对乳腺病灶进行第二次超声检查的意义

目的：对于增强磁共振和首次超声检查诊断不一致的乳腺病灶,再次进行超声检查,结合病理结果讨论第二次超声检查的意义.材料与方法：搜集2010年8月-2012年6月在我院先后进行乳腺超声检查和增强磁共振检查的女性患者.对于增强磁共振和超声检查诊断不一致的乳腺病灶,进行第二次超声检查.最后共有14名患者入组,获得18个病灶.这些病灶的确切诊断以手术后病理结果为金标准.乳腺病灶的影像诊断采用BI-RADS分类方法：BI-RADS 3类和4a、4b类病灶倾向良性,4c、5类倾向恶性.计算第二次超声检查和增强磁共振检查的敏感性、特异性、准确性、阳性预测值和阴性预测值.采用Fisher确切概率法对第二次超声和增强磁共振检查的各个诊断率进行检验,P＜0.05（双侧）有统计学意义.结果：18个病灶中最后经病理证实良性病变14个、恶性病变4个.第二次超声检查和增强磁共振检查的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为75％、92.86％、88.89％、75％、92.86％和75％、50％、55.56％、30％、87.5％.结论：对于增强磁共振和首次超声检查诊断不一致的乳腺病灶,第二次超声检查是有价值的.第二次超声检查的特异性优于增强磁共振.

Significance of second-look ultrasound for breast lesions

Objective： To assess the significance of second-look ultrasound for breast lesions with different diagnosis be- tween enhanced magnetic resonance imaging（MRI） and ultrasound. Materials and Methods： From August 2010 to June 2012, female patients undertaking ultrasound and enhanced MRI were collected successively. For breast lesions with different diagno- sis between enhanced MRI and ultrasound, second-look ultrasound （SLUS） was applied. Finally, 14 women were collected, and 18 lesions were acquired. The final diagnosis for the breast lesions was based on the pathological diagnosis, so-called golden standard. BI-RADS （Breast imaging reporting and data system） was used in the diagnosis with ultrasound and MRI： lesions of BI-RADS 3, BI-RADS 4a and BI-RADS 4b were considered as benignity. However, lesions of BI-RADS 4c and BI-RADS 5 were considered as malignancy. Sensitivity, specificity, accuracy, positive and negative predictive values （PPV and NPV） of second-look ultrasound and enhanced MRI were calculated. The diagnostic rate was tested by Fisher＇s exact test. When P〈0.05 （double tail）, the test was significant. Results： In the 18 lesions confirmed by pathology, 14 lesions were benign and 4 lesions were malignant. The sensitivity, specificity, accuracy, PPV and NPV of second-look ultrasound and enhanced MRI were 75%, 92.86%, 88.89%, 75%, 92.86% and 75%, 50%, 55.56%, 30%, 87.5%, respectively. Conclusion： For breast lesions with dif- ferent diagnosis between enhanced MRI and ultrasound, second-look ultrasound is valuable. The specificity of second-look ul- trasound is superior to enhanced MRI.