| 摘要: |
| 摘要：目的 探讨恶性造影特征对BIRADS-US4类乳腺不典型病变再次分级诊断价值，方法：对124例（130个病灶）造影前分为BIRADS-US4类乳腺病灶行超声造影检查，依据病变恶性造影特征（不均匀增强，周边环状高增强，增强后范围扩大，内部充盈缺损，周边放射性汇聚）再次对病变进行分级诊断，无任一恶性造影特征者降为3级，有其中任意一项者升一级，有其中任意两项者升两级，有其中三项及以上者升为5级，依据手术病理结果探讨超声造影恶性特征对BIRADS-US4类不典型乳腺病变再次分级诊断价值，结果：130个病灶均经手术病理证实，其中良性67个，恶性63个。造影前BIRADS-US4A类病灶61个，4B类病灶41个，4C类病灶28个，超声造影再次分级后BIRADS-US3类病灶49个，BIRADS-US4A类病灶13个，4B类病灶7个，4C类病灶12个，5级病灶49个，超声造影诊断BIRADS-US4类病灶灵敏度，特异度，准确性，阳性及阴性预测值分别为90.4%，83.6%，86.9%，83.8%，90.3%，依据恶性肿瘤超声造影特征再次分级并与病理对照超声造影恶性特征能够降低良性病灶活检率68.5%（46/67），同时提高约73.0%（46/63）恶性病灶诊断信心，结论：依据乳腺肿瘤恶性造影特征对BIRADS-US4类不典型病灶再次分级在降低BIRADS4类不典型病灶穿刺活检风险的同时，也能够提高此类病变中恶性病灶诊断信心，能够优化BIRADS-US4类病变分级，更好地为临床提供诊断及治疗的参考依据，值得注意的是对少部分超声造影特征不典型的乳腺癌病灶进行再次分级时需要谨慎，需密切结合二维超声特征同时建议穿刺活检避免漏诊。
关键词：恶性；造影特征，BIRADS-US4类，分级 |
| 关键词: 恶性 造影特征,BIRADS-US4类,分级 |
| DOI： |
| 投稿时间：2018-03-07修订日期：2018-03-23 |
| 基金项目: |
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| The Value of Malignancy Contrasted Imaging Features in secondary grade diagnosis of BI-RADS-US Type 4 Atypical Breast Lesions |
| gaojunxi,song tao |
| () |
| Abstract: |
| Abstract: Objective To explore the value of contrast-enhanced malignancy imaging features in secondary grade diagnosis of Breast Imaging Reporting and Data System for Ultrasonography (BI-RADS-US) Type 4 atypical breast lesions. Method After initial diagnosis by ultrasound (US), 124 BI-RADS-US Type 4 patients with 130 lesions were examined by contrast-enhanced US (CEUS) and were classified again before surgery according to five contrast-enhanced malignancy imaging features: inhomogeneous enhancement, peripheral ring-like enhancement, expansive enhancement, internal filling defects and surrounding radioactive convergence. Lesions with no contrast-enhanced features of malignancy were categorized as Type 3; lesions with one, two or three features of malignancy were categorized as Type 4A, 4B or 4C, respectively; and lesions with four or more indices of malignancy were categorized as Type 5. The value of contrasted imaging features of malignancy in diagnosing BI-RADS-US type 4 atypical breast lesions was analyzed. Result: 130 lesions were confirmed by surgery and pathology, including 67 benign lesions and 63 malignant lesions. BIRADS-US4 A lesions were 61, 41 lesions of 4B, 28 lesions of 4C before CEUS, Grade BIRADS-US3 lesions were 49, BIRADS-US4 lesions were 13, 7 lesions of 4B, 12 lesions of 4C, 49 lesions of 5 grade after CEUS. The sensitivity, specificity, accuracy, positive and negative predictive value of contrast-enhanced ultrasound in the diagnosis of BIRADS-US4 atypical breast lesions were 90.4%, 83.6%, 86.9%, 83.8%, 90.3%,respectively, CEUS decreased the benign lesion biopsy ratio to 68.5% (46/67) and increased the diagnosis ratio of malignant lesions to 73.0% (46/63).Conclusion: Breast malignant tumor imaging characteristics of BIRADS-US4 atypical lesions with high accuracy, in reduce BIRADS-US4 atypical lesions biopsy risk, also can improve malignant lesions diagnostic confidence at the same time, so as to further optimize the BIRADS-US4 atypical breast lesions classification, it can better provides reference basis for clinical diagnosis and treatment BIRADS-US4 atypical breast lesions. It is important to note that a small number of atypical features of contrast-enhanced ultrasound breast cancer lesions need to be cautious when regarding, they should be closely combined with the two-dimensional ultrasound features and suggest puncture biopsy to avoid missed diagnosis. |
| Key words: Malignant contrast characteristics, BIRADS-US4 atypical, classification |
