超声造影联合弹性成像对BI-RADS 4类乳腺肿块的诊断价值
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摘要
目的探讨超声造影(CEUS)联合弹性成像(UE)对BI-RADS 4类乳腺病灶的诊断价值。方法回顾性分析经手术病理证实的190枚BI-RADS 4类病灶的UE及CEUS声像图特点,以手术病理结果为"金标准",采用受试者工作特征(ROC)曲线分别评估两者单独及联合应用调整BI-RADS分类的诊断效能。结果 190枚病灶,病理结果显示良性71枚,恶性119枚。CEUS各增强特点良恶性组间差异均有统计学意义。CEUS、UE及常规超声的受试者工作特征曲线下面积(AUROC)分别为0.848,0.767,0.818,均小于UE联合CEUS调整BI-RADS分类的方法(AUROC为0.935),诊断效能具有统计学意义(P<0.01)。常规超声、UE、CEUS的敏感度、特异度、准确率分别为97.5%,67.6%,86.3%;68.1%,76.1%,71.1%;65.5%,91.5%,75.3%。CEUS联合UE调整BI-RADS分类后的敏感度98.3%,特异度88.7%,准确率94.7%。结论 CEUS在乳腺良恶性病灶的鉴别上有一定的应用价值,CEUS联合UE能进一步提高BI-RADS 4类乳腺病灶的良、恶性鉴别诊断。
Objective To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS) and elastography(UE) for BI-RADS 4 breast lesions. Methods The characteristics of UE and CEUS sonograms of 190 BI-RADS 4 lesions confirmed by pathology were analyzed retrospectively. The pathological results were used as "gold standard", the receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy of both the individual and combined adjustment of the BI-RADS classification. Results Of the 190 lesions, 71 were benign and 119 were malignant. There were statistically significant differences between benign and malignant CEUS enhancement features. The area under the receiver operating characteristic curve(AUROC) of CEUS, UE, and ultrasonography were 0.848, 0.767, and 0.818, respectively, which were smaller than the method for adjusting BI-RADS classification by UE and CEUS(AUROC was 0.935). The diagnostic efficacy was statistically significant(P<0.01). The sensitivity, specificity and accuracy of US, UE and CEUS were 97.5%, 67.6%, and 86.3%; 68.1%, 76.1%, and 71.1%; 65.5%, 91.5%, and 75.3%, respectively. The sensitivity, specificity and accuracy of the method for adjusting BI-RADS by CEUS were 98.3%, 88.7%, and 94.7%, respectively. Conclusion CEUS has certain application value in the differentiation of benign and malignant breast lesions. CEUS combined with UE can further improve the differential diagnosis of BI-RADS 4 breast lesions.
Objective To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS) and elastography(UE) for BI-RADS 4 breast lesions. Methods The characteristics of UE and CEUS sonograms of 190 BI-RADS 4 lesions confirmed by pathology were analyzed retrospectively. The pathological results were used as "gold standard", the receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy of both the individual and combined adjustment of the BI-RADS classification. Results Of the 190 lesions, 71 were benign and 119 were malignant. There were statistically significant differences between benign and malignant CEUS enhancement features. The area under the receiver operating characteristic curve(AUROC) of CEUS, UE, and ultrasonography were 0.848, 0.767, and 0.818, respectively, which were smaller than the method for adjusting BI-RADS classification by UE and CEUS(AUROC was 0.935). The diagnostic efficacy was statistically significant(P<0.01). The sensitivity, specificity and accuracy of US, UE and CEUS were 97.5%, 67.6%, and 86.3%; 68.1%, 76.1%, and 71.1%; 65.5%, 91.5%, and 75.3%, respectively. The sensitivity, specificity and accuracy of the method for adjusting BI-RADS by CEUS were 98.3%, 88.7%, and 94.7%, respectively. Conclusion CEUS has certain application value in the differentiation of benign and malignant breast lesions. CEUS combined with UE can further improve the differential diagnosis of BI-RADS 4 breast lesions.
引文
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[2] 程莹莹,张增芳,毕万利.应变率比值法与面积比值法联合应用在乳腺结节鉴别诊断中的价值[J].医学影像学杂志,2017,27(3):475-478.
[3] Hu Y,Yang Y,Gu R,et al.Does patient age affect the PPV(3) of ACR BI-RADS ultrasound categories 4 and 5 in the diagnostic setting?[J].Eur Radiol,2018,28(6):2492-2498.
[4] Zhi H,Ou B,Xiao XY,et al.Ultrasound elastography of breast lesions in chinese women:a multicenter study in China [J].Clin Breast Cancer,2013,13(5):392-400.
[5] Mu WJ,Zhong WJ,Yao JY,et al.Ultrasonic elastography research based on a multicenter study:adding strain ratio after 5-point scoring evaluation or not [J].PLoS One,2016,11(2):1-19.
[6] Xiao X,Dong L,Jiang Q,et al.Incorporating contrast-enhanced ultrasound into the BI-RADS scoring system improves accuracy in breast tumor diagnosis:a preliminary study in china [J].Ultrasound Med Biol,2016,42(11):2630-2638.
[7] Krouskop TA,Wheeler TM,Kallel F,et al.Elastic moduli of breast and prostate tissues under compression [J].Ultrason Imaging,1998,20(4):260-274.
[8] Balleyguier C,Ciolovan L,Ammari S,et al.Breast elastography:the technical process and its applications [J].Diagn Interv Imaging,2013,94(5):503-513.
[9] Sadigh G,Carlos RC,Neal CH,et al.Accuracy of quantitative ultrasound elastography for differentiation of malignant and benign breast abnormalities:a meta-analysis [J].Breast Cancer Res Treat,2012,134(3):923-931.
[10] Ciurea AI,Bolboaca SD,Ciortea CA,et al.The influenceof technical factors on sonoelastographic assessment of solid breast nodules [J].Ultraschall Med,2011,32(1):27-34.
[11] Wang XY,Kang LK,Lan CY.Contrast-enhanced ultrasonography in diagnosis of benign and malignant breast lesions [J].Eur J Gynaecol Oncol,2014,35 (4):415 -420.
[12] Zhao YX,Liu S,Hu YB,et al.Diagnostic and prognostic values of contrast-enhanced ultrasound in breast cancer:a retrospective study [J].Onco Targets Ther,2017,22(10):1123-1129.
[13] 陕泉源,罗佳,梁瑾瑜,等.超声造影鉴别诊断乳腺良恶性肿瘤[J].中国医学影像技术,2015,12(7):1045-1048.