弹性成像对超声引导乳腺肿块穿刺活检指导价值研究

目的探讨超声弹性成像对超声引导BI-RADS 4级乳腺肿块穿刺活检的指导价值。方法回顾性分析141例经超声引导下BI-RADS 4级乳腺肿块穿刺活检患者的临床资料。所有患者穿刺前均进行常规超声及弹性成像检查,以BI-RADS分级及弹性评分评价乳腺肿块的良恶性。结果 BI-RADS分级为4a级的阴性预测值(NPV)为89.6%,弹性评分≤3分的NPV为95.5%,两者比较,差异无统计学意义(P>0.05);BI-RADS分级为4b级的阳性预测值(PPV)为59.3%,弹性评分≥4分的PPV为85.3%,两者比较,差异有统计学意义(P<0.05);BI-RADS分级为4c级的PPV为89.7%,弹性评分≥4分的PPV为96.9%,两者比较,差异无统计学意义(P>0.05);BI-RADS分级≥4b级的PPV为72.0%,弹性评分≥4分的PPV为90.9%,两者比较,差异有统计学意义(P<0.05)。结论弹性评分<3分的4a级乳腺肿块可以短期随访观察;弹性评分为5分的4c级乳腺肿块建议直接手术治疗;对于良恶性难以鉴别的4b级乳腺肿块,超声弹性成像可以进一步提高其PPV,建议穿刺活检明确诊断。

Elasticity imaging of breast lumps biopsy guided by ultrasound guidance value

Objective To investigate the value of elastography instructing ultrasound-guided BI-RADS4 breast lumps puncture. Meth-ods A retrospective study was performed on 141 patients with breast lesions of BI-RADS4,the clinical data was analyzed,convention-al ultrasound examination and elastography was performed before puncture. To evaluate breast lesions being benign or malignant by BI-RADS classification and elastography score. Results NPV of 4a was 89. 6% and NPV of 4a with less than or equal to 3 score was 95. 5%,there was no significant difference between them(P>0. 05);PPV of 4b was 59. 3%,and PPV of 4b with more than or equal to 4 score was 85. 3% and the difference between them was statistically significant(P<0. 05);PPV of 4c was 89. 7%,and PPV of 4c with more than or equal to 4 score was 96. 9%,and there was no significant difference between them(P>0. 05);PPV of BI-RADS4 with more than or equal to 4 score was 90. 9%, which was significantly different from PPV of BI-RADS4 which was 72. 0%( P <0. 05). Conclusion Patients of 4a with less than 3 score can be performed short-term follow-up;4c with 5 score is suggested to be op-erated directly;for 4b that benign or malignant lesions cannot be separated easily,UE score can improve its PPV,which needs to be un-derwent puncture to make a definite diagnosis that the mass is benign or malignant.