超声BI—RADS分级在社区乳腺癌筛查中的价值

目的探讨乳腺超声影像报告和数据系统（Breast Imaging Reporting and Data System,BI-RADS）在乳腺癌筛查中的应用价值。方法对2011年1月1日～2013年4月30日在我院门诊、体检中心及社区作乳腺检查的1588例女性作了BI-RADS分级,并对其中111例经手术病理证实的患者结果与BI-RADS分级进行相关分析。结果1588例女性中,BI_RADS分级：1级3例（O．19％）;2级680例（42．82％）;3级748例（47．10％）;4级132例（8．31％）;5级25例（1．57％）。手术的111例患者中良性肿块71例,恶性肿块40例,与超声BI-RADS分级密切相关,尤其分级为4级、5级的患者,超声诊断与手术病理结果的符合率分别达到76％与96％。结论超声BI-RADS分级在社区乳腺癌筛查中,不但能提高诊断的特异性,而且还可提高时乳腺恶性肿瘤诊断的敏感性,具有重要的推广应用价值。     

Subcategorization of ultrasonographic BI-RADS category 4: positive predictive value and clinical factors affecting it

The objective of this study was to evaluate the positive predictive value (PPV) in ultrasonographically (US)-detected breast lesions of BI-RADS category 4a, 4b and 4c and to find how various clinical factors influenced the PPV of category 4. A total of 2142 women with 2430 breast lesions diagnosed on US as BI-RADS category 4 and underwent biopsy were included. Among them, 452 (18.6%) were pathologically confirmed as malignancy. PPV of each US BI-RADS subcategory was 7.6% (149/1963) for category 4a, 37.8% (68/180) for category 4b and 81.9% (235/287) for category 4c. Several clinical factors were more significantly seen in malignancy of category 4a and 4b, whereas none of the factors showed significance in category 4c. Subcategorization of category 4 is a feasible method in predicting malignancy in which patients’ age, lack of multiplicity and symptoms affected the PPV of category 4 lesions. (E-mail: ekkim@yuhs.ac)     

超声对乳腺实性包块的BI-RADS3、4、5分级与结果对照研究

目的探讨超声BI-RADS3、4、5分级对乳腺实性病变的诊断价值。方法回顾性分析经病理证实的193位患者231个病灶的BI-RADS3、4、5分级诊断的准确性及总体敏感性、特异性、准确性、阳性及阴性预测值。结果总体的敏感性、特异性、准确性、阳性及阴性预测值分别为68.4%、50.0%、68.4%、68.4%、100%。BI-RADS3、4、5分级的准确性分别为95.1%、44.3%、76.7%,各级之间比较差异均有统计学意义（P〈0.001）。结论超声BI-RADS分级诊断准确性不一致,对4级病变的穿刺活检具有较高必要性。对乳腺实性病变进行BI-RADS分级并提出进一步处理方案可细化对病变的评估。     

钼靶BI-RADS系统与病理快速冰冻在乳腺癌诊断中的对比研究

目的对比分析194例钼靶BI-RADS系统与病理快速冰冻在乳腺癌诊断中的差别,以期取长补短,提高正确诊断率。方法回顾性复习194例乳腺疾病的钼靶结果及病理资料,依据BI-RADS分级方法及WHO乳腺及女性生殖系统疾病标准,把进行乳腺病理快速冰冻检查的病例与其BI-RADS分级结果进行对比,分析BI-RADS系统分级与病理快速冰冻检查结果的符合率及可能原因。结果钼靶诊断与病理诊断总符合率96.39%,敏感度为97.62%,特异度为88.46%。结论病理快速冰冻检查结合钼靶诊断结果,可以对疾病有一个整体概念,指导取材,取长补短,能提高诊断的准确率。     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

乳腺导管原位癌的MRI表现及与病理分级的关系

背景与目的：乳腺导管原位癌(ductal carcinoma in situ,DCIS)的组织学分级是其预后的一个重要因素,高核级有较高的浸润趋势,且术后复发率高。本研究旨在评估DCIS的MRI表现及与病理学分级关系。方法：回顾性分析94例经病理证实为DCIS的MRI表现,分析其MRI形态学及动态增强表现,进一步讨论MRI特点与组织学核级别间的相关性。结果：94例患者中检出97个DCIS病灶,非肿块样强化病灶49个,其中节段样强化29个(59.18%);肿块样强化48个。动态增强表现：包括Ⅰ型曲线20个,Ⅱ型曲线50个,Ⅲ型曲线27个。BIRADS：BI-RADS 4A类22个,BI-RADS 4B类19个,BI-RADS 4C类29个,BI-RADS 5类27个。与组织病理学关系：HNGDCIS病变范围较non-HNG DCIS广(非肿块样强化：P=0.01;肿块样强化：P=0.03),而不同核级别DCIS的MRI形态学间差异无统计学意义(P>0.05),HNG DCIS时间信号强度曲线更易出现流出型(P=0.01),BI-RADS显示HNGDCIS更易被判定为BI-RADS 4C类及BI-RADS 5类(P=0.02)。结论：非肿块样强化DCIS以段样分布常见,结合形态学、血流动力学及BI-RADS分类,可较全面评价DCIS组织学核级别程度,对临床具有重要的指导意义。     

超声直接及间接征象的乳腺图像和报告数据体系评分对乳腺实性肿块的诊断价值

目的 探讨超声直接及间接征象乳腺图像和报告数据体系(BI-RADS)评分对乳腺实性肿块良恶性诊断的价值.方法 应用二维以及彩色多普勒技术检查并详细记录132个乳腺肿块的超声直接及间接征象,参照BI-RADS评分标准予以赋值评分,并与病理结果 进行对照.结果 由乳腺肿块直接征象(肿块纵横比、形态、边界、内部回声、后方回声、血流分级、微小钙化)以及间接征象(局部皮肤厚度改变、Cooper韧带改变、腋窝淋巴结肿大、深浅筋膜改变、肿块周边毛刺改变)综合而成的总积分在良恶性乳腺肿块组之间的差异有统计学意义,恶性肿块总积分为(8.94±2.85)分,高于良性肿块[(3.09±1.97)分,P＜0.05];除皮肤厚度改变外,其余各征象的积分在乳腺良恶性肿块组之间的差异均有统计学意义(均P＜0.05).依据受试者工作特性曲线(ROC曲线),直接征象中,总积分≥4分为最佳临界值,其诊断乳腺良恶性肿块的灵敏度和特异度分别为0.84和0.93;间接征象中,总积分≥1分为最佳临界值,其诊断乳腺良恶性肿块的灵敏度和特异度分别为0.82和0.74;二者联合后,总积分≥5分为最佳临界值,其诊断乳腺良恶性肿块的灵敏度和特异度分别为0.88和0.90.结论 对乳腺实性肿块的超声直接和间接征象特征进行赋值评分,可使诊断更加客观,是一种简便、有效的半定量、全面分析方法.

Abstract：

Objective To explore the value of BI-RADS ultrasonic scores of direct and indirect ultrasonographic signs in diagnosis of solid breast lesions. Methods Reference to the standard BI-RADS score,ultrasonic scores of direct and indirect ultrasonographic signs of 132 solid breast lesions were assigned, and were compared with pathological results. Results By the direct signs of breast lesions (aspect ratio, shape, border, internal echo, posterior echo, flow grade, sand-like calcification) and indirect signs (changes in local skin thickness, Cooper ligament changes, axillary lymph nodes, depth of reinforcement membrane changes, mass changes in the surrounding burr), the integral from the total scores in benign and malignant breast masses showed a statistically significant difference. The total score of malignant lesions (8.94±2.85) was significantly higher than that of benign tumors (3. 09±1. 97, P<0. 05). Except skin thickness, all the remaining scores of the signs of benign and malignant breast tumors showed a significant difference between the two groups (P<0.05). By receiver operating curve (ROC) analysis, the best critical value of the total score of direct signs was ≥4, with a sensitivity and specificity of 0. 84 and 0. 93, respectively, in distinguishing breast carcinoma from benign lesions. The best critical value of the total score of indirect signs was ≥1, with a sensitivity and specificity of 0. 82 and 0. 74, respectively. The critical value of the combination of the direct and indirect signs was ≥5 in differential diagnosis of malignant and benign lesions, with a sensitivity and specificity value of 0.88 and 0.90, respectively. Conclusion The assignment score to the ultrasound characteristics of the direct and indirect signs of solid breast lesions can make a more objective diagnosis, yet it is a simple, effective, comprehensive and semi-quantitative analysis method.     

超声介导下BI-RADS 4级乳腺肿物行空心针穿刺活检的诊断意义

目的:探讨超声介导下BI-RADS 4级乳腺肿物患者行空心针穿刺活检对肿物性质的诊断价值。方法:随机抽取我科于2014年1月-2014年12月共500例已行手术治疗的乳腺肿块患者,收集其穿刺病理与切检病理（包括术中快速冰冻切片或术后病理）结果,应用SPSS 17.0对其空心针穿刺活检与切除活检结果一致性作比较分析,并将超声下BI-RADS 4级的病例单独列出,检验组间一致性。结果:超声介导下空心针穿刺活检（US-CNB）与切除活检的病理诊断结果符合率为96.23%,BI-RADS 4级病例诊断结果符合率为94.57%,与整体准确率相差不大,与切除活检具有良好的一致性。结论:US-CNB作为对乳腺肿瘤的术前诊断手段之一,对超声下良恶性难以鉴别的BI-RADS 4级乳腺肿物具有较好的诊断价值。     

Probably Benign Solid Breast Lesions on Ultrasound: Need for Biopsy Reassessed

Objective: To determine the negative predictive value of ultrasound for breast masses with probably benignmorphology, and to assess whether follow-up may be an acceptable alternative to biopsy. Methods: After InstitutionalReview Board approval, all solid breast masses categorized as probably benign (American College of Radiology BreastImaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and havingeither tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillancewere included. Result: A total of 157 lesions in 40 patients constituted the study population. The mean patient age was31.3 years (range, 20-56 years). Seventeen of these 157 lesions underwent tissue diagnosis with no invasive breast cancer.Out of the remaining 140 lesions, 115 were stable on imaging for 24 months or more. The rest 25 were deemed benignbecause of decrease in size on follow up (n=1), non-recommendation of further imaging by the second radiologist onfollow up ultrasound (n= 13) or presence of benign tissue diagnosis in the largest lesion (n=11). Conclusion: Ultrasoundhas 100% negative predictive value for breast lesions with probably benign morphology, whether palpable or not.Follow up is an appropriate option to immediate biopsy of such lesions keeping in mind that noncompliance withsurveillance may be a potential problem.     

剪切波弹性成像鉴别诊断乳腺BI-RADS 4A类病灶良恶性的价值

目的探讨剪切波弹性成像鉴别诊断乳腺影像报告和数据系统(BI-RADS)4A类病灶良恶性的价值。方法回顾性分析131例乳腺病变患者(共133个BI-RADS 4A类病灶)的常规超声及剪切波弹性成像检查资料,根据病理结果分为良性组110个和恶性组23个。获取并比较两组病灶的剪切波速度最大值(SWVmax)、剪切波速度最小值(SWVmin)、剪切波速度差值(ΔSWV)及弹性彩色模式。以病理结果为金标准,绘制上述各参数诊断乳腺BI-RADS 4A类病灶良恶性的受试者工作特征(ROC)曲线,计算并比较其曲线下面积(AUC)。将剪切波弹性成像各参数联合临床资料、常规超声特征构建Logistic回归模型并验证其诊断效能。结果两组年龄、Adler血流分级、SWVmax、SWVmin、ΔSWV及弹性彩色模式比较,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,SWVmax、SWVmin、ΔSWV及弹性彩色模式鉴别乳腺病灶良恶性的AUC分别为0.767、0.643、0.755及0.780,敏感性分别为65.2%、60.9%、69.6%及69.6%,特异性分别为90.0%、60.9%、86.4%及86.4%,SWVmax、ΔSWV及弹性彩色模式的AUC比较差异均无统计学意义,但均高于SWVmin(均P<0.05)。将年龄(X1)、Adler血流分级(X2)及弹性彩色模式(X3)纳入回归模型,建立的Logistic回归方程为:Logistic(P)=-7.579+1.078X1+4.986X2+7.376X3,其AUC、敏感性及特异性分别为0.864、78.3%及90.9%,诊断效能明显大于剪切波弹性成像各参数(均P<0.05)。结论剪切波弹性成像在乳腺BI-RADS 4A类病灶良恶性的鉴别诊断中有一定价值,其中SWVmax、ΔSWV及弹性彩色模式的诊断性能较高,弹性彩色模式联合年龄、Alder血流分级可提高BIRADS 4A类恶性病灶的检出率。