复合多模态超声技术成像鉴别结节性ACR BI-RADS 4类乳腺病变的应用价值  

The Application Value of Composite Multimodal Ultrasound Imaging in Differentiating Malignant From Benign ACR BI-RADS Category 4 Nodular Breast Lesions

作　　者：肖美华[1] 裴书芳[1] 丛淑珍[1] 刘娟娟[1] 冯占武[1] 郭玉萍[1] XIAO Mei-hua;PEI Shu-fang;CONG Shu-zhen;LIU Juan-juan;FENG Zhan-wu;GUO Yu-ping(Department of Ultrasound,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院超声科、广东省医学科学院,广州510080

出　　处：《循证医学》2021年第4期232-239,共8页The Journal of Evidence-Based Medicine

基　　金：广东省医学科学技术研究基金(B2019120);广东省医学科学技术研究基金(C2018001)。

摘　　要：目的探讨多模态超声超微血流成像(superb microvascular imaging,SMI)、实时组织超声弹性成像(real-time tissue ultrasound elastography,RTE)及常规彩超(ultrasound,US)在鉴别结节性美国放射学会(American College of Radiology,ACR)乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)4类乳腺病变上的应用价值。方法纳入300名患者共325个ACR BI-RADS 4类乳腺结节,术前均进行多模态超声成像检查。以病理结果为诊断金标准,比较各种方法的敏感性、特异性、准确性、阳性预测值(positive predictive value,PPV)、阴性预测值(negative predictive value,NPV)及多模态超声联合应用时的诊断效能。结果在鉴别诊断结节性BI-RADS 4类乳腺病变良恶性上,在诊断的敏感性、特异性、准确性、PPV、NPV方面,US分别为75.41%、72.41%、73.54%、62.16%、83.05%;SMI分别为86.01%、88.67%、87.69%、82.03%、91.37%;RTE分别为87.70%、89.16%、88.62%、82.31%、92.35%;多模态超声成像联合诊断分别为95.08%、93.10%、93.85%、91.34%、95.45%。US、SMI、RTE和多模态超声联合成像在鉴别诊断结节性BI-RADS 4类病变时,受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)分别为73.9%、88.6%、90.5%和97.0%。结论多模态超声成像能够弥补常规超声成像在鉴别结节性ACR BI-RADS 4类乳腺病变良恶性上的劣势,提供更全面、丰富的诊断信息,显著提高难鉴别良恶性ACR BI-RADS 4类乳腺结节的诊断效能。Objective To investigate the application value of superb microvascular imaging(SMI),real-time tissue ultrasound elastography(RTE),and conventional high-frequency color Doppler ultrasound(US) in differentiating malignant from benign American College of Radiology(ACR)Breast Imaging Reporting and Data System(BI-RADS)category 4 nodular breast lesions.Methods were included. Multimodal ultrasound including US,SMI and RTE were performed before surgery. The sensitivity,specificity,accuracy,positive predictive value(PPV),negative predictive value(NPV)and diagnostic efficiency of multimodal ultrasound were compared with pathological result.Results BI-RADS category 4 nodular breast lesions,the sensitivity,specificity,accuracy,PPV and NPV of US were 75.41%,72.41%,73.54%,62.16% and 83.05%,respectively;those of SMI were 86.01%,88.67%,87.69%,82.03% and 91.37%;those of RTE were 87.70%,89.16%,88.62%,82.31% and 92.35% respectively;and those of multimodalultrasound combined diagnosis were 95.08%,93.10%,93.85%,91.34% and 95.45%,respectively. The area underreceiver operating characteristic curve(AUC) was 73.9%、88.6%、90.5% and 97.0% for US,SMI,RTE and multimodal ultrasound imaging in the differential diagnosis of ACR BI-RADS category 4 nodular breast lesions.Conclusions Multimodal ultrasound imaging can compensate the disadvantages of single imaging technology,especially conventional US,in differentiating malignant from benign ACRBI-RADS category 4 nodular breast lesions,and provide more comprehensive diagnostic information of nodules,and significantly improve the diagnostic efficiency of ACR BI-RADS category 4 breast nodules which were difficult to identify from malignant to benign lesions.

关 键 词：多模态超声成像 超微血流成像 实时组织弹性成像 结节性ACR BI-RADS 4类乳腺病变 

分 类 号：R730.41[医药卫生—肿瘤] R737.9[医药卫生—临床医学]