乳腺超声影像评分系统在乳腺良恶性肿块鉴别中的应用
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摘要
目的：
本文旨在建立一个以BI-RADS-US分级为基础并结合本院实际的乳腺超声影像评分系统,探讨该系统在乳腺肿块良恶性鉴别诊断中的应用价值。
方法：
统计2012年1月至2012年2月,浙江大学医学院附属第二医院肿瘤外科收治的乳腺肿块病例共80例,参照BI-RADS-US标准建立乳腺超声影像评分系统,对其术前超声影像进行评分,并与术后病理诊断金标准(gold standard)进行比照。计数良性组评分与恶性组评分,验证二者是否存在显著性差异,并根据约登指数(Youden's index)选择合适的数值作为超声诊断乳腺肿块良恶性的阈值。
结果：
经手术病理证实为恶性肿瘤42例、良性肿瘤38例,其中恶性肿瘤组评分在6-10分,平均为8.6±1.083,中位数为9分；良性肿块组评分在5-8分,平均分为5.71±0.956,中位数为5分。两组间有显著性差异(P<0.05)。为达到最大真实性选择8分作为诊断乳腺恶性肿块的下限,6分作为诊断乳腺良性肿块的上限；该评分系统对乳腺恶性肿块诊断的阳性预测值为：94.6%,阴性预测值为：83.7%；对乳腺良性肿块诊断的阳性预测值为：93.5%,阴性预测值为81.6%。
结论：
该评分系统在乳腺良恶性病变鉴别诊断方面有较高的敏感性和特异性,对临床医生鉴别乳腺肿块的良恶性程度有重要参考意义。
Objective:
This article aims to explore the use of breast ultrasound imaging scoring system in differential diagnosis of benign and malignant breast lumps.
Methods:
From Jan.2012to Feb.2012, retrospective study of the ultrasound images and pathology diagnosis of80patients with breast lumps, establish a breast ultrasound imaging scoring system based on BI-RADS-US(Breast imaging reporting and data system-Ultrasound), calculate the malignant group and benign group's score, and set a threshold to diagnose the benign breast and malignant breast lumps. Sensitivity, specificity, positive predictive rate, negative predictive rate of ultrasonography were measured.
Results:
Confirmed by pathology,42cases of malignant tumors,38cases of benign tumors; The score of malignant group is6-10, average of8.6±1.083, median of9; The score of benign tumor group is5-8, average of5.71±0.956, median of5points. Between the two groups, there are significant differences (P<0.05). Select points8as lower limit of the diagnosis of malignant breast lumps, select points6as upper limit of the diagnosis of benign breast lumps; To the malignant breast lumps, the positive predictive value is94.6%, negative predictive value is83.7%; To the benign breast lumps, the positive predictive value is93.5%, negative predictive value is81.6%. Conclusion:
Scoring system of breast ultrasound imaging has high sensitivity and specificity in the differential diagnosis of benign and malignant breast lesions.
本文旨在建立一个以BI-RADS-US分级为基础并结合本院实际的乳腺超声影像评分系统,探讨该系统在乳腺肿块良恶性鉴别诊断中的应用价值。
方法：
统计2012年1月至2012年2月,浙江大学医学院附属第二医院肿瘤外科收治的乳腺肿块病例共80例,参照BI-RADS-US标准建立乳腺超声影像评分系统,对其术前超声影像进行评分,并与术后病理诊断金标准(gold standard)进行比照。计数良性组评分与恶性组评分,验证二者是否存在显著性差异,并根据约登指数(Youden's index)选择合适的数值作为超声诊断乳腺肿块良恶性的阈值。
结果：
经手术病理证实为恶性肿瘤42例、良性肿瘤38例,其中恶性肿瘤组评分在6-10分,平均为8.6±1.083,中位数为9分；良性肿块组评分在5-8分,平均分为5.71±0.956,中位数为5分。两组间有显著性差异(P<0.05)。为达到最大真实性选择8分作为诊断乳腺恶性肿块的下限,6分作为诊断乳腺良性肿块的上限；该评分系统对乳腺恶性肿块诊断的阳性预测值为：94.6%,阴性预测值为：83.7%；对乳腺良性肿块诊断的阳性预测值为：93.5%,阴性预测值为81.6%。
结论：
该评分系统在乳腺良恶性病变鉴别诊断方面有较高的敏感性和特异性,对临床医生鉴别乳腺肿块的良恶性程度有重要参考意义。
Objective:
This article aims to explore the use of breast ultrasound imaging scoring system in differential diagnosis of benign and malignant breast lumps.
Methods:
From Jan.2012to Feb.2012, retrospective study of the ultrasound images and pathology diagnosis of80patients with breast lumps, establish a breast ultrasound imaging scoring system based on BI-RADS-US(Breast imaging reporting and data system-Ultrasound), calculate the malignant group and benign group's score, and set a threshold to diagnose the benign breast and malignant breast lumps. Sensitivity, specificity, positive predictive rate, negative predictive rate of ultrasonography were measured.
Results:
Confirmed by pathology,42cases of malignant tumors,38cases of benign tumors; The score of malignant group is6-10, average of8.6±1.083, median of9; The score of benign tumor group is5-8, average of5.71±0.956, median of5points. Between the two groups, there are significant differences (P<0.05). Select points8as lower limit of the diagnosis of malignant breast lumps, select points6as upper limit of the diagnosis of benign breast lumps; To the malignant breast lumps, the positive predictive value is94.6%, negative predictive value is83.7%; To the benign breast lumps, the positive predictive value is93.5%, negative predictive value is81.6%. Conclusion:
Scoring system of breast ultrasound imaging has high sensitivity and specificity in the differential diagnosis of benign and malignant breast lesions.
引文
[1]Parkin, D.M., Fernandez, L.M. Use of statistics to assess the global burden of breast cancer. Breast J.,2006,12(Suppl 1):S70-80.
[2]Parkin, D.M., Bray, F., Ferlay J., et al. Global cancer statistics,2002. CA Cancer J.Clin.,2005,55:74-108.
[3]杨玲,李连弟,陈育德等.中国乳腺癌发病死亡趋势的估计与预测.中华肿瘤杂志,2006,28(6)：438-440.
[4]方志沂.乳腺癌临床诊断,乳腺肿瘤学.2000,北京：科学技术出版社,381-390.
[5]王欣,陈中扬.乳腺癌早期诊断的现状与挑战.中华乳腺病杂志,2007,2：5-7.
[6]李文英.超声和钼靶X线诊断乳腺癌的价值比较.上海交通大学硕士论文,2007.
[7]Moss, H.A., Britton, P.D., Flower, C.D.R., et al. How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population? Clin.Radiol.,1999,54(10):676-682.
[8]Coveney, E.C., Geraghty, J.G., O'Laoide, R., et al. Reasons underlying negative mammography in patients with palpable breast cancer. Clin.Radiol.,1994,49(2): 123-125.
[9]Agarwal, G., Pradeep, P.V., Aggarwal, V., et al. Spectrum of breast cancer in Asian women. World J. Surg.,2007,31(5):1031-1040.
[10]Crystal, P., Strano, S.D., Shcharynski, S., et al. Using sonography to screen women with mammographically dense breasts Am.J.Roentgenol.,2003,181:177-182.
[11]Vittorio, C., Nehmat, H., Aurora, F., et al. Breast screening with ultrasound in women with mammography-negative dense breasts:Evidence on incremental cancer detection and false positives, and associated cost.Eur.J.Cancer,2008,44(4):539-544.
[12]Chandra, M.S., Susan, P.W., Peter, H.A., et al. A review of breast ultrasound. J. Mammary Gland Biol. Neoplasia.,2006,11:113-123.
[13]Mendelson EB, Baum JK, Berg WA, et al. Breast imaging re-porting and data system, ultrasound[M]. Reston, American College of Radiology,2003.1-81.
[14]Levy L, Suissa M, Chiche JF, et al. BI-RADS ultrasonography[J]. Euro J Radial, 2007,61(2):202-211.
[15]Azoury F, Sayad P, Rizk A. Thoracoscopic management of a pericardial migration of a breast biopsy localization wire. Ann. Thorac. Surg.87(6),1937-1939 (2009).
[16]American College of Radiology. Breast Imaging Reporting and Date System[M] 4th ed. Rest on:American College of Radiology,2003:256-258.
[17]Stavros, A.T., Thickman, D., Rapp, C.L., et al. Solid breast nodules:use of sonography to distinguish between benign and malignant lesions. Radiology, 1995,196(1):123-134.
[18]Stavros, A.T., Rapp, C.L., Parker, S.H. Ultrasound of solid breast nodules: Distinguishing benign from malignant, in Breast Ultrasound.2004, Lippincott Williams&Wilkins:Philadelphia446-525(Google Book Search).
[19]Stavros, A.T. Sonographic evaluation of solid breast nodules. Breast Cancer Res.Symposium Mammographicum 2004,2004,6(Suppl 1):P3.
[20]Kolb, T.M., Lichy,J., Newhouse, J.H. Comparison of the performance of screening mammography, physical examination and breast US and evaluation of factors that influence them:an analysis of 27,825 patient evaluations. Radiology, 2002,225(1):165-175.
[1]Parkin, D.M., Bray, F., Ferlay,J., et al. Global cancer statistics,2002.CA Cancer J.Clin.,2005,55:74-108
[2]沈镇宙,邵志敏主编.现代乳腺肿瘤学进展.2002,上海：上海科学技术文献出版社.
[3]杨玲,李连弟,陈育德等.中国乳腺癌发病死亡趋势的估计与预测.中华肿瘤杂志,2006,28(6)：438-440.
[4]邵志敏,余科达.乳腺外科的发展趋势[J].中国普外基础与临床杂志,2007,14(3)：252-254.
[5]刘复生.中国肿瘤病理学分类.2000,北京：科学技术文献出版社.
[6]方志沂.乳腺癌临床诊断,乳腺肿瘤学.2000,北京：科学技术出版社,381-390.
[7]Crystal, P., Strano, S.D., Shcharynski, S., et al. Using sonography to screen women with mammographically dense breasts Am.J.Roentgenol.,2003,181:177-182.
[8]Vittorio, C., Nehmat, H., Aurora, F., et al. Breast screening with ultrasound in women with mammography-negative dense breasts:Evidence on incremental cancer detection and false positives, and associated cost.Eur.J.Cancer,2008,44(4):539-544.
[9]Chandra, M.S., Susan, P.W., Peter, H.A., et al. A review of breast ultrasound. J. Mammary Gland Biol. Neoplasia.,2006,11:113-123.
[10]Van Goethem, M., Tjalma, W., Schelfout, K., et al. Magnetic resonance imaging in breast cancer. European Journal of Surgical Oncology,2006,32(9):901-910.
[11]Amalu, W.C. A review of breast thermography. Int. Acad. Clinical Thermology, 2003.
[12]胡永升.现代乳腺影像诊断学.2001,北京：科学出版社,45-75.
[13]Hong AS, Rosen EL, Soo MS, et al. BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features.American Journal of Roentgenology,2005,184:1260-1265.
[14]Heinig, J., Witteler, R., Schmitz, R., et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet. Gynecol.,2008,32(4):573-578.
[15]Hong, A.S., Rosen, E.L., Soo, M.S., et al.BI-RADS for sonography: positive and negative predictive values of sonographic features.Am. J.Roentgenol.,2005, 184(4):1260-1265.
[16]Elizabeth, L., Martha, B.M., Barbara, S., et al. BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology 2006,239:385-391.
[17]Welsh, Williams RR, BirmirminghamA, et al. Thethioredoxin redoxinhibitor slmethyproryl 2 imidazolyl disulfideand-pleurotin inhibit hypoxiainduced factorl and vascual-endothelial growth factor formation. Mol Cancer Ther,2003,2: 235-243.
[18]Baluk P, Morikawa S, Haskell A, et al. Abnormalities of basement membrane on blood vessels and endothelial sprouts in-tumors. Am J Pathol,2003,163: 1801-1815.
[19]Milz P, Lienemami A, Kessler M, et al. Evaluation of breast-lesions by power Doppler, sonography. EurRadiol,2001,11:547-554.
[20]Ahmed R, Ali SM. Role of imaging in diagnosis of carcinoma-of breast. J Coll Physiciana Surg Pak,2005,15:238-241.
[21]Sahin AC, Sumer H. Color Doppler ultrasound and spectral- analysis of tumor vessels in the differential diagnosis of-solid breast masses. Invest Radiol,1996, 2:72-79.
[22]Insana MF, Pellot-Barakat C, Sridhar M, et al. Viscoelastic imaging of breast tumor microenvironment with ultrasound [J]. J Mammary Gland Biol Neoplasia,2004,9 (4):393-404.
[23]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.
[24]Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis [J]. Radiology,2006,239(2):341-350.
[25]Tan SM, Teh HS, Mancer JF, et al. Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography--a clinical approach [J]. Breast,2008,17(3):252-257.
[26]Thomas A, Kummel S, Fritzsche F, et al. Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: improved differentiation of breast lesions?[J]. Acad Radiol,2006,13(12):1496-1504.
[27]Zhi H, Ou B, Luo BM, et al. Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions[J]. J Ultrasound Med,2007,26 (6):807-815.
[28]Zhu QL, Jiang YX, Liu JB, et al. Real-time ultrasound elastography:its potential role in assessment of breast lesions[J]. Ultrasound Med Biol,2008,34(8):1232-1238.
[29]Parajuly SS, Lan PY, Yan L, et al. Breast elastography: a hospital-based preliminary study in China[J]. Asian Pac J Cancer Prev,2010,11(3):809-814.
[30]Lee JH, Kim SH, Kang BJ, et al. Role and clinical usefulness of elastography in small breast masses [J]. Acad Radiol,2011,18(1):74-80.
[31]Schueller G, Schueller WC, Helbich TH. Acc-Uracy of ultrasound guided, large-core needle breasy. Eur Radiol,2008,18:1761-1773.
[2]Parkin, D.M., Bray, F., Ferlay J., et al. Global cancer statistics,2002. CA Cancer J.Clin.,2005,55:74-108.
[3]杨玲,李连弟,陈育德等.中国乳腺癌发病死亡趋势的估计与预测.中华肿瘤杂志,2006,28(6)：438-440.
[4]方志沂.乳腺癌临床诊断,乳腺肿瘤学.2000,北京：科学技术出版社,381-390.
[5]王欣,陈中扬.乳腺癌早期诊断的现状与挑战.中华乳腺病杂志,2007,2：5-7.
[6]李文英.超声和钼靶X线诊断乳腺癌的价值比较.上海交通大学硕士论文,2007.
[7]Moss, H.A., Britton, P.D., Flower, C.D.R., et al. How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population? Clin.Radiol.,1999,54(10):676-682.
[8]Coveney, E.C., Geraghty, J.G., O'Laoide, R., et al. Reasons underlying negative mammography in patients with palpable breast cancer. Clin.Radiol.,1994,49(2): 123-125.
[9]Agarwal, G., Pradeep, P.V., Aggarwal, V., et al. Spectrum of breast cancer in Asian women. World J. Surg.,2007,31(5):1031-1040.
[10]Crystal, P., Strano, S.D., Shcharynski, S., et al. Using sonography to screen women with mammographically dense breasts Am.J.Roentgenol.,2003,181:177-182.
[11]Vittorio, C., Nehmat, H., Aurora, F., et al. Breast screening with ultrasound in women with mammography-negative dense breasts:Evidence on incremental cancer detection and false positives, and associated cost.Eur.J.Cancer,2008,44(4):539-544.
[12]Chandra, M.S., Susan, P.W., Peter, H.A., et al. A review of breast ultrasound. J. Mammary Gland Biol. Neoplasia.,2006,11:113-123.
[13]Mendelson EB, Baum JK, Berg WA, et al. Breast imaging re-porting and data system, ultrasound[M]. Reston, American College of Radiology,2003.1-81.
[14]Levy L, Suissa M, Chiche JF, et al. BI-RADS ultrasonography[J]. Euro J Radial, 2007,61(2):202-211.
[15]Azoury F, Sayad P, Rizk A. Thoracoscopic management of a pericardial migration of a breast biopsy localization wire. Ann. Thorac. Surg.87(6),1937-1939 (2009).
[16]American College of Radiology. Breast Imaging Reporting and Date System[M] 4th ed. Rest on:American College of Radiology,2003:256-258.
[17]Stavros, A.T., Thickman, D., Rapp, C.L., et al. Solid breast nodules:use of sonography to distinguish between benign and malignant lesions. Radiology, 1995,196(1):123-134.
[18]Stavros, A.T., Rapp, C.L., Parker, S.H. Ultrasound of solid breast nodules: Distinguishing benign from malignant, in Breast Ultrasound.2004, Lippincott Williams&Wilkins:Philadelphia446-525(Google Book Search).
[19]Stavros, A.T. Sonographic evaluation of solid breast nodules. Breast Cancer Res.Symposium Mammographicum 2004,2004,6(Suppl 1):P3.
[20]Kolb, T.M., Lichy,J., Newhouse, J.H. Comparison of the performance of screening mammography, physical examination and breast US and evaluation of factors that influence them:an analysis of 27,825 patient evaluations. Radiology, 2002,225(1):165-175.
[1]Parkin, D.M., Bray, F., Ferlay,J., et al. Global cancer statistics,2002.CA Cancer J.Clin.,2005,55:74-108
[2]沈镇宙,邵志敏主编.现代乳腺肿瘤学进展.2002,上海：上海科学技术文献出版社.
[3]杨玲,李连弟,陈育德等.中国乳腺癌发病死亡趋势的估计与预测.中华肿瘤杂志,2006,28(6)：438-440.
[4]邵志敏,余科达.乳腺外科的发展趋势[J].中国普外基础与临床杂志,2007,14(3)：252-254.
[5]刘复生.中国肿瘤病理学分类.2000,北京：科学技术文献出版社.
[6]方志沂.乳腺癌临床诊断,乳腺肿瘤学.2000,北京：科学技术出版社,381-390.
[7]Crystal, P., Strano, S.D., Shcharynski, S., et al. Using sonography to screen women with mammographically dense breasts Am.J.Roentgenol.,2003,181:177-182.
[8]Vittorio, C., Nehmat, H., Aurora, F., et al. Breast screening with ultrasound in women with mammography-negative dense breasts:Evidence on incremental cancer detection and false positives, and associated cost.Eur.J.Cancer,2008,44(4):539-544.
[9]Chandra, M.S., Susan, P.W., Peter, H.A., et al. A review of breast ultrasound. J. Mammary Gland Biol. Neoplasia.,2006,11:113-123.
[10]Van Goethem, M., Tjalma, W., Schelfout, K., et al. Magnetic resonance imaging in breast cancer. European Journal of Surgical Oncology,2006,32(9):901-910.
[11]Amalu, W.C. A review of breast thermography. Int. Acad. Clinical Thermology, 2003.
[12]胡永升.现代乳腺影像诊断学.2001,北京：科学出版社,45-75.
[13]Hong AS, Rosen EL, Soo MS, et al. BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features.American Journal of Roentgenology,2005,184:1260-1265.
[14]Heinig, J., Witteler, R., Schmitz, R., et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet. Gynecol.,2008,32(4):573-578.
[15]Hong, A.S., Rosen, E.L., Soo, M.S., et al.BI-RADS for sonography: positive and negative predictive values of sonographic features.Am. J.Roentgenol.,2005, 184(4):1260-1265.
[16]Elizabeth, L., Martha, B.M., Barbara, S., et al. BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology 2006,239:385-391.
[17]Welsh, Williams RR, BirmirminghamA, et al. Thethioredoxin redoxinhibitor slmethyproryl 2 imidazolyl disulfideand-pleurotin inhibit hypoxiainduced factorl and vascual-endothelial growth factor formation. Mol Cancer Ther,2003,2: 235-243.
[18]Baluk P, Morikawa S, Haskell A, et al. Abnormalities of basement membrane on blood vessels and endothelial sprouts in-tumors. Am J Pathol,2003,163: 1801-1815.
[19]Milz P, Lienemami A, Kessler M, et al. Evaluation of breast-lesions by power Doppler, sonography. EurRadiol,2001,11:547-554.
[20]Ahmed R, Ali SM. Role of imaging in diagnosis of carcinoma-of breast. J Coll Physiciana Surg Pak,2005,15:238-241.
[21]Sahin AC, Sumer H. Color Doppler ultrasound and spectral- analysis of tumor vessels in the differential diagnosis of-solid breast masses. Invest Radiol,1996, 2:72-79.
[22]Insana MF, Pellot-Barakat C, Sridhar M, et al. Viscoelastic imaging of breast tumor microenvironment with ultrasound [J]. J Mammary Gland Biol Neoplasia,2004,9 (4):393-404.
[23]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.
[24]Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis [J]. Radiology,2006,239(2):341-350.
[25]Tan SM, Teh HS, Mancer JF, et al. Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography--a clinical approach [J]. Breast,2008,17(3):252-257.
[26]Thomas A, Kummel S, Fritzsche F, et al. Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: improved differentiation of breast lesions?[J]. Acad Radiol,2006,13(12):1496-1504.
[27]Zhi H, Ou B, Luo BM, et al. Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions[J]. J Ultrasound Med,2007,26 (6):807-815.
[28]Zhu QL, Jiang YX, Liu JB, et al. Real-time ultrasound elastography:its potential role in assessment of breast lesions[J]. Ultrasound Med Biol,2008,34(8):1232-1238.
[29]Parajuly SS, Lan PY, Yan L, et al. Breast elastography: a hospital-based preliminary study in China[J]. Asian Pac J Cancer Prev,2010,11(3):809-814.
[30]Lee JH, Kim SH, Kang BJ, et al. Role and clinical usefulness of elastography in small breast masses [J]. Acad Radiol,2011,18(1):74-80.
[31]Schueller G, Schueller WC, Helbich TH. Acc-Uracy of ultrasound guided, large-core needle breasy. Eur Radiol,2008,18:1761-1773.