乳腺超声造影对BI-RADS-US 4类不典型乳腺病变再次分级的诊断价值  

Diagnostic value of contrast-enhanced ultrasound in reclassification of BI-RADS-US type 4 atypical breast lesions

作　　者：高军喜[1] 迪力木拉提.艾斯木吐拉 杨磊[1] 宋涛[1] GAO Junxi;Di li mu la ti·Ai si mu tu la;YANG Lei;SONG Tao(Department of Abdomenal Ultrasound Diagnosis,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院腹部超声诊断科,乌鲁木齐市830011 [2]新疆医科大学第一附属医院乳腺外科,乌鲁木齐市830011

出　　处：《临床超声医学杂志》2018年第12期811-814,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨乳腺超声造影特征对乳腺超声影像报告和数据系统(BI-RADS-US)4类乳腺不典型病变再次分级的诊断价值。方法选取我院经手术病理证实的乳腺病变患者124例,共计130个病灶,其中良性67个,恶性63个。术前常规超声检查BI-RADS-US 4类分类后行超声造影检查,依据病变恶性造影特征(不均匀增强、周边环状高增强、增强后范围扩大、内部充盈缺损、周边放射性汇聚)再次对病变进行分级诊断,无其中任意一项恶性造影特征者降为3级,具备其中任意一项者升1级,具备其中任意两项者升2级,具备其中三项及以上者升为5级;依据手术病理结果探讨超声造影恶性特征对BI-RADS-US 4类不典型乳腺病变再次分级诊断价值。结果造影前BI-RADS-US 4A类病灶61个,4B类病灶41个,4C类病灶28个;超声造影再次分级后BI-RADS-US 3类病灶49个,BI-RADS-US 4A类病灶13个,4B类病灶7个,4C类病灶12个,5级病灶49个;超声造影诊断BI-RADS-US 4类病灶敏感性、特异性、准确率、阳性预测值和阴性预测值分别为90.4%、83.6%、86.9%、83.8%、90.3%,依据恶性肿瘤超声造影特征再次分级能够降低良性病灶穿刺活检率[68.7%(46/67)],同时提高恶性病灶诊断准确率[73.0%(46/63)]。结论依据乳腺肿瘤恶性造影特征对BI-RADS-US4类不典型病灶再次分级,既可降低BI-RADS 4类不典型病灶穿刺活检风险,又可提高该类病变中恶性病灶诊断准确率,优化BI-RADS-US 4类病变分级,更好地为临床提供诊断及治疗的参考依据。Objective To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)imaging features in reclassification of breast imaging reporting and data system for ultrasonography(BI-RADS-US)type 4 atypical breast lesions.Methods A total of 124 BI-RADS-US type 4 patients with 130 lesions(67 benign lesions and 63 malignant lesions)confirmed by surgical pathology were examined by CEUS and reclassified before surgery according to five contrast-enhanced malignant imaging features:inhomogeneous enhancement,peripheral ring-like enhancement,expansive enhancement,internal filling defects and surrounding radioactive convergence.Lesions without contrast-enhanced features of malignancy were categorized as type 3,lesions with one,two or three features of malignancy were categorized as type 4A,4B or 4C,respectively,and lesions with four or more indices of malignancy were categorized as type 5.The value of CEUS features of malignancy in diagnosing BI-RADS-US type 4 atypical breast lesions was analyzed.Results BI-RADS-US 4A lesions were 61,41 lesions of 4B,28 lesions of 4C before CEUS.Reclassied grade BI-RADS-US 3 lesions were 49,13 lesions of 4A,7 lesions of 4B,12 lesions of 4C,49 lesions of 5 grade after CEUS.The sensitivity,specificity,accuracy,positive and negative predictive value CEUS in the diagnosis of BI-RADS-US 4 atypical breast lesions were 90.4%,83.6%,86.9%,83.8%,90.3%,respectively.The benign lesion biopsy ratio decreased to 68.7%(46/67)and the diagnosis ratio of malignant lesions increased to 73.0%(46/63)according to the features of breast malignant tumor imaging characteristics.Conclusion Breast malignant tumor imaging characteristics of BI-RADS-US 4 atypical lesions can reduce BI-RADS-US 4 atypical lesions biopsy risk,also can improve malignant lesions diagnostic confidence at the same time,which optimize the BI-RADS-US 4 atypical breast lesions classification to better provide reference basis for clinical diagnosis and treatment of BI-RADS-US 4 atypical breast lesions.

关 键 词：超声检查 造影剂 造影特征 恶性 乳腺超声影像报告和数据系统4类 分级 

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]