超声引导穿刺活检对乳腺BI-RADS 4类肿块的诊断价值
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摘要
目的讨探BI-RADS 4类肿块4A、4B、4C三个亚型常规超声诊断与穿刺病理诊断符合率及超声引导下粗针活检对乳腺BIRADS 4类肿块的诊断价值。方法回顾性分析120枚乳腺BI-RADS 4类肿块,并按低度、中度及高度可疑恶性程度分为4A、4B、4C三组,依次24枚、15枚和81枚肿块,将常规超声诊断结果与超声引导下16G粗针活检病理结果作对照分析。结果 120枚病灶共穿刺313针,均获得满意病理结果,其中良性46枚,恶性74枚。4A、4B、4C三组检出恶性肿瘤分别为3枚、4枚、67枚,阳性预测值(PPV)分别为12.5%、26.67%和82.72%,4C类与4A类和4B类之间有差异统计学意义(P<0.05),4A类和4B类之间无显著差异(P>0.05)。无1例出血、感染及气胸等并发症发生。结论超声引导乳腺活检术,安全、便捷、可靠、并发症少,为BI-RADS 4类肿块早期确诊的首选方法。
Objective To investigate the diagnostic value of the three subtypes of BI-RADS type 4 mass(4 A,4 B,4 C)and the diagnostic value of ultrasound guided coarse needle biopsy for breast BI-RADS type 4 masses.Methods 120 cases of breast BI-RADS type 4 masses were retrospectively analyzed.All the patients were examined and diagnosed by a senior ultrasound doctor,and according to the degree of suspected malignancy,they were divided into three groups:low,moderate and highly suspicious.The results of conventional ultrasound diagnosis were compared with the pathological results of 16 Gthick needle biopsy guided by ultrasound.Results All the 120 lesions were obtained satisfactory pathological results,including 46 benign lesions.74 malignant lesions.3 malignant masses in BIRADS 4 Agroup,4 malignant masses in BI-RADS 4 Bgroup,67 malignant masses in BI-RADS 4 Cgroup.The PPV of each BI-RADS category were 12.5%in category 4 A,26.67%in category 4 B,82.72%in category 4 C.The difference of PPV among category 4 Cand 4 A 、4 Bwere statisticlly significant(P<0.05),There were no significant difference in category 4 Aand 4 B(P>0.05).No complicatios such as bleeding,infection and pneumothorax occurred.ConclusionsBecause of the large risk span of BI-RADS 4 tumors,benign and malignant lesions are more serious.Even the senior ultrasound doctor will have the possibility that the benign is misdiagnosed as malignant and the malignant is misdiagnosed as benign.Ultrasound guided biopsy for breast masses is simple,satisfactory,and has few complications.It can improve the theoretical basis for early diagnosis and early treatment of breast cancer,and is worth popularizing in clinical practice.
Objective To investigate the diagnostic value of the three subtypes of BI-RADS type 4 mass(4 A,4 B,4 C)and the diagnostic value of ultrasound guided coarse needle biopsy for breast BI-RADS type 4 masses.Methods 120 cases of breast BI-RADS type 4 masses were retrospectively analyzed.All the patients were examined and diagnosed by a senior ultrasound doctor,and according to the degree of suspected malignancy,they were divided into three groups:low,moderate and highly suspicious.The results of conventional ultrasound diagnosis were compared with the pathological results of 16 Gthick needle biopsy guided by ultrasound.Results All the 120 lesions were obtained satisfactory pathological results,including 46 benign lesions.74 malignant lesions.3 malignant masses in BIRADS 4 Agroup,4 malignant masses in BI-RADS 4 Bgroup,67 malignant masses in BI-RADS 4 Cgroup.The PPV of each BI-RADS category were 12.5%in category 4 A,26.67%in category 4 B,82.72%in category 4 C.The difference of PPV among category 4 Cand 4 A 、4 Bwere statisticlly significant(P<0.05),There were no significant difference in category 4 Aand 4 B(P>0.05).No complicatios such as bleeding,infection and pneumothorax occurred.ConclusionsBecause of the large risk span of BI-RADS 4 tumors,benign and malignant lesions are more serious.Even the senior ultrasound doctor will have the possibility that the benign is misdiagnosed as malignant and the malignant is misdiagnosed as benign.Ultrasound guided biopsy for breast masses is simple,satisfactory,and has few complications.It can improve the theoretical basis for early diagnosis and early treatment of breast cancer,and is worth popularizing in clinical practice.
引文
[1]詹维伟,朱强,李建初,等.主编.中国浅表器官超声检查指南[M].北京:人民卫生出版社,2017:183-185.
[2]周鹏,张家庭,王先明,等.微创旋切术在乳腺BI-RADS 4A类“微钙化非肿块型”病灶诊治中的应用[J].中国超声医学杂志,2016,32(7):594-596.
[3]刘世强,王卫,熊瑞,等.超声引导下经皮穿刺活检诊断乳腺肿瘤的临床价值[J].中国老年学杂志,2016,36(8):2003-2004.
[4]American College of Radiology.Breast imaging reporting and data system(BI-RADS),4th ed[J].American College of Radiology,2013.reston.
[5]王云月,阮骊韬,任予,等.CEUS诊断乳腺癌研究进展[J].中国医学影像技术,2018,34(4):633-636.
[6]CHEN W,ZHENG W,BAADE P,et al.Cancer statistics in China,2015[J].A Cancer Journal for Clinicians,2016,66(2):115-132.
[7]张庆坤,冷晓玲,张芬,等.超声造影对早发性乳腺癌的诊断价值[J].中国超声医学杂志,2015,31(3):305-307.
[8]NAROD S A.Breast cancer in young women[J].Nature Review Clinical Oncology,2012,9(8):460470.
[9]AZIM H A,PARTRIDGE A H.Biology of breast cancer in young women[J].Breast Cancer Research,2014,16(4):427.
[10]PARKIN D M,FERNANDEZ L M.Use of statistics to assess the global burden of breast cancer[J].Breast J,2006,12(1):70-80.
[11]郑燕,董凤林,范晴敏,等.超声弹性成像在BI-RADS 4A类肿块良性性诊断中的应用[J].中国超声医学杂志,2017,33(3):206-209.
[12]颜宏.乳腺肿块BI-RADS分级与介入超声经皮穿刺活检技术联合应用于乳腺肿瘤中的诊断价值[J].影像研究与医学应用,2017,1(6):10-11.
[13]王金祥,曹旭表.超声引导下穿刺活检对BI-RADS分级4A至4C乳腺肿物诊断价值[J].中国肿瘤临床,2017,44(2):83-86.
[14]候新燕,黄晓玲,高宇,等.BI-RADS对超声引导下乳腺穿刺活检的指导价值[J].中国超声医学杂志,2011,27(9):786-788.
[15]王思宇,韩秀婕,何磊,等.乳腺肿物BI-RADS分级与病理分化的相关性研究[J].中国超声医学杂志,2016,32(8):691-693.
[2]周鹏,张家庭,王先明,等.微创旋切术在乳腺BI-RADS 4A类“微钙化非肿块型”病灶诊治中的应用[J].中国超声医学杂志,2016,32(7):594-596.
[3]刘世强,王卫,熊瑞,等.超声引导下经皮穿刺活检诊断乳腺肿瘤的临床价值[J].中国老年学杂志,2016,36(8):2003-2004.
[4]American College of Radiology.Breast imaging reporting and data system(BI-RADS),4th ed[J].American College of Radiology,2013.reston.
[5]王云月,阮骊韬,任予,等.CEUS诊断乳腺癌研究进展[J].中国医学影像技术,2018,34(4):633-636.
[6]CHEN W,ZHENG W,BAADE P,et al.Cancer statistics in China,2015[J].A Cancer Journal for Clinicians,2016,66(2):115-132.
[7]张庆坤,冷晓玲,张芬,等.超声造影对早发性乳腺癌的诊断价值[J].中国超声医学杂志,2015,31(3):305-307.
[8]NAROD S A.Breast cancer in young women[J].Nature Review Clinical Oncology,2012,9(8):460470.
[9]AZIM H A,PARTRIDGE A H.Biology of breast cancer in young women[J].Breast Cancer Research,2014,16(4):427.
[10]PARKIN D M,FERNANDEZ L M.Use of statistics to assess the global burden of breast cancer[J].Breast J,2006,12(1):70-80.
[11]郑燕,董凤林,范晴敏,等.超声弹性成像在BI-RADS 4A类肿块良性性诊断中的应用[J].中国超声医学杂志,2017,33(3):206-209.
[12]颜宏.乳腺肿块BI-RADS分级与介入超声经皮穿刺活检技术联合应用于乳腺肿瘤中的诊断价值[J].影像研究与医学应用,2017,1(6):10-11.
[13]王金祥,曹旭表.超声引导下穿刺活检对BI-RADS分级4A至4C乳腺肿物诊断价值[J].中国肿瘤临床,2017,44(2):83-86.
[14]候新燕,黄晓玲,高宇,等.BI-RADS对超声引导下乳腺穿刺活检的指导价值[J].中国超声医学杂志,2011,27(9):786-788.
[15]王思宇,韩秀婕,何磊,等.乳腺肿物BI-RADS分级与病理分化的相关性研究[J].中国超声医学杂志,2016,32(8):691-693.