乳腺微钙化BI-RADS分类的临床阳性预测值分析

目的分析乳腺微钙化病变BI-RADS分类的阳性预测值及意义。方法收集经手术证实的52例乳腺患者资料,钼靶X线片均显示有微钙化。根据BI-RADS分类标准进行良恶性评估,分为3~5级,与病理结果对照比较。结果BI-RADS分类对3级病变的诊断准确率、5级病变的阳性预测值分别为100%、95.2%;恶性肿瘤组的阳性预测值达100%;良性病变组的评估中存在66.7%(10/15)高估现象;微钙化伴肿块或致密影的阳性预测值较单纯钙化组高;微钙化呈段样、区域性分布时恶性风险较高。结论乳腺微钙化BI-RADS分类对3级、5级病变的临床阳性预测有较高价值,但对4级微钙化病变诊断特异性较低,需结合其他检查,避免不必要的活检。     

BI-RADS 3-5级在乳腺肿瘤临床诊断中的作用分析

目的探讨超声乳腺影像报告和数据系统(BI-RADS)3-5级在乳腺肿瘤临床诊断中的作用。方法选取本院乳腺肿物超声诊断为BI-RADS 3-5级的乳腺肿瘤患者63例。以病理结果为金标准,判断BI-RADS 3-5级在乳腺肿瘤中诊断价值。结果结果显示,41例为良性病变,22例为恶性病变;以病理结果为标准,BI-RADS 5级中恶性病变符合率高于3级、4级,且4级符合率高于3级,差异有统计学意义(P0.05);BI-RADS 4c组恶性病变符合率高于4a组、4b组,差异有统计学意义(P0.05);声像图特征上,BI-RADS 3级肿块形态规则,边缘清晰,纵横比≧1,无微钙化、后方回声衰减;BI-RADS 4级肿块大多形态规则、边缘清晰,纵横比多≧1,少部分存在微钙化、后方回声衰减;BI-RADS 5级肿块形态不规则,边缘模糊,纵横比多1,大多存在微钙化、后方回声衰减。结论 BI-RADS 3-5级可为良恶性乳腺肿瘤诊断、鉴别提供可靠依据。     

实时超声造影对提高乳腺肿瘤BI-RADS分类准确性的价值

目的探讨超声造影对提高乳腺肿瘤乳腺影像报告和数据系统(BI-RADS)分类准确性的价值。资料与方法收集151个乳腺肿瘤的常规超声及超声造影资料,根据常规超声进行BI-RADS分类;并行超声造影检查,结合病灶造影增强扫描特点重新进行分类,与病理结果进行比较,并比较常规超声BI-RADS分类与结合超声造影的BI-RADS分类对乳腺肿物恶性风险分层的评估能力。结果结合超声造影增强扫描特点后,BI-RADS分类的变化主要发生在3类和4A类,常规超声BI-RADS分类评估诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为92.2%、52.1%、72.8%、80.5%、75.7%;结合超声造影图像特点后的BI-RADS分类,其诊断特异度、准确度、阴性预测值分别提高至72.9%、86.8%、83.3%,与常规超声比较,差异有统计学意义(P<0.05)。常规超声BI-RADS分类评估ROC曲线下面积为0.802,与结合超声造影后的曲线下面积0.878比较,差异有统计学意义(P<0.05)。结论在常规超声BI-RADS分类的基础上,结合病灶的造影增强模式有助于提高超声BIRADS分类对乳腺肿块恶性风险分层的评估能力。     

男性乳腺疾病的超声诊断

目的探讨男性乳腺常见疾病的声像图表现,以提高其诊断水平。方法 82例经超声检查并经临床证实的男性乳腺疾病,包括乳腺发育症65例,乳腺炎7例,乳腺癌5例,乳腺纤维腺瘤2例,乳腺脂肪瘤3例,对所有患者的声像图表现进行了回顾性分析。结果声像图显示男性乳腺疾病随病种而有不同表现,乳腺发育症呈弥漫型与结节型低回声区;乳腺癌呈边界不清和内部回声不均匀的病灶,常伴灶内微小钙化;急性乳腺炎表现为乳头周围局限性低回声区,边界清楚,回声均匀,而慢性乳腺炎表现为乳房内不均质低回声区;乳腺纤维腺瘤表现为椭圆形实质低回声光团,边缘光整;乳腺脂肪瘤表现为边界清楚的扁椭圆形稍高或低回声光团。本组2例慢性乳腺炎误诊为乳腺癌。诊断敏感性、特异性、准确性、阳性预测值及阴性预测值分别为100%,97.4%,96.3%,71.4%,97.4%。结论超声检测能直观显示男性乳腺病变的部位、大小、形态、内部回声及血流显像特征,有助于鉴别良性与恶性病变。     

乳腺神经内分泌肿瘤的超声表现与病理对照分析

目的 探讨乳腺神经内分泌肿瘤(NEN)的超声检查声像图表现，并与病理结果对照分析，以提高其认识和诊断符合率。方法 选取本院经超声检查与病理证实为NEN患者25例，分析其术前超声图像、病理及临床资料，对照病理表现总结其超声图像特征。结果 25例患者病灶中，右侧乳腺16例，左侧乳腺9例，单发病灶20例，一侧多发病灶5例。超声表现形态不规则22例，圆形或椭圆形3例；边界不清14例，边界清晰11例；边缘呈分叶状16例，毛刺蟹足样6例，规整3例；内部呈混合回声13例，低回声12例；后方回声无变化16例，后方回声增强8例，后方回声衰减1例；肿瘤内部可见钙化4例；术前提示腋窝淋巴结肿大10例，病理证实为淋巴结转移9例(1例术前同时伴有肋骨、肺、颅内转移),1例病理阴性，另有1例超声检查未发现转移淋巴结，病理诊断腋窝淋巴结存在微转移；CDFI显示病灶内0～Ⅰ级血流16例，Ⅱ～Ⅲ级9例。结论 乳腺NEN多表现为混合回声或实性低回声团块，形态多不规则，边界清晰或不清，边缘不规整，CDFI可见有血流显示。超声检查结合临床资料及病理对照分析，可以提高其诊断率，为临床确定治疗方案提供参考价值。     

超声乳腺影像报告和数据系统与18F-FDG PET/CT在乳腺疾病诊断中的相关性及联合应用价值

目的：分析超声乳腺影像报告和数据系统（BI-RADS）分级与18F-脱氧葡萄糖（18F-FDG）PET/CT之间的相关性,并评价其在乳腺疾病诊断中的联合应用价值。资料与方法对103例疑似乳腺癌患者的18F-FDG PET/CT图像及超声BI-RADS分级进行回顾性研究,分析最大SUV（SUVmax）与超声BI-RADS分级的相关性,并以病理或长期随访结果为“金标准”,分别分析其灵敏度、特异度、阳性及阴性预测值。结果在103例疑似乳腺癌患者中,良性46例,恶性57例;SUVmax与超声BI-RADS分级的Pearson相关系数r=0.464（P<0.01）;所有患者中PET/CT诊断的灵敏度、特异度、阳性及阴性预测值分别为89.47%、73.91%、80.95%、84.99%;BI-RADS分级诊断的灵敏度、特异度、阳性及阴性预测值分别为94.70%、69.60%、79.42%、91.38%;在BI-RADS 3~4级的患者中PET/CT诊断的灵敏度、特异度、阳性及阴性预测值分别为88.90%、71.40%、66.65%、90.91%;BI-RADS分级诊断的灵敏度、特异度、阳性及阴性预测值分别为88.90%、46.40%、51.60%、86.67%。结论 SUVmax与超声BI-RADS分级不具有明显相关性,对于BI-RADS 3~4级病例, BI-RADS分级诊断的特异度明显降低,PET/CT可以很好地弥补这一缺点,两者联合诊断乳腺疾病具有一定的临床推广潜力。     

MRI对乳腺恶性肿块切除术后残留病灶的评估

目的:探讨乳腺MRI对乳腺恶性肿块切除术后残留病灶的诊断价值。方法:回顾性分析2009年9月-2012年9月肿块切除术后病理为恶性,需再次手术的患者共87例,再次手术前均行MRI,运用BI-RADS分类标准对MRI表现进行评估。结果:87例中28例(28/87)经病理证实为病灶残留。BI-RADS分类为Ⅱ类或Ⅲ类的共42例,4例病灶残留,其中21例患者行乳腺保乳手术;BI-RADS分类为Ⅳ类或Ⅴ类的共45例,24例病灶残留,其中4例的患者行乳腺保乳手术。MRI诊断残留病灶的灵敏度、特异度、阳性预测值、阴性预测值分别为85.7%、64.4%、53.3%和90.5%。MRI各种征象中导管样强化、节段性强化及结节样强化提示残留病灶的阳性预测值分别为77.8%、71.4%和54.5%。结论:MRI-BI-RADS分类标准有助于乳腺恶性肿块切除术后残留病灶的评估,导管样强化、节段性强化及结节样强化提示病灶残留。     

乳腺癌自动乳腺全容积扫描图像特征及其BI-RADS分级应用分析

目的 :探讨自动乳腺全容积扫描(automated breast volume scanner,ABVS)图像特征,以及依据ABVS的BI-RADS对乳腺癌的诊断价值。方法:选择134例(共137个病灶)乳腺癌女性患者,根据ABVS图像特征,将病灶分为汇聚征、边缘模糊、毛刺、成角、分叶5种,BI-RADS分级对应3、4a、4b、4c、5级,并与病理结果对比分析。结果:137个病灶中汇聚征61个(44.5%),边缘毛刺51个(37.2%),边缘模糊8个(5.8%),边缘成角8个(5.8%),边缘分叶5个(3.6%),边缘较光滑4个(2.9%)。137个病灶中伴钙化89个。BI-RADS分级:3级2个病灶,4a级13个,4b级13个,4c级50个,5级59个。以4级为恶性的标准,依据ABVS的BI-RADS分级诊断乳腺癌符合率为98.5%。结论:ABVS的冠状面汇聚征、边缘毛刺及伴钙化对乳腺癌有较高的敏感性,依据ABVS的BI-RADS分级在乳腺癌诊断中具有较高的应用价值。     

乳腺乳头腺瘤的超声表现

目的:探讨乳腺乳头腺瘤的高频超声图像特征.材料和方法:回顾性分析7例经术后病理证实的乳腺乳头腺瘤的超声图像资料.在灰阶声像图上观察病灶形状、大小、边界、内部回声及后方回声.应用彩色多普勒血流成像(CDFI)观察病灶内部及周围血流分布和供应情况.结果:6例乳腺乳头腺瘤声像图表现为乳头内圆形或椭圆形低回声结节,境界清楚,后方回声增强,彩色多普勒显示结节内少量血流或边缘血流.1例位于左乳乳头后方低回声结节,边界清晰,周边见薄的包膜回声,彩色多普勒显示其内中等量的血流信号.结论:乳腺乳头腺瘤是一种少见的乳腺良性肿瘤,超声检查有助于乳腺乳头腺瘤的诊断及鉴别诊断.     

乳腺硬化性腺病伴纤维腺瘤形成1例

1病例资料
　　女,46岁。体检发现右侧乳腺实性结节就诊。患者无疼痛,无皮肤红肿、破溃,无发热,无乳头溢液。超声检查：右乳腺2点钟近乳头处大小约0.7 cm×0.5 cm的实性结节,边界欠清晰,形态不规则,后方回声衰减,内可见点状强回声钙化（图1A）。于右乳腺8点钟距乳头约1 cm处大小约0.9 cm×0.4 cm的实性结节,边界欠清晰,内可见粗大强回声钙化（图1B）。CDFI：结节内未见血流信号。超声诊断：右侧乳腺实性结节（2点钟位者 BI-RADS分4B级、8点钟位者 BI-RADS分级4A级）。在超声引导下旋切2点钟及8点钟肿物,完整切除送检。病理诊断：乳腺硬化性腺病伴纤维腺瘤形成。     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.

Abstract：

Objective To study the value of breast imaging reporting and data system (BI-RADS)in Chinese breast cancer screening. Methods A total number of 3483 women participated in breast cancer screening with mammography in Hexi district in Tianjin from August to December 2009, which was organized by ministry of public health. BI-RADS assessment categories and recommendations were compared with histological findings. The precision, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Among 3483 screening mammography cases, 267 were almost entirely fat breast, 1245 were scauered fibroglandular, 1890 were dense and 81 extremely dense.There were 1011 patients(29.0%) with category 1, 1741 (50.0%) with category 2, 383 (11.0%) with category 3, 59 patients(1. 7%) with category 4 and 16 (0. 5%) with category 5 according to BI-RADS assessment categories. Totally, 71 women with 77 lesions were confirmed by histological examinations. There were 29 malignant and 48 benign lesions. The diagnostic precision, sensitivity, specificity of BI-RADS were 63. 6% (49/77) , 93. 1% (27/29) and 45.8% (22/48) . The general PPV of BI-RADS was 50. 9%(27/53). The PPV of categories 0, 4, 5 were 25.0% (1/4), 36. 4% (12/33) and 87. 5% (14/16). The NPV of categories 2 and3 were90.9% (10/11), 100.0% (12/12). Conclusions B1-RADS is of much value in assessing the breast malignancy. It is applicable in Chinese breast cancer screening.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.     

乳腺影像学报告及数据系统:超声良恶性病变鉴别诊断初探

1992年美国放射学会制定了乳腺影像学报告及数据系统(breast imaging reporting and data system,BI-RADS),2003年第四版修订时包括了超声诊断(BI-RADS-US)。本文旨在初步探讨BI-RADS-US对于乳腺良恶性病变鉴别诊断的能力。我们收集了2006年1月至2007年3月期间、获得病理诊断的乳腺占位性病变共69例72灶。均为女性,年龄14-83岁,平均41.6岁。首先根据一般的非BI-RADS标准,做出良恶性鉴别。然后用BI-RADS-US标准进行鉴别和分级(0-6级),其中2级和3级为良性和良性可能性大,4级为性质待定,5级为恶性可能性大。计算并比较上述两种方法的准确性、敏感性、特异性。结果在72病灶中,根据非BI-RADS标准,诊断为良性者40灶,符合病理诊断者38灶(95.0%),诊断为恶性者23灶,符合病理者18灶(78.3%);诊断为性质待定者9灶。根据BI-RADS-US标准和分级,2级和3级共有37灶,与病理结果符合者为36灶(97.2%);5级有31灶,与病理符合者为22灶(71.0%);4级有4灶。非BI-RADS和BI-RADS-US的准确性各为83.3%和81.9%(P=1.000),敏感性各为91.7%和95.8%(P=1.000),特异性各为79.2%和75.0%(P=0.754)。总之,第一版BI-RADS-US在乳腺良恶性病变鉴别诊断方面的初步应用表现出较高的敏感性,而与非BI-RADS方法比较则尚无明显差别。     

Breast ultrasound computer-aided diagnosis using BI-RADS features

RATIONALE AND OBJECTIVES: Based on the definitions in mass category of Breast Imaging Reporting and Data System developed by American College of Radiology, eight computerized features including shape, orientation, margin, lesion boundary, echo pattern, and posterior acoustic feature classes are proposed. MATERIALS AND METHODS: Our experimental database consists of 265 pathology-proven cases including 180 benign and 85 malignant masses. The capacity of each proposed feature in differentiating malignant from benign masses was validated by Student's t test and the correlation between each proposed feature and the pathological result was evaluated by point biserial coefficient. Binary logistic regression model was used to relate all proposed features and pathological result as a computer-aided diagnosis (CAD) system. The diagnostic value of each proposed feature in the CAD system was further evaluated by the feature selection methods. Additionally, the likelihood of malignancy for each individual feature was also estimated by binary logistic regression. RESULTS: On each proposed feature, the malignant cases were significantly different from the benign ones. The correlation between the angular characteristic and pathological result was indicated as very high. Three substantial correlations appear in features irregular shape, undulation characteristic, and degree of abrupt interface, but the relationship for orientation feature is low. For the constructed CAD system, the performance indices accuracy, sensitivity, specificity, PPV, and NPV were 91.70% (243 of 265), 90.59% (77 of 85), 92.22% (166 of 180), 84.62% (77 of 91), and 95.40% (166 of 174), respectively, and the area index in the ROC analysis was 0.97. Compared with the significant contribution of angular characteristic, the diagnostic values of posterior acoustic feature and orientation feature were relatively low for the CAD system. When three or more angular characteristics are discovered or the degree of abrupt interface is lower than 18, the likelihood of malignancy could be predicted as greater than 40%. CONCLUSION: The computerized BI-RADS sonographic features conform to the sign of malignancy in the clinical experience and efficiently help the CAD system to diagnose the mass.     

Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses?

Objective

To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses.

Materials and methods

Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria.

Results

Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p < 0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p < 0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively.

Conclusion

PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.