探讨超声引导下穿刺活检联合BI-RADS分级法弹性校正定量评估诊断乳腺癌的临床价值

摘要

目的 探讨超声引导下穿刺活检(ultrasound-guided core needle biopsy,US-CNB)联合BI-RADS分级法弹性校正对乳腺BI-RADS分级4B与4C类单发结节在乳腺癌精准定量诊断中的价值评估.方法 选取2014年9月 ~2016年9月就诊于南京市中西医结合医院经乳腺超声常规检查后弹性校正分级为BI-RADS 4B与4C的177例单发结节患者的资料,测算评估后行US-CNB,以术后病理结果为金标准,对比其精准定量诊断乳腺癌在特异度、灵敏度、准确率、假阴性率、假阳性率等诊断效能评价上与术后病理诊断乳腺癌的符合率是否存在差异.结果177例超声弹性校正为4B与4C的单发结节患者测算评估后其US-CNB的病理结果显示,117例为乳腺癌、60例为良性肿物,而术后病理结果显示,122例为乳腺癌、55例为良性肿物.其中117例BI-RADS分级法弹性校正后穿刺活检的病理结果与术后病理结果一致均为乳腺癌;60例结果为良性结节的患者中,5例术前US-CNB分别报告为硬化性腺病、导管内乳头状瘤、纤维腺瘤而术后病理类型为导管内癌伴微小浸润、浸润性导管癌、黏液癌、浸润性乳头癌和化生性癌.US-CNB联合BI-RADS分级法弹性校正对乳腺BI-RADS分级4B与4C类单发结节在乳腺癌精准定量诊断中的效能评价其特异度均为100%,灵敏度分别为94.82%、96.88%,准确率分别为96.77%、97.62%,假阴性率分别为5.17%、3.12%,假阳性率为0.结论 US-CNB联合BI-RADS分级弹性校正对乳腺4B与4C类单发结节在特异度、灵敏度及准确率方面效能评价肯定,作为一种精准的诊疗技术为临床后续治疗方案以及预后判断提供了准确的病理依据与重要信息.%Objective To evaluate the clinical significance of ultrasound-guided core-needle biopsy(US-CNB)in the diagnosis of breast masses for categories 4B and 4C in a validation study of 177 cases at the second edition of the Breast Imaging Reporting and Data System(BI-RADS).Methods The pathological characteristics of 177 patients with breast masses who underwent ultrasound elastography strain ratio(ESR)correction and US-CNB in the department of ultrasonography at Nanjin Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine from Sept 2014 to Sept 2016 were retrospectively analyzed. Each patient was evaluated with postoperative pathology as the gold standard. Results In a series screening of ESR and US-CNB in the 177 patients,117 cases were diagnosed with breast cancer,and 60 cases had benign masses. Finally,122 cases were confirmed with breast cancer,and 55 cases had benign lesions according to postoperative pathology. As we demonstrated here,the final study findings show that 117 cases of US-CNB were consistent with the results of postoperative pathology with breast cancer. However,5 of 60 patients had benign lesions on US-CNB,of which reported types sclerosing adenosis, ductal papillary neoplasm and fibroadenomas were confirmed as breast carcinomas on postoperative pathology, with the categories of DCIS with microinvasion,invasive ductal carcinoma,mucous carcinoma,invasive papillary carcinoma and metaplastic carcinoma. The clinical validation value of specificity of US-CNB in the diagnosis of breast carcinoma for categories 4B and 4C was 100%. Simultaneously,the sensitivity,accuracy,false-negative rate and false-positive rate for categories 4B and 4C were 94.82% and 96.88%,96.77% and 97.62%,5.17% and 3.12%, respectively, and 0%. Conclusion The clinical validation value of the BI-RADS ESR and US-CNB in the diagnosis of breast carcinoma for categories 4B and 4C with respect to the specificity,sensibility and accuracy is worthy of affirmation of the significant differences(P < 0.05,P < 0.01). As an accurate diagnosis and treatment technology,it provides an accurate pathological basis and important information for clinical follow-up treatment and prognosis.