| 摘要: |
| 目的 比较超声造影（CEUS）5分法与CEUS预测模型对不同大小乳腺影像报告和数据系统（BI-RADS）4类乳腺病灶的诊断价值。方法 收集我院收治经穿刺活检或手术病理结果证实的乳腺病变患者165例（共166个病灶），均行常规超声和CEUS检查，且BI-RADS分类为4类。根据病灶大小分为直径≤2.0 cm组101个，直径＞2.0 cm组65个。分析病灶的CEUS特征，包括增强强度、增强时相、增强方式、增强形态、增强边界、增强均匀性、灌注缺损、增强范围、蟹足征及滋养血管。应用CEUS 5分法和CEUS预测模型重新判定病灶良恶性，绘制受试者工作特征（ROC）曲线比较两种方法对不同大小BI-RADS 4类乳腺病灶良恶性的诊断效能。结果 直径≤2.0 cm组中良恶性病灶的10项CEUS特征比较差异均有统计学意义（均P＜0.05）；直径＞2.0 cm组中良恶性病灶的CEUS特征除增强强度、增强方式及灌注缺损外，其余7项特征比较差异均有统计学意义（均P＜0.05）。ROC曲线分析显示，对于直径≤2.0 cm的病灶，CEUS 5分法、CEUS预测模型诊断其良恶性的曲线下面积（AUC）分别为0.884、0.861，差异无统计学意义；对于直径＞2.0 cm的病灶，CEUS 5分法、CEUS预测模型诊断其良恶性的AUC分别为0.932、0.864，差异有统计学意义（P＜0.01）。CEUS 5分法中评分为2、3、5分病灶的诊断符合率较高，评分为1、4分病灶的诊断符合率偏低；CEUS预测模型中A、D、E、F模型的预测效能较好，B模型次之，C模型较差。结论 对于直径≤2.0 cm的BI-RADS 4类乳腺病灶，CEUS 5分法与CEUS预测模型的诊断价值相当；对于直径＞2.0 cm的BI-RADS 4类乳腺病灶，CEUS 5分法具有更高的诊断价值。 |
| 关键词: 超声检查 造影剂 乳腺病灶 BI-RADS 4类 良恶性 诊断效能 |
| DOI： |
| 投稿时间：2022-08-24修订日期：2023-02-28 |
| 基金项目:海南省卫生健康行业科研项目（22A200079）；院内科研培育基金项目(海医二附院2019-13) |
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| CEUS 5-point method and CEUS predictive models assessment of different sizes BI-RADS 4 of breast lesions comparative research |
| wangaizhu,huangxuning,zhanghongxia |
| (the Second Affiliated Hospital of Hainan Medical University;Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University) |
| Abstract: |
| Objective：To compare the diagnostic value of CEUS 5-point method and CEUS predictive models for breast imaging report and data system（BI-RADS） 4 of breast lesions with different sizes. Methods：165 patients (166 lesions in total) with breast lesions confirmed by puncture biopsy or surgical pathology in our hospital were collected.All patients were examined by conventional ultrasound and CEUS, and BI-RADS was classified into 4 categories.According to the size of the lesions, 101 lesions were classified into the group with diameter ≤ 2.0cm and 65 lesions were classified into the group with diameter > 2.0cm.The CEUS characteristics of the lesions were analyzed,including enhanced intensity，enhanced phase，enhanced mode，enhanced morphology，enhanced boundary，enhanced homogeneity，perfusion defect，enhanced range，crab foot sign，and nourishing vessels.The CEUS 5-point method and CEUS predictive models were used to re-determine the benign and malignant lesions, and receiver operating characteristic (ROC) curve was drawn to compare the diagnostic efficacy of the two methods for the benign and malignant of BI-RADS 4 breast lesions with different sizes. Results：The 10 CEUS characteristics of benign and malignant lesions with diameter ≤ 2.0cm were statistically significant differences（all P<0.05）.CEUS characteristics of benign and malignant lesions with diameter > 2.0cm，except for enhanced intensity，enhanced mode and perfusion defect，there were statistically significant differences in the 7 enhancement characteristics（all P<0.05）.ROC curve analysis showed that for lesions with diameter ≤ 2.0cm，the area under the curve（AUC） of CEUS 5-point method and CEUS predictive models for diagnosis of benign and malignant lesions were 0.884 and 0.861，respectively，with no statistical significance.For lesions with diameter > 2.0cm，the AUC of benign and malignant lesions diagnosed by CEUS 5-point method and CEUS predictive models were 0.932 and 0.864，respectively，with statistically significant difference（P<0.01）.The diagnostic coincidence rate of lesions with 2，3 and 5 scores in CEUS 5-point method was high，while the diagnostic coincidence rate of lesions with 1 and 4 scores was low；Among CEUS predictive models，A，D，E and F models had better predictive performance，followed by B model and C model. Conclusions：For BI-RADS 4 breast lesions with diameter ≤ 2.0cm，the CEUS 5-point method is equivalent to the diagnostic value of the CEUS predictive models；for BI-RADS 4 breast lesions with diameter > 2.0cm，the CEUS 5-point method has higher diagnostic value. |
| Key words: Ultrasonography Contrast agent Breast lesions Breast imaging report and data system 4 Benign and malignant Diagnostic efficacy |
