超声BI-RADS 3级乳腺病灶的回顾性分析

发布时间：2018-06-17 21:31

  本文选题：超声检查 + 乳腺病灶　； 参考：《苏州大学》2014年硕士论文

【摘要】：目的： 通过回顾性分析443例BI-RADS3级乳腺病灶超声影像学特征，探讨超声对BI-RADS3级乳腺病灶的诊断价值及影响因素。 材料与方法： （1）首先根据超声乳腺影像报告和数据系统（BI-RADS-US）标准对超声初步诊断为乳腺良性病灶（BI-RADS3级），且有明确病理结果的患者共443例，进行回顾性分析。以病理学结果为金标准，获得BI-RADS3级乳腺病灶的阴性预测值（NPV），以及BI-RADS分级标准中良性病灶描述词（良性征象）的NPV。（2）采用Kim等推荐的新分级标准，由两位医师对443例BI-RADS3级乳腺病灶的超声图像重新判读，获得重新分级的结果。（3）探讨BI-RADS分级及重新分级的影响因素（超声医师年资、患者年龄、病灶大小、病灶数目及病灶体表触诊情况）。统计学分析用SPSS13.0软件进行处理。 结果： （1）超声BI-RADS3级的诊断效能：443枚BI-RADS3级乳腺病灶中，，432枚为良性，11枚为恶性。恶性病例包括：浸润性导管癌7枚、导管内癌2枚、脂肪肉瘤1枚，中-重度不典型增生1枚。以病理结果为金标准，超声BI-RADS3乳腺病灶的NPV为97.5％。乳腺良性病灶描述词NPV：椭圆形97.8％（405/414），圆形93.1％(27/29)，平行方位97.5％（432/443），边界清楚98.6％（358/363），边缘窄而锐利98.1％（418/426）。 （2）根据新分级标准重新分级结果：155枚（155/443）乳腺病灶被调升至BI-RADS4级，其中恶性病灶为10枚，检出率为90.9％（10/11），良性病灶为145枚，根据BI-RADS4级的推荐处理意见（穿刺活检），推算活检假阳性率为33.6％（145/432）。 （3）BI-RADS分级的影响因素：乳腺病灶体表触诊情况是影响BI-RADS分级的主要因素（P=0.036），恶性乳腺病灶更易被触及。而医师年资、患者年龄、乳腺病灶数目及大小对BI-RADS分级无明显影响（P均＞0.05）。 （4）重新分级的影响因素：患者年龄及乳腺病灶是否多发是影响重新分级的主要因素（2=51.931，P＜0.001；2=9.295，P=0.002），年龄≥40岁、乳腺病灶多发的病例更可能被调升至BI-RADS4级。而医师年资、病灶大小及病灶体表触诊情况对其重新分级无明显影响（2=0.768，2=0.656，2=0.348，P均＞0.05）。 结论： 超声对乳腺良性病灶的筛选有很高的NPV。重新分级可以大幅度提高恶性病灶的检出率，但将导致较高的穿刺假阳性率。病灶能否触及是影响BI-RADS分级的主要因素。患者年龄及乳腺病灶是否多发是影响重新分级的主要因素。
[Abstract]:Purpose :

The diagnostic value and influencing factors of ultrasound on BI - RADS3 grade breast lesions were investigated by retrospective analysis of 443 BI - RADS3 grade breast lesions .

Materials and Methods :

( 1 ) The primary diagnosis of breast benign lesions ( BI - RADS3 grade ) was first diagnosed according to the ultrasound breast image report and data system ( BI - RADS - US ) standard . Statistical analysis was performed with SPSS 13.0 software .

Results :

( 1 ) The diagnostic efficacy of ultrasound BI - RADS3 grade : 432 of 443 BI - RADS3 grade breast lesions were benign and 11 were malignant . The malignant cases included 7 lesions in invasive ductal carcinoma , 2 in ductal carcinoma , 1 in fat sarcoma , and 95.1 % ( 27 / 29 ) in circular shape and 97.5 % ( 432 / 443 ) in parallel orientation . The border was clear 98 . 6 % ( 358 / 363 ) , with a narrow margin of 98.1 % ( 418 / 426 ) .

( 2 ) According to the new grading standard re - grading results : 155 ( 155 / 443 ) breast lesions were adjusted to BI - RADS4 grade , of which the malignant lesions were 10 , the detection rate was 90.9 % ( 10 / 11 ) , the benign lesions were 145 , according to the recommended treatment opinion of BI - RADS4 ( puncture biopsy ) , the false positive rate of biopsy was 33.3 % ( 145 / 432 ) .

( 3 ) The influence factors of BI - RADS classification : the contact status of breast lesions was the main factor affecting the grading of BI - RADS ( P = 0.036 ) , and malignant breast lesions were more easily accessible , while the number and size of breast lesions were not significantly affected by physician ' s seniority , age of the patient , number and size of breast lesions ( P > 0.05 ) .

( 4 ) influencing factors of re - grading : the age of the patient and whether the lesions of breast lesions were the main factors influencing the re - grading ( 2 = 51.931 , P < 0.001 ) ;
2 = 9.295 , P = 0.002 ) , more likely to be raised to BI - RADS4 level in patients with 鈮

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