乳腺超声弹性成像BI-RADS 4 级肿块校正及穿刺活检的诊断价值*

目的：对比分析乳腺BI-RADS 分级中4 级肿块经超声弹性成像应变率比值校正及超声引导下穿刺活检术的诊断价值。方法：收集2014年1 月至2016年6 月120 例承德医学院附属医院行乳腺肿块手术切除患者的资料，术前全部肿块BI-RADS 分级为4级，经超声弹性成像应变率比值校正后行超声引导下穿刺活检术，以病理为金标准对比超声弹性成像应变率比值与穿刺活检的诊断价值。结果：120 例乳腺患者BI-RADS 4 级肿块经超声弹性成像应变率比值校正后，其中46例BI-RADS 4 级不变、59例降为BI-RADS3 级、15例升为BI-RADS5 级，与病理结果对照，经超声弹性成像应变率比值校正及穿刺活检诊断的灵敏度、特异度及准确率分别为90.7% 、81.8% 、85.5% 及88.8% 、98.5% 、95.0% ，经超声弹性成像应变率比值校正与穿刺活检诊断乳腺恶性肿块的差异具有统计学意义（P < 0.05），诊断良性肿块的差异无统计学意义（P > 0.05）。 结论：超声引导下穿刺活检术对乳腺BI-RADS4 级肿块有较高定性诊断价值，仅次于病理诊断，超声弹性成像应变率比值对乳腺 BI-RADS4 级肿块分级校正及指导穿刺活检具有一定的临床价值。

Ultrasound elasticity imaging correction and biopsy diagnosis value in BI-RADS 4 breast mass

Objective:To compare the diagnostic value of strain ratio correction in ultrasound elasticity imaging and ultrasound-guided percutaneous biopsy for the diagnosis of breast imaging reporting and data system (BI-RADS) 4 breast mass. Methods:From January 2014 to June 2016 in the Affiliated Hospital of Chengde Medical College, 120 patients with breast tumor resection and preoperative BI-RADS4 of all the masses were included in this study. The diagnostic value of contrast ultrasound elastography strain ratio correction and biopsy in ultrasound-guided percutaneous biopsy was evaluated with pathology as the gold standard. Results:In the 120 cases of grade BI-RADS4 mass by ultrasound elastography after correction, 46 cases were graded BI-RADS4 without changing;59 cases were downgraded to BI-RADS3, and 15 cases were upgraded to BI-RADS5. The pathology, ultrasonic elastography strain ratio correction, biopsy diagnostic sensitivity, specificity, and accuracy were 90.7%, 81.8%, 85.5%, 88.8%, 98.5%, and 95.0%, respectively. A significant difference was found between ultrasonic elastography strain ratio correction and ultrasound-guided biopsy for the diagnosis of breast malignant mass (P<0.05), whereas no significant difference was found for the diagnosis of benign mass (P>0.05). Conclusion:Ultrasound-guided puncture biopsy is highly valuable in qualitative diagnosis of BI-RADS4 breast mass. After the pathological diagnosis, ultrasound elastography strain ratio has certain clinical value in BI-RADS4 guided biopsy and correction of mass classification.