乳腺超声影像报告与数据系统分类对乳腺导管上皮内瘤变的诊断价值

目的 探讨乳腺超声影像报告与数据系统（BI-RADS-US）分类对乳腺导管上皮内瘤变（DIN）的诊断价值.方法 将2010年1月至2012年10月北京天宜乳腺医院手术或穿刺活组织检查证实的135例乳腺导管内病变（含116例DIN）与高频彩色多普勒超声诊断进行回顾性对照分析.依据美国乳腺影像报告数据系统（BI-RADS）和乳腺影像学特征及多普勒血流对病变进行BI-RADS-US分类.将BI-RADS-US 3～4类且病理诊断为DIN者判为阳性,而非DIN者判为假阳性;将BI-RADS-US 1～2类且病理诊断为DIN者判为假阴性,而非DIN者判为阴性.由此计算BI-RADS-US诊断DIN的ROC曲线下面积.结果 在DIN患者中：普通型导管增生（UDH） 35例,其中20例（57.14%,20/35）超声表现为乳腺呈片状回声增强或低回声结节,BI-RADS-US 2类;平坦型上皮异形（FED）4例,以及导管上皮非典型性增生（ADH）50例,其中37例（68.52%,37/54）超声表现为乳腺导管扩张伴管腔内乳头状突起性病变或腺体局部增厚伴低回声结节,病灶以Ⅰ级血流信号为主,BI-RADS-US 3～4a类;导管原位癌（DCIS）27例,其中19例（70.37%,19/27）超声表现为乳腺导管不规则增宽,管壁增厚伴管腔内簇状微钙化,或不规则低回声结节,或聚集分布的小囊区,病灶以Ⅱ级血流信号为主,BI-RADS-US 4类.BI-RADS-US 3～4类诊断乳腺DIN的ROC曲线下面积为0.699.结论 BI-RADS-US对DIN具有一定的诊断价值.

Value of breast imaging reporting and data system ultrasonography in diagnosis of breast ductal intraepithelial neoplasia

Objective To assess the value of breast imaging reporting and data system uhrasonography （BI-RADS-US） in the diagnosis of breast ductal intraepithelial neoplasia（DIN）. Methods Totally 135 cases of breast ductal intraepithelial lesions （including 116 cases of DIN）confirmed in surgery or biopsy in Beijing Tianyi Breast Hospital from January 2010 to October 2012, were retrospectively analyzed to compare the pathological results with high-frequency color Doppler ultrasound findings. According to the BI-RADS, the imaging characteristics of breast and Doppler blood flow features, we applied the classification of BI-RADS-US. The cases in BI-RADS-US 3-4 diagnosed with DIN were regarded as positive, non-DIN as false-positive. The cases in BI-RADS-US 1-2 diagnosed with DIN were considered as false negative, non-DIN as negative. Thereby the area under ROC curve was calculated. Results In the patients with DIN, there were 35 cases of usual ductal hyperplasia （ UDH）, including 20 cases （57. 14%, 20 /35 ） in BI-RADS-US 2, whose US manifestations showed crushed-stone like echoes or hypoechoic nodules; there were 4 cases of flat epithelial atypia （FED） and 50 cases of atypical duetal hyperplasia （ADH）, including 37 cases （68.52% ,37/54） in BI-RADS-US 3-4a, whose US manifestations showed breast ductal ectasia associated with intraluminal convex papilate, or regional thickening of gland with hypoechoic nodules, and mainly grade I blood flow signals in the lesions; there were 27 cases of ductal carcinoma in situ （DCIS）, including 19 cases （70. 37%, 19/27） in BI-RADS-US 4, whose US manifestations showed irregular ductal widening, wall thickening associated with intraluminal clustered microcalcifications, or irregular hypoechoic nodules, or aggregation of small cysts, and mainly grade Ⅱ blood flow signals in the lesions. The area under the ROC curve for BI-RADS-US 3-4 was 0. 699. Conclusion BI-RADS-US was helpful in the diagnosis of breast DIN.