应变弹性成像对 BI-RADS 4 A级乳腺病变分类诊断的价值

目的：探讨应变弹性成像技术是否能提高 US BI-RADS 4A级乳腺病变分类诊断效能。方法选择2014年5月至2016年3月因乳腺病变在我院就诊的患者中，经常规二维及彩色多普勒诊断为US BI-RADS 4A级的患者75例，乳腺病灶共87个，经二维及彩色多普勒超声评定为 BI-RADS 4A级的乳腺病灶，进行应变弹性成像检查，采用改良5分法进行评分，结合二维及彩色超声重新进行BI-RADS分级，≥4分升为4B-C级，＝3分级别不变，＜3分降至3级，并与病理结果进行对照。结果87个乳腺病灶中，弹性评分≥4的6个，＝3分的11个，＜3分的70个。病理结果显示87个乳腺肿瘤中，恶性肿瘤8个，弹性评分≥4的4个，＝3分的2个，＜3分的2个；以弹性评分≥3分为恶性，弹性评分＜3分为良性标准，诊断恶性肿瘤的敏感性、特异性及准确率分别为75．0％、86．1％和85．1％，阴性预测值97．1％，优于常规超声，差异有统计学意义（ P＜0．05）。结合弹性成像后的再次BI-RADS分级，良性组的恶性率降至2．8％，恶性组的恶性率升至35．3％，差异有统计学意义（P＜0．05）。结论弹性成像技术能有效提高BI-RADS 4A级乳腺病变的分级诊断效能，能极大地减少术前活检率，具有较好的临床应用前景。

Value of strain elastography in the classification diagnosis of US BI-RADS 4 A breast pathologic lesion

Objective To explore whether strain elastography could improve the classification diagnosis of US BI -RADS 4A breast pathologic lesion .Methods Eighty-seven breast foci of the 75 patients diagnosed with the two-dimensional color Doppler ultra-sonography as BI-RADS 4A were selected for the study , and then, strain elastography was performed .The modified 5-point method was used for further evaluation , and BI-RADS classification was performed again with the help of the two-dimensional color Doppler ultra-sonography.The cases with the scores of ≥4 were upgraded as the 4B-C grade, the cases with the scores of =3 remained in the same grade, and the cases with the scores of <3 were downgraded to be the third grade .The results were compared with the pathological re-sults.Results Of the 87 breast lesions, 6 were evaluated to have elasticity scores of ≥4, 11 were assessed to have elasticity scores of=3, and 70 were assessed to have elasticity scores of <3.There were 8 malignant tumors confirmed by pathological examination in the 87 breast lesions, of which 8 lesions had elasticity scores of ≥4, 3 lesions had elasticity scores of =3, and 2 lesions had elasticity scores of <3.With the elasticity scores of ≥3 and <3 as the standards for respectively malignant and benign tumors , the sensitivity, specificity and accuracy of the method for detecting malignant tumors were respectively 75%, 86.1% and 85.1%, and the negative predictive value (NPV) was 97.1%, which was superior to that of conventional ultrasonography (P<0.05).With further classification of BI-RADS in combined use of elastography , the malignancy rate in the benign group was reduced to 2.8%and the malignancy rate in the malignant group was increased to 35.3%, and significant differences could be noted , when compared with those previous figures ( P<0.05).Conclusion Elastography could effectively promote the classification diagnostic accuracy of BI -RADS 4A breast pathologic lesion
and could considerably reduce the rate of biopsy before surgery .With this reason , it promised good clinical application .