建立乳腺超声BI—RADS评估分类评分标准的初步研究  

A detailed criterion of BI-RADS assessment category based on US-BI-RADS： a preliminary study

作　　者：赵海娜[1] 彭玉兰[1] 骆洪浩[1] 何玉霜[1] 金亚[1] 杨盼[1] 

机构地区：[1]四川大学华西医院超声科,成都610041

出　　处：《中华超声影像学杂志》2015年第3期242-245,共4页Chinese Journal of Ultrasonography

基　　金：四川省科技厅支撑项目（21112SZ0145）;成都市科技局（12PPYB053SF-002）

摘　　要：目的基于乳腺超声图像特征建立BI—RADs评估分类评分系统，旨在为超声医师提供乳腺超声评估分类的客观依据。方法回顾分析2011年1—9月及2012年1月行乳腺超声检查并经病理证实的1938例女性病例，以21）11年病例为模型病例，通过单因素分析，获得各个超声征象诊断乳腺癌的权重，依据各特征的权重给予相应的赋值，建立评估分类评分标准模型，以乳腺影像报告与数据系统第4版为标准，提出BI—RADS评估分类3类、4类、5类及4类亚类的分类评分标准；最后以2012年病例为测试病例，验证该评分标准的有效性。结果纳入24个BI—RADS征象术语，其中18项差异有统计学意义（P〈0．05）。依据OR值大小，将征象分为大征象、中征象、小征象3类，各类赋值分别为3分、2分、1分，建立评分模型如下：Score=3＊（X1＋X2＋…＋X6）＋2＊（X7＋X8＋…＋X12）＋（X9＋X10＋…＋X18），其中X1-X18依次为Cooper韧带受牵拉、强回声晕、皮肤增厚、腋窝淋巴结、结构扭曲、边缘毛刺征、不规则形、模糊、水肿、边界不完整、阻力指数≥0．7、肿块内微钙化、成角、流速≥20cm／s、后方回声衰减、方位不平行、微小分叶、血流分级为Ⅱ级或Ⅲ级。依据BI—RADS标准，假设〈2分为3类，2≤Score〈6分为4A类，6≤Scored10分为4B类，10≤Score〈16分为4C类，≥16分为5类。模型病例与测试病例3类、4A类、4B类、4C类及5类阳性预测值分别为1．5％／1．4％、6．9％／3．4％、22．1％／21．1％、62．5％／69．4％、96．1％／92．7％。结论数据评分系统能够客观评估乳腺肿块B1-RADS标准分类，便于医生间交流和预测乳腺癌危险度。Objective To set up an objective criterion for BI-RADS assessment. Methods The breast sonograms of 1 938 female cases were retrospectively studied which had been confirmed by pathology from January to September 2011 and 2012 January. 1 660 cases during 2011 were model cases, and the importance of each single feature in distinguishing between benign and malignant was obtained with Chi square and OR value. A detailed criterion of BI-RADS assessment category was set up based on US-BI-RADS. Results Eighteen of 24 lexicons were statistically significant distinguished between benign and malignant breast masses（ P 〈0.05）. The lexicons were divided into major suspicious signs, middle ones and minor ones assigned 3 points,2 points and 1 point,and a scoring model was established as follows：Score= 3 ＊ （X1 ＋ X2 ＋ …… ＋ X6 ） ＋ 2 ＊ （X7 ＋ Xs ＋ …… ＋ X12 ） ＋ （X9 ＋ X10（, ＋…… ＋ X18 ）. Based on BI-RADS,the positive predictive value of model cases was 1.5 %, 6.9 % ,22.1% ,62.5 % ,96.1 % followed by category 3,4A, 4B, 4C and 5, and it was 1.4%,3.4% ,21.1 % ,69.4% ,92.7% in test cases. Conclusions The scoring model could be useful for BI-RADS final assessment more obieetively,and could make it more convenient to predict the risk of breast cancer.

关 键 词：超声检查 乳腺疾病 乳腺影像报告与数据系统 

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]