First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability?

ObjectivesTo evaluate the outcome of repeated short-term follow-up with ultrasound in no high-risk young patients with a BI-RADS3 lesion at first examination.MethodsIn this IRB-approved study 492 women, aged 18–34 years (mean ± standard deviation, 28 ± 4.5 years) with first breast ultrasound examination in 2012–2014 were retrospectively evaluated. Inclusion criteria were: at least one BI-RADS3 lesion and (a) biopsy/surgical excision or (b) follow-up of at least 18 months (including a 6-month follow-up). BI-RADS category assigned during follow-up and pathologic findings in cases undergoing biopsy/surgical excision were collected. At the 6- and 18-month follow-up the recommended biopsy rates (RBR) and the corresponding positive predictive value (PPV) were calculated.ResultsIn 97 patients, 151 BI-RADS3 lesions were identified. Biopsy/surgical excision was initially performed in 25/151 (16.5%) lesions. After 6-month, category was downgraded to BI-RADS1/2 in 23/126 (15.3%) and upgraded to BI-RADS4 in 9/126 lesions (7.1%). Pathological diagnosis of these lesions was fibroadenoma in 5 and benign phyllodes tumor in 4 cases (RBR 7%, PPV_bio 44.4%). After 18-month one lesion was classified BI-RADS4 and pathological diagnosis was fibroadenoma (RBR 1.1%, PPV_bio 0%).ConclusionsOur preliminary data show that follow-up imaging performed after 18 months from a first BI-RADS3 diagnosis does not affect clinical treatment and 6-month follow-up may be sufficient to assess the stability of probably benign lesions.     

BI-RADS分级在彩超检查乳腺良、恶性肿瘤中的规范化应用

目的:通过彩超检查手段,探讨BI-RADS分级在乳腺肿瘤中的规范化应用及其价值。方法:回顾性分析多例经手术、病理证实的乳腺良、恶性肿瘤患者的超声表现及彩色多普勒血流特点,重点是恶性肿瘤及交界性肿瘤的界定,规范其诊断时的应用标准。结果:经手术及活检病理诊断,经过术前BI-RADS分级方法筛查,超声诊断符合率为89.5%,其中误诊为良性54例(6.2%),误诊为恶性36例(4.2%),主要是4级(a,b,c)结节的鉴定存在误诊及偏差。结论:乳腺恶性肿瘤在声像图中的可疑征象:形态不规则、边缘不光整、高回声晕、垂直生长、后方回声衰减、瘤体内微钙化、血供丰富,其中形态不规则、边缘毛刺、边缘成角、肿瘤内微钙化为预测恶性肿瘤的主要指标,其余改变可作为次要指标。通过对上述指标的合理应用,使用统一的专业术语、标准的诊断归类及检查程序,达到早期、准确的诊断乳腺疾病尤其是恶性肿瘤。     

超声未能诊断乳腺癌的原因回顾分析

【摘要】 目的 回顾分析在先前乳腺超声诊断为假阴性,而在超声随访中进展为乳腺癌的病人资料,并分析可能产生假阴性的原因。 方法 筛选本院PACS系统中病理确诊的乳腺癌病例,选取其中先前超声没有诊断,而在随访检查出乳腺癌的病例,共56例。由二位副教授职称的超声医师在非双盲的情况下回顾分析保存在PACS系统中乳腺超声图像,并结合其钼靶、MRI等其它影像资料,分析原因（漏诊、误诊、处理不当）,两人取得一致意见。结果 56个乳腺癌病例中,有14例无法获取完整影像学资料,其余42个乳腺癌的BI-RADS分级为3～5级,分析表明：①7例为漏诊,初次诊断全部由低年资医生做出。②27例为误诊,误诊主要原因为肿块边缘规整（8例）,大小稳定（3例）,内部回声均匀（2例）,多发病灶、良恶性重叠（5例）;妊娠、哺乳时期（3例）;其中先前乳腺病变超声BI-RADS 3级的有27例（64.29%）。③8例处理不当,主要来自对钼靶、MRI图像关联不够,2例为超声引导下取样错误所致。结论 在超声检查罹患乳腺肿瘤的病人中,回顾分析总结认为：低年资医师有待增加超声诊断乳腺癌的经验;误诊的概率要高于漏诊及处理不当,其中BI-RADS 3级病变误诊率最高;超声检查应与MRI、钼靶图像紧密关联。     

超声造影比弹性成像更准确诊断乳腺BI-RADS 4a类结节

目的  分析超声造影和弹性成像在乳腺BI-RADS 4a类结节中的诊断价值。方法  纳入我院2019年1月~2023年2月经常规超声检测诊断为BI-RADS 4a类的患者115例,对每个病灶进行分析,以病理结果为金标准,构建超声造影评分和弹性成像两种诊断方法的ROC曲线,比较两种方法对乳腺BI-RADS 4a类结节良恶性诊断的价值。结果  115例患者中,良性病灶87例,恶性病灶28例。超声造影评分和弹性成像两种诊断方法Kappa值小,一致性较差（P=0.258）。以病理结果作为金标准,造影评分的诊断价值更高（敏感度、特异性及准确度分别为0.812、0.976、0.956）,与金标准之间的一致性较弹性成像更高。超声造影评分的诊断曲线下面积为0.976,高于弹性成像数值（0.784）。两种不同诊断方法显示恶性结节患者的年龄较良性患者偏高,结节最大直径偏大。结论  超声造影方法较弹性成像能明显提高乳腺BI-RADS 4a类结节良恶性诊断的准确率,降低术前活检的风险,值得临床推广。     

Breast ultrasound elastography—Results of 193 breast lesions in a prospective study with histopathologic correlation

Purpose

To evaluate the diagnostic performance of ultrasound elastography in breast masses.

Material and methods

193 lesions (129 benign, 64 malignant) were analyzed with the EUB 8500 Logos-ultrasonic-unit (Hitachi Medical, Japan) and a linear-array-transducer of 7.5-13-MHz. Standard of reference was cytology (FNAfine needle aspiration) or histology (core biopsy). The elastic-score was classified according to a 6-point colour-scale (Ueno classification; 1-3 = benign, 4-5 = malignant). Conventional B-mode ultrasound (US) findings were classified according to the BI-RADS classification. Statistical analysis included sensitivity, specificity, ROC-analysis and kappa-values for intra-/interobserver reliability.

Results

The mean score for elasticity was 4.1 ± 0.9 for malignant lesions, and 2.1 ± 1.0 for benign lesions (p < 0.001). With a best cut-off point between elasticity scores 3 and 4, sensitivity was 96.9%, and specificity 76%. Setting a best cut-off point for conventional US between BI-RADS 4 and 5, sensitivity was 57.8%, and specificity 96.1%. Elastography provided higher sensitivity and lower specificity than conventional US, but two lesions with elasticity score 1 were false negative, whereas no lesion scored BI-RADS 1-3 were false negative. ROC-curve was 0.884 for elastography, and 0.820 for conventional US (p < 0.001). Weighted kappa-values for intra-/interobserver reliability were 0.784/0.634 for BI-RADS classification, and 0.720/0.561 for elasticity scores.

Conclusion

In our study setting, elastography does not have the potential to replace conventional B-mode US for the detection of breast cancer, but may complement conventional US to improve the diagnostic performance.     

超声与钼靶BI-RADS分级对乳腺浸润性导管癌的诊断

目的:研究超声与钼靶BI-RADS分级对乳腺浸润性导管癌(IDC)的诊断。方法:回顾分析98例105个术后病理证实的IDC病灶的超声与钼靶BI-RADS 3~5分级影像图,比较两者以及两者联合对IDC的诊断价值。结果:超声与钼靶分级以及两者联合诊断IDC的准确性分别为85.7%(90/105)、77.1%(81/105)、95.2%(100/105);超声与钼靶BI-RADS分级对IDC的诊断,两者之间有统计学意义(P0.05),超声与钼靶两者联合诊断,诊断价值高于单一方法(P0.05)。结论:本组研究中,超声和钼靶按BI-RADS分级,均对IDC有较高的的诊断价值,两者联合诊断IDC的准确率更高。     

超声造影检查在乳腺BI-RADS 4类的乳腺肿块良恶性鉴别诊断中的价值

目的:探讨超声造影检查在常规超声诊断为乳腺BI-RADS 4类的乳腺肿块良恶性鉴别诊断中的价值。方法:对2016年7月至2017年10月在西安交通大学第一附属医院门诊就诊并经常规超声诊断为乳腺BI-RADS 4类的76例患者共76个乳腺肿块进行超声造影检查,以穿刺活检或手术切除病理结果为金标准建立诊断试验分析。结果:最终病理证实良性病变53例（良性组）,恶性病变23例（恶性组）。超声造影特点如形态不规则、边界不清晰、有穿入或扭曲血管、对比剂不均匀性增强、内部有充盈缺损及造影后面积较二维增大在恶性组的比例显著高于良性组,差异有统计学意义（P<0.05）。超声造影诊断乳腺BI-RADS 4类病灶良恶性鉴别诊断的敏感度、特异度及准确性分别为96%、85%和88%。结论:良恶性乳腺肿块的超声造影特征明显不同,超声造影可以有效鉴别BI-RADS 4类乳腺病灶的良恶性,有望提高穿刺活检的恶性检出率。     

Role of BI-RADS Ultrasound Subcategories 4A to 4C in Predicting Breast Cancer

Background

The Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) categorization revised in 2013 by the American College of Radiology resulted in unquestionable standardization of reports and confirmed category 3 and 5 as benign and malignant lesions, respectively. In contrast, suspected images (category 4) have subcategorization criteria, although theses have been detailed difficult to apply. The aim of the present study was to determine the role of the US 4A to 4C BI-RADS subcategories in predicting malignancy.

不同组织学类型和分子分型的乳腺黏液癌82例超声声像图特征表现

目的 分析不同组织学类型和不同分子分型的乳腺黏液癌（MBC）的超声声像图特征。方法 回顾性分析四川天府新区人民医院2013年6月至2021年6月经手术后证实为乳腺黏液癌的病人82例的临床和超声资料,根据超声乳腺影像报告和数据系统（BI-RADS）进行描述和分类,比较不同组织学类型和不同分子分型MBC的差异,并进行统计学分析。结果 单纯型乳腺黏液癌（PMBC）和混合型乳腺黏液癌（MMBC）相比较,在非平行方位、毛刺状、声影、肿块内微钙化、结构扭曲、血管供应、腋窝淋巴结异常的发生率[71.4%(5/7)比21.3%(16/75)、100.0%(4/4)比9.1%(1/11)、66.7%(2/3)比13.0%(6/46)、58.3%(14/24)比12.7%(7/55)、37.1%(13/35)比17.0%(8/47)、38.1%(16/42)比12.5%(5/40)、50.0%(9/18)比18.7(12/64)]均显著升高（P<0.05）。Luminal B型与Luminal A型相比较,在不均匀背景回声、椭圆形、血管供应、BI-RADS 3类的发生率[70.0%(14/20)比2...     

超声BI-RADS 3、4、5级对乳腺肿瘤临床诊断的意义

目的研究超声乳腺影像报告和数据系统(Breast imaging reporting and data system,BI-RADS)3、4、5级在乳腺肿瘤临床诊断中的应用价值。方法选取我院乳腺肿物超声诊断为BI-RADS 3、4、5级的患者170例,173个病灶,以术后病理诊断为金标准,研究超声BI-RADS 3-5级对乳腺肿瘤的诊断价值。结果超声BI-RADS3~5级对乳腺肿块诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为91.38%、67.83%、58.89%、93.98%;超声3、4、5级病灶中恶性肿瘤的百分率分别为6.02%(5/83)、51.35%(38/74)、93.75%(15/16),各级之间比较其差异均有统计学意义(P<0.01);不同年龄段中,年龄<40岁组患恶性肿瘤百分率为2.94%,年龄≥40岁组患恶性肿瘤百分率为53.33%。结论超声BI-RADS分级能够对乳腺肿块进行比较准确的评估,是早期发现乳腺癌的有效检查方式,为乳腺肿物选择手术时机有重要的参考价值。