《中国肿瘤临床》2012年第10期702-705,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨常规超声联合弹性成像在乳腺实性病变良恶性鉴别诊断中的应用,特别对BI-RADS 4类病变的临床诊断价值。方法:搜集2010年8月至2011年6月间于天津医科大学附属肿瘤医院行乳腺常规超声和超声弹性成像检查的204例患者资料,共210个病变。常规超声诊断依据美国放射学会的乳腺影像报告和数据系统超声(BI-RADS-US)标准,弹性评分依据日本Tsukuba大学弹性成像评分标准。结果:204例患者210个乳腺实性病变中,组织病理学结果为恶性病变124个(59.1%),良性病变86个(40.9%)。常规超声诊断的敏感性、特异性和准确性分别为88.7%、84.9%和87.1%;弹性成像诊断的敏感性、特异性和准确性分别为83.1%、81.4%和82.4%;二者联合诊断的敏感性、特异性和准确性分别为85.5%、97.7%和90.5%。在BI-RADS 4类需活检的61个病变中,经病理证实恶性病变46个,良性病变15个,其中弹性成像诊断的敏感性、特异性和准确性分别为93.5%、93.3%和93.4%。两者联合诊断的特异性和准确性明显高于单独常规超声或弹性成像(P值分别为0.003、0.049)。结论:常规超声和超声弹性成像联合应用可明显提高对乳腺实性病变诊断的特异性及准确性,对于常规超声诊断为BI-RADS4类需活检的病变,结合弹性成像诊断可有效减少不必要的活检。Objective： To evaluate the performance of elastography in the differential diagnosis of benign and malignant breast le- sions. In particular, to determine the beneficial effects of elastography to the differentiation of Breast Imaging and Reporting Data Sys- tem 4 （ BI-RADS 4 ） breast lesions, which require a biopsy, as diagnosed via conventional ultrasound. Methods： Between August 2010 and June 2011,204 women with 210 lesions were enrolled in the study. After conventional ultrasound examination, elastography was performed using a manual freehand compression technique. Results： Pathological examination revealed 124 malignant lesions （ 59.1% ） and 86 benign lesions out of 210 （ 40.9 % ）. The sensitivity, specificity, and accuracy of the ultrasound were 88.7 %, 84.9 %, and 87.1%, respectively; those for elastography were 83.1%, 81.4 %, and 82.4 %, respectively; and those for the combination of ultra- sound and elastography were 85.5 %, 97.7 %, and 90.5 %, respectively. For the 61 BI-RADS 4 lesions diagnosed via conventional ultra- sound, 46 were malignant and 15 were benign. The sensitivity, specificity, and accuracy of elastography were 93.5 %, 93.3 %, and 93.4 %, respectively. Conclusion： Elastography provides more information for breast lesion diagnoses. In addition, the combination of ultrasound and elastography has high specificity and accuracy in differentiating benign breast lesions from malignant ones. Elastogra- phy reduces the need for biopsy for low-risk BI-RADS 4 lesions.

关 键 词：超声检查 弹性成像 BI—RADS4 乳腺病变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R655.8[医药卫生—诊断学]