常规超声检查联合声触诊组织成像技术鉴别诊断乳腺良恶性病变的价值

目的采用乳腺影像报告与数据系统（BI-RADS）分类诊断标准，探讨常规超声检查联合声触诊组织成像（VTI）技术鉴别诊断乳腺良恶性病变的价值。 方法对2013年1月至2014年10月同济大学附属第十人民医院经手术病理证实的389例乳腺肿瘤患者395个病灶，术前行常规超声检查及VTI检查，VTI模式下对乳腺良恶性病变进行分级，记录乳腺病灶边界是否清晰进行，并分别采用常规超声检查、常规超声检查联合VTI技术对乳腺良恶性病变进行BI-RADS分类。采用χ²检验比较乳腺良恶性病变VTI分级、VTI模式下病灶边界情况差异。以手术病理结果作为金标准，计算常规超声检查、常规超声检查联合VTI技术鉴别诊断乳腺良恶性病变的敏感度、特异度、准确性，并采用McNemar?s test进行比较。 结果本组395个乳腺病灶中，282个（71.4%）为乳腺良性病变，113个（28.6%）为乳腺恶性病变。75.5%（213/282）的乳腺良性病变为VTI分级Ⅱ~Ⅲ级，83.2%（94/113）的乳腺恶性病变为VTI分级Ⅳ~Ⅴ级。乳腺良恶性病变VTI模式下分级差异有统计学意义（χ²=114.759，P<0.01）。77.7%（219/282）的乳腺良性病变VTI模式下肿块边界不清晰，78.8%（89/113）的乳腺恶性病变VTI模式下肿块边界多清晰。乳腺良恶性病变VTI模式下病灶边界情况差异有统计学意义（χ²=108.480，P<0.01）。常规超声检查鉴别诊断乳腺良恶性病变的敏感度为97.3%，特异度为54.2%，准确性为66.6%；常规超声检查联合VTI技术鉴别诊断乳腺良恶性病变的敏感度为98.2%，特异度为84.4%，准确性为88.4%。常规超声联合VTI技术鉴别诊断乳腺良恶性病变的特异度、准确性均高于常规超声检查鉴别诊断乳腺良恶性病变的特异度、准确性，且差异均有统计学意义（χ²=79.425、67.549，P均<0.01）；但敏感度差异无统计学意义（χ²=11.974，P>0.05）。 结论常规超声检查联合VTI技术能够提高乳腺良恶性病变鉴别诊断的特异度和准确性。

The value of conventional ultrasound combined with virtual touch tissue imaging in differentiating benign and malignant breast lesions

ObjectiveTo discuss the value of conventional ultrasound combined with virtual touch tissue imaging (VTI) in differentiating benign and malignant breast lesions by breast imaging reporting and data system (BI-RADS) diagnostic criteria. MethodsFrom January 2013 to October 2014, 395 breast lesions from 389 patients from the Tenth People's Hospital, Tongji University were included in present study. All the lesions were confirmed by surgery pathology. Conventional ultrasound and VTI examinations were done before surgery. Both benign and malignant lesions were classified into varied categories based on the boundary of lesions under VTI mode. Benign and malignant breast lesions were classified into BI-RADS categories by conventional ultrasound or conventional ultrasound combined with VTI. The χ² test was used to compare the differences of lesions′ boundaries between VTI categories and VTI mode. The pathology findings were used as golden criteria, to calculate the sensitivity, specificity and accuracy of conventional ultrasound as well as conventional ultrasound combined with VTI. And their diagnostic performances were compared by McNemar′s test. ResultsOf 395 breast lesions, 282 (71.4%) were benign, 113 (28.6%) were malignant. 75.5% (213/282) benign lesions were classified as Ⅱ-Ⅲ under VTI mode, while 83.2% (94/113) malignant lesions were classified as Ⅳ-Ⅴ under VTI mode. The differences in classification between them was statistically significant (χ²=114.759, P<0.01). 77.7% (219/282) benign lesions had unclear boundaries under VTI mode, while 78.8% (89/113) malignant lesions had clear boundaries under VTI mode. The differences in boundaries between them was statistically significant (χ²=108.480, P<0.01). The sensitivity, specificity and accuracy of conventional ultrasound in differentiating benign and malignant breast lesions were 97.3%, 54.2% and 66.6% respectively; while the sensitivity, specificity and accuracy of conventional ultrasound combined with virtual touch tissue imaging in differentiating benign and malignant breast lesions were 98.2%, 84.4% and 88.4% respectively. The specificity and accuracy were higher when only using conventional ultrasound with statistical significance (χ²=79.425, 67.549, both P<0.01); however the sensitivity had no significantly different (χ²=11.974, P<0.01). ConclusionConventional ultrasound combined with virtual touch tissue imaging can improve the specificity and the accuracy in differentiating benign and malignant breast lesions.