组织谐波显像下BI-RADS分级的定量评分联合超声弹性成像评分诊断乳腺良恶性病灶的价值  

BI-RADS grading quantitative score under tissue harmonic imaging combine with ultrasound elastography in the diagnosis of benign and malignant breast lesions

作　　者：冯丽萍 杨映霞 

机构地区：[1]甘肃省定西市人民医院超声科,定西市743000

出　　处：《内科》2015年第6期805-808,836,共5页Internal Medicine

摘　　要：目的探讨组织谐波显像下BI-RADS分级定量评分联合超声弹性成像评分诊断乳腺良恶性病灶的价值。方法在组织谐波显像条件下分析363个经病理证实的乳腺病灶的10项超声特征,并对其进行赋分,给予超声BI-RADS综合评分及分级,再行弹性成像评分(以罗葆明改良5分法为标准),以病理结果为金标准,比较BI-RADS定量评分、弹性成像以及两者联合诊断乳腺病灶良恶性的准确率。结果 (1)以病理诊断为金标准,将肿块综合评分定为15分,即BI-RADS4b级作为诊断乳腺肿块良恶性的界点分值,其诊断灵敏度为80.3%,特异性为95.4%,阳性预测值为89.9%,阴性预测值为90.6%,准确率为90.3%,约登指数为0.76。(2)以病理诊断为金标准,将弹性成像评分≤3分定为良性,≥4分为恶性时,其诊断灵敏度为77.0%,特异性为91.7%,阳性预测值为82.5%,阴性预测值为88.8%,准确率为86.8%,约登指数为0.69。联合诊断准确率高于综合评分及弹性成像评分单独诊断。结论以超声诊断指标综合评分为量化依据对乳腺病灶进行BI-RADS分级诊断,可以使超声报告在一定程度上更客观及规范化,同时联合弹性成像进行判断可为临床评价乳腺病灶恶性风险程度提供更可靠的依据。Objective To investigate the diagnostic value of quantitative scores of BI-RADS classification under tissue harmonic imaging combined with the ultrasound elasticity imaging in the benign and malignant breast lesions. Methods Ten sonographic features of 363 breast lesions confirmed by pathology were analyzed using tissue harmonic imaging, the points of sonographic features were assigned, and the integrated grading and classification of ultrasonic BI-RADS were performed, and then scoring for elasticity imaging was conducted on the basis of Bao-ming Luo improved 5-scoring system, finally, the diagnostic accuracy of BI-RADS grading, elasticity imaging and the combination of the two in diagnosing benign and malignant breast lesions were evaluated by comparing with pathologic results. Results （1）With pathological diagnosis as the gold standard, breast lesions composite score was identified as the 15 points, the grade of 4b was used as the cut-point of BI-RADS to diagnose the benign and malignant breast lesions, its sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, Youden index were 80.3% , 95.4% , 89.9% , 90.6% , 90.3% , 0.76, respectively. （2） The score of elasticity imaging ≤3 was benign, while the score of elasticity imaging ≥ 4 was malignant, its sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, Youden index were 77.0%, 91.7%, 82.5% , 88.8% , 86.8% , 0.69, respectively. The diagnostic accuracy of combined diagnosis was higher than that of single diagnosis. Conclusions Ultrasound diagnostic indicator composite score for quantification of breast lesions based on BI-RADS classification diagnostics can objectify and normalize the ultrasonic report, and combined diagnosis can provide a more reliable basis for the evaluation of malignant potential of breast lesion.

关 键 词：乳腺病灶 组织谐波 弹性成像 超声检查 定量分析 

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]