超声造影对乳腺X线摄影BI-RADS 3~5类病变的诊断效能

目的 探讨CEUS对乳腺X线摄影（MG）诊断为BI-RADS 3～5类病变的诊断价值。方法 对120例乳腺摄影诊断为BI-RADS 3～5类病变的患者行CEUS检查，所有患者均于影像学检查后接受病理检查。以病理结果为金标准，计算MG与CEUS的诊断敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV），并进行统计学分析，比较其诊断效能。结果 120例中，MG诊断为BI-RADS 3类病变37例，其中CEUS诊断2例真阳性，4例假阳性；BI-RADS 4类病变60例，CEUS诊断14例真阳性，33例真阴性；BI-RADS 5类病变23例，CEUS诊断18例真阳性，2例假阳性，3例CEUS诊断阴性者均为假阴性。MG与CEUS对BI-RADS 3～5类病变的诊断敏感度差异无统计学意义（95.12% vs 82.93%， P=0.366），CEUS的诊断特异度明显高于MG（81.01% vs 44.30%， P<0.001）；MG与CEUS的PPV和NPV差异均有统计学意义（P均<0.05）。结论 CEUS应用于乳腺摄影BI-RADS 3、4、5类病变中，可提高其诊断特异度；对于BI-RADS 3类病变，CEUS阴性诊断可增强诊断信心。

Diagnostic efficacy of CEUS in diagnosis of mammographic BI-RADS 3-5 category breast lesions

Objective To evaluate the value of CEUS in diagnosis of mammographic BI-RADS 3-5 category breast lesions. Methods A total of 120 mammographic BI-RADS category 3-5 breast lesions were analyzed by targeted CEUS and biopsied. Pathological result was regarded as the golden standard. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mammography (MG) and CEUS were calculated respectively and compared statistically. Results Of the 120 cases, CEUS diagnosed 2 as true positive and 4 as false positive in 37 mammographic BI-RADS 3 lesions, 14 as true positive and 33 as true negative in 60 mammographic BI-RADS 4 lesions, and 18 as true positive and 2 as false positive and 3 as false negative in 23 mammographic BI-RADS 5 lesions. The sensitivity of MG and CEUS had no significant difference (95.12% vs 82.93%, P=0.366). The specificity of CEUS was significantly higher than that of MG (81.01% vs 44.30%, P<0.001). The PPV and NPV between MG and CEUS had significant differences (both P<0.05). Conclusion CEUS can be used to improve the diagnostic specificity in mammographic BI-RADS 3, 4, 5 lesions. A negative diagnosis by CEUS in mammographic BI-RADS 3 lesions can increase the diagnostic convidence.