计算机辅助诊断技术可提高肿块最大径≤10 mm早期乳腺癌的超声诊断效能

目的探讨计算机辅助诊断在早期乳腺癌诊断中的价值。方法对120枚病理证实的最大径≤20 mm乳腺肿块(乳腺癌结节50枚，良性结节70枚)超声图像进行回顾性分析，根据肿块大小分为最大径≤10 mm组(56枚)、最大径11~20 mm组(64枚)两组，由2名超声医师参照BI-RADS-US分类予以诊断，结合计算机超声辅助诊断结果后再次诊断，以病理结果为金标准，对比分析计算机辅助诊断在超声诊断早期乳腺癌中的作用。结果乳腺肿块最大径≤10 mm组中，应用普通超声对早期乳腺癌的敏感性、特异性和准确性分别为62.5%、59.4%、60.7%，操作性曲线下面积(AUC)为0.61。结合计算机辅助诊断技术结果为79.2%、81.3%、80.4%；AUC为0.80。对于最大径11~20 mm组，常规超声的敏感性、特异性和准确性分别为69.2%、68.4%、68.8%，ROC曲线AUC为0.69。结合计算机辅助诊断结果为80.8%、81.6%、81.3%；AUC为0.81。计算机辅助诊断后两组不同大小乳腺肿块的敏感性、特异性、准确性及AUC均有提高，乳腺肿块最大径≤10 mm组的准确率及AUC提高尤为显著，差异有统计学意义(P < 0.05)。结论计算机辅助诊断技术有助于提高早期乳腺癌的超声诊断效能，尤其是辅助最大径≤10 mm的早期乳腺癌的诊断。 

Application of computer-aided ultrasonography in assisting radiologists to diagnose early breast cance

ObjectiveTo investigate the application of computer-aided ultrasonography assisting radiologists in differential diagnosis for early breast cancer.MethodsThe representative images of 120 breast masses (maximum diameter ≤20 mm, 50 breast cancer nodules, 70 benign nodules) pathologically proved were reviewed retrospectively. According to the size of the mass, patients were divided into maximum diameter ≤10 mm group (56 nodules) and maximum diameter 11-20 mm group (64 nodules). Two radiologists made their diagnosis with reference to the breast imaging report and data system ultrasonography (BI-RADS-US) classification. Combined with computer-aided ultrasonography results, all the masses were re-diagnosed. Pathological results were used as gold standard. Diagnostic performance for US and the combination of US and computer-aided diagnosis was compared.ResultsFor the maximum diameter ≤10 mm group, conventional US diagnostic sensitivity, specificity and accuracy of radiologists were 62.5%, 59.4% and 60.7%, respectively, and the area under the receiver operating characteristic (ROC) curve (AUC) were 0.61. And the sensitivity, specificity and accuracy of the combination of US and computer-aided technology were 79.2%, 81.3% and 80.4%, AUC was 0.80. For the maximum diameter 11-20 mm group, conventional US diagnostic sensitivity, specificity and accuracy of the radiologists were 69.2%, 68.4% and 68.8%, respectively, and the AUC were 0.69. And the sensitivity, specificity and accuracy of the combination of US and CAD were 80.8%, 81.6% and 81.3%, AUC was 0.81. After computer-aided diagnosis, the sensitivity, specificity, accuracy and AUC of two groups with different sizes of breast mass were increased, especially significant promotion of the accuracy and AUC in maximum diameter ≤10 mm group (P < 0.05).ConclusionIt is demonstrated that computer-aided diagnosis can help radiologists improving their diagnostic efficacy, especially for early breast cancer with maximum diameter ≤10 mm.