三维超声在BI-RADS分级中的诊断价值及应用

发布时间：2018-05-19 00:18

本文选题：二维超声 + 三维超声　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的探讨三维超声在乳腺良恶性疾病中的诊断价值及在BI—RADS分级评估中的可行性。方法回顾性分析经病理确诊的242例315个乳腺病灶的超声声像图特征，首先用二维超声收集病灶的形状、前后径/长径、内部回声、钙化、后方回声、周缘、周围组织改变、边缘、血流，之后用三维超声记录病灶冠状面的周边特性，，依据乳腺影像报告与数据系统（BI—RADS）分级标准，对比分析二维与三维超声分级结果，并用Logistic回归进行多因素分析，分析超声各征象在乳腺良恶性疾病中的诊断价值。结果 1.315个乳腺病灶中良性188个、恶性127个。二维超声、三维超声的定性诊断准确率分别是82.54%、97.46%，两者差异有统计学意义（P＜0.001）。2.11项超声征象，包括形状、前后径/长径、内部回声、钙化、后方回声、周缘、周围组织改变、边缘、血流、界面回声和“汇聚征”在乳腺良恶性病灶中差异均有统计学意义（P＜0.001）。其中4项进入回归模型，其标准化回归系数排序为周缘（1.1557）＞前后径/长径（1.1434）＞周围组织改变（0.9480）＞内部回声（0.5564）。 3.在BI—RADS分级评估中，二维和三维超声在4级判断中差异有统计学意义（P=0.020），在3级和5级中差异无统计学意义（P=1.000、P=0.577）。3级的174个病灶中，96个冠状面中表现为完整的界面回声反射，占55.17%；5级的110个病灶中，100个在冠状面中表现为“汇聚征”，占90.91%。“汇聚征”和完整界面回声反射在良恶性分布中差异有统计学意义（x2=61.177，P＜0.001）。结论 1.三维超声比二维超声在乳腺良恶性疾病诊断中准确性较高。 2.在二维超声和三维超声冠状面的共11项征象中，对鉴别乳腺良恶性疾病影响度最大的是周缘。 3.三维超声冠状面征象包括界面回声反射和“汇聚征”。完整界面回声反射在良性病变中表现为著，倾向于BI—RADS3级；“汇聚征”在恶性病变中表现为著，倾向于BI—RADS5级。 4.与二维超声相比，三维超声有助于合理分配BI—RADS分级情况，降低4级病灶的数量，从而减少不必要的活检。
[Abstract]:Objective to evaluate the diagnostic value of three-dimensional ultrasound in benign and malignant breast diseases and the feasibility of BI-RADS grade evaluation. Methods the ultrasonographic features of 315 breast lesions in 242 cases confirmed by pathology were analyzed retrospectively. The shape, anteroposterior / long diameter, internal echo, calcification, posterior echo, circumference and surrounding tissue of the lesions were collected by two-dimensional ultrasound. The peripheral characteristics of the coronal plane of the lesion were recorded by three-dimensional ultrasound. According to the BI-RADS classification standard of breast image reporting and data system, the results of two-dimensional and three-dimensional ultrasound grading were compared and analyzed, and the multivariate analysis was performed by Logistic regression. To analyze the diagnostic value of ultrasound signs in benign and malignant breast diseases. Result Of the 315 breast lesions, 188 were benign and 127 malignant. The accuracy of qualitative diagnosis of two-dimensional ultrasound and three-dimensional ultrasound were 82.54 and 97.46, respectively. The difference between them was statistically significant (P < 0.001) .2.11 ultrasonic signs, including shape, anteroposterior / long diameter, internal echo, calcification, posterior echo, circumference. There were significant differences in peripheral tissue changes, edge, blood flow, interface echo and convergence sign in benign and malignant breast lesions (P < 0.001). Four of the items entered the regression model, and the standardized regression coefficients were ranked as follows: circumference 1.1557) > anteroposterior / long-diameter 1.1434) > peripheral tissue change 0.9480) > internal echo 0.5564). 3. In the evaluation of BI-RADS grade, there was significant difference between 2D and 3D ultrasound in grade 4 judgment. In grade 3 and grade 5, there was no significant difference. In 174 lesions of grade 0.577.3, 96 coronal planes showed complete interface echo reflex. Of the 110 lesions in grade 55.17, 100 showed "convergence sign" in the coronal plane, accounting for 90.91%. There was significant difference in the distribution of benign and malignant between "convergence sign" and complete interface echo reflex (P < 0.001). Conclusion 1. Three-dimensional ultrasound is more accurate than two-dimensional ultrasound in the diagnosis of breast benign and malignant diseases. 2. Among the 11 features of two dimensional ultrasound and three dimensional ultrasound coronal plane, the most significant influence on the differential diagnosis of benign and malignant breast diseases was peripheral. 3. The coronal features of three-dimensional ultrasound include interface echo reflection and convergence sign. The complete interface echo reflex was found in benign lesions and tended to BI-RADS3 grade, while convergence sign was found in malignant lesions and tended to BI-RADS5 grade. 4. Compared with two dimensional ultrasound, three dimensional ultrasound is helpful to reasonably distribute BI-RADS grade and reduce the number of 4 grade lesions, thus reducing unnecessary biopsy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.9;R445.1

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