超声乳腺影像报告数据系统3～5级评分标准的初探  

The Preliminary Study of Scoring Criteria of Breast Imaging Reporting and Data Ultrasound System Category 3～5

作　　者：彭梅[1] 詹韵韵[1] 姜凡[1] 张新书[2] 李娅荣[1] 伍婷婷[1] 

机构地区：[1]安徽医科大学第二附属医院超声诊断科,合肥市230601 [2]中科院合肥物质科学研究院医学物理与技术中心

出　　处：《中国超声医学杂志》2014年第3期202-206,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨超声乳腺影像报告数据系统（breastimagingreportinganddatasystem，BI－RADs）3～5级评分标准在乳腺肿块诊断中的应用价值。方法根据国内外文献对BI-RADS系统中描述乳腺肿块特征（包括形态等7项指标）对肿块良恶性判断贡献率的不同，分别进行赋分并加入年龄因素，制订超声BI－RADS3～5级评分标准。依据该标准对103个乳腺肿块给予综合评分、分级。以病理结果为金标准，计算每级的恶性构成比，并与BI－RADs每级别的理论风险范围相比较。绘制ROC陆线，寻找诊断乳腺肿块良恶性最理想的界点分值。结果（1）BI－RADS3级（分值8～10分）共34个肿块，均为良性病变；BI—RADs4a级（分值1l～13分）共27个肿块，25个为良性病变，2个为恶性病变，恶性构成比为7％；BI－RADs4b级（分值14～16分）共11个肿块，5个为良性病变，6个为恶性病变，恶性构成比为55％；BI－RADS4c级（分值17～19分）共13个肿块，1个为良性病变，12个为恶性病变，恶性构成比为92％；BHiADs5级（分值≥20分）共18个肿块，均为恶性，恶性构成比为1。0％。本研究中BI－RADs分级各组的恶性构成比均在各组的理论风险范围内；（2）将肿块综合评分15分，作为诊断乳腺肿块良恶性的界点分值，其灵敏度为92．11％，特异度为96．92％，阳性预测值94．59％，阴性预测值95．45％，约登指数O．89。结论BI－RADs3～5级评分标准可使超声报告得到较客观的规范统一，有利于向临床提供可靠的风险范围，指导临床采取不同的处理方案。Objective To explore the diagnostic value of the scoring criteria of Breast imaging reporting and data ultrasound system category 3～5 for breast lesions. Methods The age and the 7 features of sonograghic images inclu ding lesion shape etal were analyzed. The scoring criteria of category 3～5 was obtained due to the features of different contribution in diagnosis of breast benign and malignant lesions. According to the the system, 103 breast lesions were scored and graded. The pathological results after surgery were selected as golden standard, the malignant predicted val ue in each group was compared with theorized risk degree of malignancy by BI-RADS. ROC curve was drawn. The cut off value was the most ideal point for differentiating breast benign and malignant breast lesions. Results （1） The comprehensive score of 3 category was 8～10,34 benign breast lesions were contained. The comprehensive score of 4a category was 11～13,25 cases benign lesions and 2 cases malignant lesions were contained. The comprehensive score of 4b category was 14 ～ 16,5 cases benign lesions and 6 cases malignant lesions were contained. The comprehensive score of 4c category was 17 ～ 19, 1 cases benign lesion and 12 cases malignant lesions were contained. The comprehen sive score of 5 category was equal or greater than 20,18 malignant lesions were contained. The proporting of malignant lesions in each category were 0% ,7% ,55%, 92% ,100~ respectively. （2） Score 15 was the best cut-off value by ul- trasonography for differentiating bengin and malignant breast lesions. The sensitivity, specificity, positive predictive value,negative predictive value and youden index were 92.11% ,96.92% ,94.59% ,95.45% and 0.89. Conclusions BI-RADS assessment category according to the scoring system can partly standardize ultrasonic report and offer reliable guiding information for clinical diagnosis and treatment of breast lesion.

关 键 词：超声检查 乳腺肿块 乳腺影像报告数据系统 评分 

分 类 号：R445.1[医药卫生—影像医学与核医学]