BI-RADS分类联合超声弹性成像在乳腺癌早期筛查的应用研究

发布时间：2018-08-08 18:13

【摘要】：目的:分析BI-RADS(Breast imaging reporting and data system)分类联合超声弹性成像在乳腺实性结节鉴别诊断中的价值,并探究在女性乳腺癌早期筛查的应用及效果,为今后开展女性乳腺健康教育、制定乳腺癌早期筛查计划提供科学依据。方法:选取我院超声科在2015年1月-2016年10月因触诊可及乳腺肿块来我院行乳腺超声检查的131例乳腺结节患者为研究对象,除外典型的囊性肿物及以囊性为主的混合性肿物,均经手术切除并行组织病理学检查。年龄15岁--83岁,平均年龄为45.3±10.5岁。使用仪器为HITACHI二郎神超声诊断仪,使用6--13MHz的高频线阵探头。先进行常规超声检查,再应用超声弹性成像(UE,Ultrasonic Elastography)技术进行评分及进行应变率比值(SR,Strain Ratio)的测量。数据应用SPSS19.0软件进行统计分析。计算各方法的准确度、灵敏度、特异度、阳性预测值、阴性预测值。各种方法均采用卡方检验观察组间差异是否有统计学意义。结果:以下结果均以手术后组织病理学诊断结果作为金标准进行对照1.常规超声BI-RADS分类评价实性结节良恶性的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为89.31%、80.56%、92.63%、80.56%、92.63%。2.超声弹性成像评分以4分及5分为恶性来评价实性结节良恶性的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为83.97%、75.00%、87.37%、69.23%、90.22%。3.确定3.12为应变率比值良恶性的最佳诊断界限值,以≥3.12为恶性评价,3.12为良性评价,其对实性结节良恶性评价的准确度、灵敏度及特异度、阳性预测值、阴性预测值分别为84.73%、80.56%、86.31%、69.05%、92.13%。4.常规超声BI-RADS分类结合弹性成像评分对乳腺实性结节良恶性诊断的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为87.02%、97.22%、83.16%、68.62%、98.75%。5.四种超声方法诊断乳腺实性结节的准确度、灵敏度、特异度两两比较,灵敏度常规超声结合弹性评分较其他每种方法均高,且差异有统计学意义(P0.05)。特异度常规超声较常规超声结合弹性评分高,且差异有统计学意义(P0.05)。结论:1.常规超声、超声弹性成像评分、超声弹性成像应变率比值、常规超声结合弹性成像评分对乳腺实性结节良恶性的鉴别均有一定的诊断价值,但单纯应用超声弹性技术对乳腺实性结节良恶性的鉴别诊断与常规超声差异无统计学意义。2.常规超声BI-RADS分类联合弹性成像评分或者联合超声弹性成像应变率比值诊断方法提高了乳腺癌的早期检出率,为乳腺癌的早发现、早诊断、早治疗提供了有意义的参考价值。建议采用联合诊断方法,有助于提高乳腺疾病早期诊断率,减少误诊率。
[Abstract]:Objective: to analyze the value of BI-RADS (Breast imaging reporting and data system) classification combined with ultrasound elastography in the differential diagnosis of breast solid nodules, and to explore the application and effect of early screening for female breast cancer, and to provide scientific basis for the future development of female breast health education and the formulation of early screening plan for breast cancer. 131 cases of breast nodules in our hospital in October, January 2015 -2016 years, due to palpation and breast lump and breast ultrasonography in our hospital, were studied. Except for typical cystic mass and cystic mass, all of them were excised and histopathologically examined. The age of 15 years old was 45.3 + 10.5 years old, with a mean age of 45.3 + 10.5. Using the instrument as the HITACHI Erlang Shen ultrasonic diagnostic instrument, the high frequency linear array probe of 6--13MHz is used. The routine ultrasound examination is performed first, then the UE (Ultrasonic Elastography) technique is used to evaluate the ratio of strain rate (SR, Strain Ratio). The data are analyzed by the SPSS19.0 software and the methods are used to calculate the methods. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value. All methods used chi square test to observe whether the differences between the groups were statistically significant. Results: the following results were compared with 1. conventional ultrasound BI-RADS to evaluate the accuracy of benign and malignant nodules. The sensitivity, specificity, positive predictive value, negative predictive value were 89.31%, 80.56%, 92.63%, 80.56%, and 92.63%.2. ultrasound elastography score was 4 and 5 as malignant to evaluate the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 83.97%, 75%, 87.37%, 69.23%, 90.22%.3. to determine 3.12 should be determined. The best diagnostic threshold value of the ratio of variable ratio, benign and malignant, was more than 3.12, and 3.12 was benign. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 84.73%, 80.56%, 86.31%, 69.05%, 92.13%.4., respectively, to the mammary gland. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the benign and malignant diagnosis of sexual nodules were 87.02%, 97.22%, 83.16%, 68.62%, and 98.75%.5., respectively, for the accuracy, sensitivity, and specificity 22 of four kinds of ultrasound methods in the diagnosis of breast solid nodules, and the sensitivity of regular ultrasound combined with elastic score was higher than that of the other methods, and the difference was different. There was a statistical significance (P0.05). The specificity of conventional ultrasound was higher than that of conventional ultrasound, and the difference was statistically significant (P0.05). Conclusion: 1. conventional ultrasound, ultrasound elastography score, ultrasonic elastography strain rate ratio, and conventional ultrasound combined with elastography have a certain diagnostic value for the differential diagnosis of benign and malignant breast nodules. There is no significant difference between the differential diagnosis of benign and malignant breast tubercle with Ultrasonic Elastic technique, but there is no significant difference between conventional ultrasound and conventional ultrasound.2. BI-RADS classification combined with elastic imaging score or combined ultrasonic elastic imaging strain rate ratio diagnosis method to improve the early detection rate of breast cancer, early detection and early diagnosis of breast cancer It is suggested that the combined diagnosis method should be used to improve the early diagnosis rate of breast diseases and reduce the misdiagnosis rate.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

【参考文献】