乳腺超声造影联合腺体分型对BI-RADS 4a类肿块的诊断价值  

Add to Favorite The Diagnostic Value of Contrast-Enhanced Ultrasound in BI-RADS Category 4a Masses of Different Breast Gland Types

作　　者：徐彤 王勇 王博 龚萱桐 张萱 杨娣 Xu Tong;Wang Yong;Wang Bo;Gong Xuantong;Zhang Xuan;Yang Di(Department of Ultrasound,Shunyi Maternal and Children's Hospital of Beijing Children's Hospital,Beijing 101300,China;Department of Ultrasound,Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing100021,China;Department of Ultrasound,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京市顺义区妇幼保健院,北京儿童医院顺义妇儿医院超声科,北京市101300 [2]中国医学科学院北京协和医学院肿瘤医院超声科,北京市100021 [3]北京中医药大学东直门医院超声科,北京市100700

出　　处：《中国超声医学杂志》2024年第11期1213-1216,共4页Chinese Journal of Ultrasound in Medicine

基　　金：北京协和医学院“协和青年科研基金”(No.2017320015)。

摘　　要：目的探讨超声造影联合乳腺X线腺体分型对BI-RADS 4a类肿块的诊断价值。方法选取就诊的常规超声诊断为乳腺BI-RADS 4a类的140例结节为研究对象,所有结节均行超声造影和乳腺X线检查,并行超声造影评分和乳腺X线腺体分型,以病理检查结果为金标准,分析超声造影评分及乳腺腺体类型评价乳腺良恶性肿块的诊断效能;并依据乳腺X线分型及超声造影评分最佳截断值调整分类诊断。结果140例患者122例为良性,恶性患者18例,排在前3位的分别为腺病、乳腺纤维腺瘤、导管内乳头状瘤,分别为50例、38例、28例;乳腺X线腺体分型:散在纤维腺体型18例,不均匀致密型94例,极度致密型28例;超声造影以3分为界,用于乳腺肿块良恶性鉴别的灵敏度、特异度及AUC分别为92.31%、81.68%及0.894;乳腺X线分型辅助诊断的灵敏度、特异度及AUC分别为63.69%、72.43%及0.732;140例患者经校正后34例患者分级维持(24.29%),10例良性患者及12例恶性患者BI-RADS上调为4b、4c及5类,常规超声84例降为3类。结论超声造影评分联合乳腺X线分型的评级调整方案,能降低部分由常规超声诊断为BI-RADS 4a类肿块的风险,减少4a类病变不必要的穿刺活检。Objective To explore the diagnostic value of contrast-enhanced ultrasound in BI-RADS category 4a masses of different breast gland types.Methods A total of 140 BI-RADS 4a breast masses diagnosed by conventional ultrasound were selected as the study subjects.All cases underwent contrast-enhanced ultrasound and molybdenum target X-ray examination.Each mass was scored with contrast-enhanced ultrasound and molybdenum target X-ray.The pathological examination results were used as the“gold standard”.The receiver operator characteristic(ROC)curve was drawn.We analyzed the diagnostic efficacy of contrast-enhanced ultrasound scores and breast gland types in differentiating the benign and malignant breast masses.Adjustment and classification of the enrolled cases was performed with the help of molybdenum target classification and the best cut-off value of contrast-enhanced ultrasound score.Results There were 122 cases of benign masses in the 140 patients and 18 cases of malignancy.The top three lesions were adenosis,breast fibroadenoma,and intraductal papilloma,which were 50 cases,38 cases,and 28 cases,respectively.Breast X-ray gland classification:18 cases were of the scattered fibroglandular body type,94 were uneven dense type,and 28 were extremely dense type;The sensitivity,specificity,and areas under the curves(AUCs)of the contrast-enhanced ultrasound to differentiate between the benign and malignant breast masses were 92.31%,81.68%,and 0.894,respectively,with a 3-point boundary;The sensitivity,specificity,and AUCs of molybdenum target typing for auxiliary diagnosis were 63.69%,72.43%,and 0.732,respectively;After correction,34 out of 140 patients maintained their classification(24.29%),while 10 benign and 12 malignant patients were up-regulated to BI-RADS categories 4b,4c,and 5.84 routine ultrasound classifications were down-regulated into the category 3.Conclusions The grading adjustment scheme of contrast-enhanced ultrasound scoring combined with molybdenum target classification can reduce the risk of misclassific

关 键 词：超声造影评分 乳腺X线分型 乳腺腺体类型 BI-RADS 4a类肿块 诊断价值 

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]