超声造影定量参数在乳腺BI-RADS 4a类病灶再分类中的应用价值  

The application value of quantitative parameters of contrast-enhanced ultrasound in the re⁃classification of BI-RADS 4a lesions

作　　者：韦立丽 梁子轩 曾琪[1] 董德福 谭启杏 韦长元[2] 杨伟萍[1] Wei Lili;Liang Zixuan;Zeng Qi;Dong Defu;Tan Qixing;Wei Changyuan;Yang Weiping(Department of Ultrasound,Affiliated Cancer Hospital of Guangxi Medical University,Nanning 530021,China;Department of Breast Surgeons,Affiliated Cancer Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院超声科,南宁530021 [2]广西医科大学附属肿瘤医院乳腺外科,南宁530021

出　　处：《广西医科大学学报》2021年第3期561-565,共5页Journal of Guangxi Medical University

基　　金：广西自然科学基金资助项目(No.2015GXNSFAA414003)。

摘　　要：目的:探讨超声造影(CEUS)定量参数在乳腺影像报告和数据系统(BI-RADS)4a类病灶再分类中的应用价值。方法:收集经CEUS检查的乳腺病患者364例,共373个病灶,包括83个良性病灶和290个恶性病灶,通过比较良、恶性病灶CEUS定量参数,找出在良、恶性病灶间存在显著差异的CEUS定量参数,构建受试者工作特征曲线(ROC曲线),同时取得差异定量参数的最佳截断值,将最佳截断值作为再分类的指标。另外,收集BI-RADS 4a类共79个乳腺病灶,以最佳截断值为再分类指标对病灶进行再分类,当病灶的定量参数均低于最佳截断值时,将其降为3类,有一个及以上定量参数高于对应最佳截断值时,保持原分类。比较BI-RADS 4a类病灶调整分类前、后活检率及恶性检出率变化差异。结果:良、恶性病灶在峰值强度、曲线斜率、曲线下总面积、流入面积、流出面积间比较,差异有统计学意义(P<0.05),最佳截断值分别为1.55、0.35、110.5、5.65、108.9,根据五者最佳截断值对所有79个BI-RADS 4a类病灶进行再分类,降为BI-RADS 3类的病灶共41个,维持BI-RADS 4a类病灶共38个,调整分类后活检率降为48.10%,调整前、后比较,差异有统计学意义(P<0.05);调整前、后恶性检出率比较,差异无统计学意义(P>0.05)。结论:超声造影定量参数峰值强度、曲线斜率、曲线下总面积及流入面积、流出面积可作为BIRADS 4a类病灶的再分类指标,可减少不必要的病灶穿刺活检。Objective:To explore the application value of quantitative parameters of Contrast-enhanced ultrasound(CEUS)in the reclassification of BI-RADS 4a lesions.Methods:A total of 364 breast disease including 373 lesions(83 benign lesions and 290 malignant lesions)were collected.By comparing the CEUS quantitative parameters of benign and malignant lesions,we found out CEUS with significant different quantitative parameters between benign and malignant lesions.Receiver Operating Characteristic(ROC)curve was constructed,and the best cut-off value of the difference quantitative parameter was obtained,and the best cut-off value was used as the index for reclassification.In addition,a total of 79 breast lesions in BI-RADS 4a category were collected,and the best cut-off value was used to reclassify the lesions.When the quantitative parameters of the lesions were all lower than the best cut-off value,they were considered as BI-RADS 3.When one or more quantitative parameters were higher than the corresponding best cut-off value,the original classification was maintained.Finally,we also compared the changes in the rate of biopsy and the detection rate of malignancy before and after the classification of BI-RADS 4a lesions.Re-sults:There was significant differences in the peak intensity,slope,total area under the curve,inflow area and flow area between benign and malignant lesions(P<0.05).The best cut-off values were 1.55,0.35,110.5,5.65 and 108.9,respectively.According to the best cut-off values of the quantitative parameters,all 79 BI-RADS Class 4a lesions were reclassified,and 41 lesions were consider as BI-RADS 3,38 lesions were maintained in BIRADS 4a,and the rate of biopsy required after classification was adjusted to 48.10%,the difference was statistically significant(P<0.05),there was no significant difference in the detection rate of malignancy(P>0.05).Conclusion:The quantitative parameters of contrast-enhanced ultrasound,including peak intensity,total area under the curve,and inflow area,could be used as reclassification

关 键 词：超声造影 乳腺病灶 定量参数 

分 类 号：R445[医药卫生—影像医学与核医学]