超声引导下穿刺活检在乳腺非肿块样病变诊断中的应用价值

目的探讨超声引导下穿刺活检在乳腺非肿块样病变中的诊断价值。 方法选取2017年1月至2018年12月杭州市第一人民医院超声科经超声检查评估为乳腺影像报告与数据系统（BI-RADS）4a类及以上的乳腺非肿块样病变患者93例，共计93个病灶。所有病变均行超声引导下穿刺活检，并经手术病理证实。应用四格表计算超声引导下穿刺活检对乳腺非肿块样病变的诊断效能。 结果手术病理结果提示，恶性病灶47个，良性病灶46个。超声引导下穿刺活检结果提示恶性病灶43个，良性50个。穿刺活检漏诊4个恶性病灶，术前超声均提示为BI-RADS 4b，术后病理证实3例为导管原位癌和1例为浸润癌。超声引导下穿刺活检诊断乳腺非肿块样病变的敏感度为91.4%（43/47），特异度为100.0%（46/46），假阴性率为8.6%（4/47），诊断准确性为95.7%（89/93）。 结论超声引导下穿刺活检对乳腺非肿块样病变的诊断存在一定的假阴性率，但敏感度、特异度及准确性均较高，具有良好的诊断价值。

Application value of ultrasound-guided needle biopsy in diagnosis of non-mass breast lesions

ObjectiveTo assess the diagnostic value of ultrasound-guided needle biopsy in non-mass breast lesions. MethodsNinety-three patients with 93 non-mass breast lesions that were classified as Breast Imaging Report and Data System (BI-RADS) 4a and above at the Department of Ultrasound, Hangzhou First People's Hospital were selected from January 2017 to December 2018. All lesions underwent ultrasound-guided needle biopsy and were confirmed by surgical pathology. The fourfold table was used to assess the diagnostic value of ultrasound-guided needle biopsy in non-mass breast lesions. ResultsThe surgical pathology results showed that there were 47 malignant lesions and 46 benign lesions. In contrast, the results of ultrasound-guided needle biopsy showed 43 malignant lesions and 50 benign lesions. Four malignant lesions were missed by biopsy, which were classified as BI-RADS 4b by ultrasound but finally confirmed as ductal carcinoma in situ in three cases and invasive carcinoma in one case by surgical pathology. The sensitivity of ultrasound-guided needle biopsy was 91.4% (43/47), the specificity was 100% (46/46), the false negative rate was 8.6% (4/47), and the diagnostic accuracy rate was 95.7% (89/93). ConclusionAlthough ultrasound-guided needle biopsy has a certain false negative rate in the diagnosis of non-mass breast lesions, it has appreciated diagnostic value with regard to a relatively high specificity, sensitivity, and diagnostic accuracy rate.