病灶大小对触诊不清的乳腺恶性病灶超声检出率的影响

摘要

Objective To evaluate the impact of lesion size on the detection rate of non-palpable breast malignant lesions and determine whether lesion size should prompt biopsy of non-palpable breast lesions.Methods The study included 816 ultrasonographically detected non-palpable breast lesions. We divided the lesions into five groups based on their largest diameters: ≤0.5 cm, 0.6-1.0 cm, 1.1-1.5 cm, 1.6-2.0 cm,and ＞ 2.0 cm. The detection rate of malignancies of different sizes were compared among these lesions, Breast Imaging Reporting and Data System (BI-RADS) category 2-3 lesions, and BI-RADS grades 4-5 lesions. The feasibility of using lesion size as biopsy indicator for BI-RADS category 2-3 non-palpable breast lesion was analyzed using ROC curve. Results Of these 816 lesions, 100 ( 12.3％ ) were found to be malignant lesions.The detection rate of malignancy significantly increased along with the increase of lesion size ( P ＜ 0.05 ).When the BI-RADS category was not considered, the frequency of malignancy in the ＞ 2.0 cm group was significantly higher than in other groups ( P ＜ 0.05 ). The frequencies of malignancy in the 0.6-1.0 cm group,1.1-1.5 cm group, and 1.6-2.0 cm group were higher than that in ≤0.5 cm group, but the difference was not significant ( P ＞ 0.05 ). For BI-RADS category 4 and 5 lesions, the frequency of malignancy in ＞ 2.0 cm group was higher than in other groups, but significant difference was only seen between ＞ 2.0 cm group and ≤ 0.5 cm group ( P ＜ 0.05 ). Conclusions Lesion size may influence the detection rate of malignancy of non-palpable breast lesions, and can be used as biopsy indicator of non-palpable breast lesions in BI-RADS 2, 3 category. When we use 1.25cm as threshold, the sensitivity and specificity may be satisfying.%目的 探讨病灶大小是否影响超声对临床触诊不清的乳腺恶性病灶的检出及能否作为临床触诊不清的乳腺病灶活检的指征.方法 超声检查发现而临床触诊不清的乳腺病灶816个.根据病灶最大径将全部病灶分为≤0.5、0.6-1.0、1.1-1.5、1.6-2.0和>2.0 cm 5组.分别比较全部病灶、乳腺影像报告和数据系统(BI-RADS)2、3级病灶及BI-RADS 4、5级病灶恶性检出率在不同病灶大小的组间差异.通过ROC曲线分析以病灶大小作为BI-RADS2、3级触诊不清乳腺病灶的活检指征是否可行.结果 816 个病灶中恶性病灶100个(12.3%).随病灶增大,恶性病灶的检出率增高(P<0.05).在不考虑BI-RADS 分级的情况下,>2.0 cm组的恶性检出率明显高于其他各组(P<0.05),0.6～1.0、1.1～1.5、1.6～2.0 cm组的恶性病灶检出率有高于≤0.5 cm组的趋势,但差异无统计学意义(P>0.05).对于BI-RADS4、5级病灶,>2.0 cm与≤0.5 cm组差异具有统计学意义(P<0.05),>2.0 cm组恶性病灶检出率有高于0.6～1.0、1.1～1.5、1.6～2.0 cm组的趋势,但差异无统计学意义(P>0.05).病灶大小可以作为BI-RADS 2、3级触诊不清乳腺病灶活检的指征.以1.25 cm为活检阈值,能够获得较满意的敏感性(83.3%)和特异性(56.9%).结论 病灶大小对触诊不清的乳腺病灶的恶性检出率有一定影响.对超声诊断为BI-RADS 2、3 级的病灶,病灶大小可以作为活检的指征之一.