乳腺 BI-RADS 分类在临床不可触及病变中的诊断价值  

The value of BI-RADS in the 3D wire guide localization biopsy of non-palpable breast lesions

作　　者：李卓琳[1] 吴建萍[1] 李鹍[1] 丁莹莹[1] 杨亚琛 张俊[1] 

机构地区：[1]昆明医科大学第三附属医院云南省肿瘤医院放射科,云南昆明650118

出　　处：《实用放射学杂志》2014年第12期1982-1985,共4页Journal of Practical Radiology

摘　　要：目的：探讨乳腺影像报告及数据系统（BI-RADS）分类对影像学发现的不可触及乳腺病变的诊断及治疗价值。方法回顾性分析217例乳腺 X 线发现异常而临床不可触及肿块的患者,所有病例常规乳腺 X 线摄片,包括头尾位（CC）及内外斜位（MLO）,部分行局部点压摄影,再行三维立体定位活检。运用 BI-RADS 分类系统为乳腺影像分类,对比影像诊断与病理结果。分析 BI-RADS 分类对病理结果的预测价值。结果217例病例中,BI-RADS 诊断Ⅲ类98例,Ⅳ类81例,Ⅴ类38例。所有病例均经手术切除。立体定位导丝引导活检病灶术前 X 线片与术后标本 X 线影像相符率100%。检出恶性病变75例（34.6%,75/217）,其中原位癌39例,占检出恶性病变的52.0%（39/75）；良性病变142个。98例 BI-RADS Ⅲ类病变中恶性病变11个,81例 BI-RADSⅣ类病变恶性病变29个；38例 BI-RADS Ⅴ类病变恶性病变35个,BI-RADS Ⅲ类、Ⅳ类、Ⅴ类的阳性预测值（PPV）分别为11.2%（11/98）,35.8%（29/81）,92.1%（35/38）。其中Ⅳ类未绝经与绝经后的阳性预测值分别为24.5%（13/53）,57.1%（16/28）。结论BI-RADS 分类可以提高乳腺 X 线立体定位活检不可触及病变的早期乳腺癌的检出率。Objective To investigate the diagnostic value and therapeutic implication of breast imaging reporting and data system （BI-RADS）in non-palpable breast lesions detected by imaging.Methods 21 7 patients,who were found clinical non-palpable suspi-cious lesions in breast by X-ray examination,were enrolled in our study.All patients underwent general mammography （including craniocaudal view and mediolateral oblique view）and mammographic spot view in some patients,then were biopsied using 3D wire guided location biopsy.The predictive value of BI-RADS was analyzed by compare the imaging diagnosis with pathological results. Results Of the 21 7 cases,98 cases were diagnosed of grade Ⅲ,81 cases of grade Ⅳ and 38 cases of grade Ⅴ using BI-RADS.All cases were confirmed by surgery.All lesions were excised completely according to the preoperative 3D wire guided location biopsy. 75 lesions were malignant （34.6%,75/21 7）,including 39 cases of carcinoma in situ （52.0%,39/75）;142 lesions were benign.1 1 cases of grade Ⅲ,29 cases of grade Ⅳ and 35 cases of grade Ⅴ were malignant.The positive predictive value of BI-RADS for gradeⅢ,grade Ⅳ and grade Ⅴ was 1 1.2% （1 1/98）,35.8% （29/81）and 92.1% （35/38）respectively.The positive predictive value of BI-RADS Ⅳ for premenopausal and postmenopausal women was 24.5% （13/53）and 57.1% （1 6/28）.Conclusion BI-RADS can improve the resection rate and biopsy rate of non-palpable breast lesions by 3D wire guided location biopsy,and the detection rate of early breast cancer.

关 键 词：乳腺 乳腺影像诊断报告系统 立体定位活检 

分 类 号：R446.8[医药卫生—诊断学] R655.8[医药卫生—临床医学]