乳腺病灶影像报告数据系统分级的超声诊断指标量化研究

目的 探讨基于病灶超声特征评分进行乳腺影像报告数据系统(BI-RADS)分级的意义.方法 分析1005个经病理证实的乳腺病灶声像图,对所有病灶的形状、边缘、回声、纵横比、周边强回声晕、后方回声、钙化、内部血流、腋下肿大淋巴结及年龄等10项指标进行综合评分并按分值进行分组,将各组病灶中恶性构成比与不同BI-RADS分级的理论恶性风险值比较,得出超声诊断指标评分与BI-RADS分级之间的对应关系.结果 (1)超声诊断指标评分≤3分、4分、5分、6分、7分、8分、9分、10分、11分、12分、13分、14分、≥15分各组病灶中恶性构成比分别为0、1.6%、4.3%、8.8%、29.5%、42.1%、55.3%、69.7%、79.2%、73.0%、77.8%、95.7%、94.5%;(2)与BI-RADS 2、3、4a、4b、4c、5级相对应的评分分别为≤3分、4分、5～7分、8～9分、10～13分、≥14分;(3)将超声征象评分为8分,即BI-RADS 4b作为临床诊断的分界点,诊断乳腺良恶性病灶的敏感度、特异度、准确度、阴性预测值、阳性预测值分别为90.2%、90.1%、90.2%、95.3%、80.7%.结论 以超声诊断指标评分为量化依据对乳腺病灶进行BI-RADS分级诊断,可以使超声报告得到一定程度的客观化及规范化,为临床评价乳腺病灶恶性风险程度提供可靠依据.

Quantity research of sonographic images for breast imaging reporting and data reporting and data system grading in breast lesions

Objective To investigate the value of breast imaging reporting and data reporting and data system （BI-RADS） assessment category based on the scores of sonographie features in the breast lesions. Methods The ultrasonic images for 1005 breast lesions confirmed by pathology were retrospectively reviewed. The age and the features of sonographic images including lesion shape, margin, halo, taller-than- wider, posterior attenuation, microcalcification, flow, lymph node were analyzed, then the scores were ob- tained due to the features. And the lesions were classified according to the scores. In each group, the malignant predicted value was compared with theorized risk degree of malignancy by BI-RADS to obtain the relationship between score and BI-RADS. Results The proportion of malignant lesions in score ≤3,4,5,6,7, 8 ,9 ,10,11,12,13 14 and ≥15 were 0,1.6% ,4.3% ,8.8% ,29.5% ,42.1% ,55.3% ,69.7% ,79.2%, 73.0% ,77.8% ,95.7% and 94.5% , respectively. The 2, 3,4a, 4b, 4c and 5 by BI-RADS were corresponded to score≤3,4,5 - 7,8 -9,10 -13 and ≥ 14, respectively. Score 6 or BI-RADS 4b was the best cut-off value by ultrasonography for differentiating malignant and begin breast lesions. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value were 90.2%, 90. 1%, 90.2% , 95.3% and 80.7% , respectively. Conclusion BI-RADS assessment category according to sonographic feature scores can partly standardize ultrasonic report and offer reliable guiding information for clinical diagnosis and treatment of breast disease.