探讨低危团簇状钙化在BI-RADS的合理归类及第二眼超声检查的辅助鉴别价值  

Exploration on the rational classification of low-risk cluster calcification in BI-RADS and the auxiliary identification value of second-look ultrasound

作　　者：胡燕标 吴飞飞 张景峰 苏明进 陈富星 李铁丰 白延军 王金瑜 HU Yanbiao;WU Feife;ZHANG Jingfeng;SU Mingjin;CHEN Fuxing;LI Tiefeng;BAI Yanjun;WANG Jinyu(Department of Radiology, Beilun District People's Hospital of Ningbo City, Ningbo 315800, P.R.China;Department of Radiology, Hua Mei Hospital, University Of Chinese Academy of Sciences, Ningbo 315010, P.R.China)

机构地区：[1]浙江省宁波市北仑区人民医院放射科,浙江宁波315800 [2]中国科学院大学宁波华美医院放射科,浙江宁波315010

出　　处：《医学影像学杂志》2020年第7期1214-1217,1221,共5页Journal of Medical Imaging

基　　金：浙江省医药卫生科技计划项目(编号:2017ZH017)。

摘　　要：目的探讨在全数字化乳腺X线摄影筛查性检查中,低危团簇状钙化的BI-RADS合理归类,以及第二眼超声检查在辅助鉴别诊断中的价值。方法收集我院经FFDM筛查性检查发现的99例共计114处团簇状钙化,1周内进行针对性超声检查,1个月内经病理组织学结果证实。以病理学检查结果为标准,比较单纯FFDM和FFDM联合第二眼超声检查在乳腺癌检出率的差异。结果FFDM联合应用超声检查,诊断灵敏度从80%上升至100%,误诊率从27.5%小幅上升至30.3%,特异度从72.5%小幅降至69.7%,漏诊率从20%降至0%,阴性似然比从0.28降至0,阳性似然比从2.91升至3.3。结论FFDM结合第二眼超声检查,规避了患者在短期随访期间的等待恐惧,避免了不必要的穿刺活检甚至切除活检,同时提高了乳腺癌的检出率。基于本组结果提出的“团簇状钙化处理流程图”及增设“BI-RADS 4F”类别的建议,对临床工作有参考借鉴意义。Objective To investigate the rational classification of low-risk clustered calcifications in BI-RADS during the FFDM screening examination and the role of second-look ultrasonography in assisting differential diagnosis.Methods A total of 114 cluster-like calcifications were collected from 99 cases of FFDM screening examinations in our hospital.Targeted ultrasonography was performed within one week and confirmed by histopathological findings within one month.Based on the results of pathological examination,the difference in the detection rate of breast cancer between FFDM and FFDM combined with second-look ultrasound was compared.Results Combined with FFDM,the diagnostic sensitivity increased from 80%to 100%,the misdiagnosis rate increased slightly from 27.5%to 30.3%,the specificity decreased from 72.5%to 69.7%,and the missed diagnosis rate decreased from 20%to 0%.However,the ratio fell from 0.28 to 0,and the positive likelihood ratio rose from 2.91 to 3.3.Conclusion FFDM screening test combined with targeted second-look ultrasound examination avoids the patient's waiting for fear during short-term follow-up,avoids unnecessary needle biopsy or even excisional biopsy,and increases the detection rate of breast cancer.Based on the results of this study,the"cluster-like calcification processed flow chart"and the proposal to add the"BI-RADS 4F"category have reference significance for clinical work.

关 键 词：全数字化乳腺X线摄影 低危 团簇状钙化 乳腺影像报告和数据系统 超声检查 

分 类 号：R737.9[医药卫生—肿瘤] R445[医药卫生—临床医学]