乳腺CEUS预测模型诊断乳腺恶性病灶的观察者间一致性:多中心研究

目的 探讨拉伸指数模型DWI鉴别诊断乳腺良恶性病变的价值。方法 收集58例乳腺病变患者，共63个病灶（良性33个，恶性30个），行多b值DWI及动态增强MRI （DCE-MRI）扫描。计算ADC、扩散分布指数（DDC）和扩散异质性指数（α）值，并生成时间-信号强度曲线（TIC）。比较良恶性病变间各参数差异，采用ROC曲线评价各参数诊断效能。结果 恶性病变ADC、DDC和α分别为（1.01±0.19）×10^-3 mm²/s、（0.89±0.23）×10^-3 mm²/s和0.75±0.09，良性病变分别为（1.41±0.27）×10^-3 mm²/s、（1.49±0.29）×10^-3 mm²/s和0.87±0.07，恶性病变均低于良性病变（P均<0.01）。各参数中DDC曲线下面积（AUC）最大（AUC=0.958），最佳诊断界值1.22×10^-3 mm²/s，敏感度和特异度分别为96.67%、81.82%，DDC与TIC联合所得AUC为0.976，对应敏感度和特异度分别为93.33%、93.94%。结论 拉伸指数模型DWI参数DDC、α能够鉴别诊断乳腺良恶性病变，DDC与TIC联合的诊断效能高于ADC和DCE。

Consistency of different physicians in diagnosis of malignant breast lesions with breast CEUS predictive model: A multicenter study

Objective To explore the consistency of different physicians in diagnosis of malignant breast lesions with breast CEUS predictive model. Methods Totally 953 patients with solitary breast nodule from multicenter who underwent ultrasound and CEUS were collected. The research team was composed by the initial group (one junior physician from each hospital), check group (one or two physicians who had at least two-year experience of CEUS examination from each hospital), research group (two senior physicians from Sichuan Academy of Medical Sciences & Sichuan Provincial People''s Hospital) and cross-blinded group (one or two vice directors or chief physicians from each hospital). At first, the lesions were classified according to the breast imaging reporting and data system (BI-RADS) by the initial group and the check group, then new BI-RADS classifications were performed by research group and cross-blind group with breast CEUS predictive model. The consistency of different physicians in diagnosis of malignant breast lesions was analyzed. Results Among 953 patients, benign lesions were found in 451 patients (451/953, 47.32%), malignant lesions were found in 435 patients (435/953, 45.65%), and precancerous lesions were found in 67 patients (67/953, 7.03%). The accuracy of the initial group, check group, research group and cross-blinded group was 71.67%(683/953), 74.92%(714/953), 80.17%(764/953) and 83.42%(795/953), respectively. The consistency of different physicians for diagnosis of malignant breast lesions between initial group and check group was good (Kappa=0.82, P<0.001), while between initial group and cross-blinded group, initial group and research group were both moderate (Kappa=0.56, 0.41; all P<0.001). The consistency of different physicians for diagnosis of malignant breast lesions between check group and cross-blinded group, between check group and research group were both moderate(Kappa=0.68, 0.51; all P<0.001). The consistency between research group and cross-blinded group with breast CEUS predictive model was moderate (Kappa=0.74, P<0.001). Conclusion The consistency of different physicians in diagnosis of malignant breast lesions with breast CEUS predictive model was moderate.