Objective To assess the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of BI-RADS-US 4 breast lesions.Methods A total of 123 lesions underwent CEUS.The CEUS features of lesions were categorized into 5 malignant or benign indexes respectively,lesions displaying any two of the five features were diagnosed as malignant or benign.The diagnostic effect of CEUS for BI-RADS-US 4 lesion was analyzed according to the pathological results as the gold standard.Results CEUS of the 123 BI-RADS-US 4 breast lesions indicated that 75 lesions were malignant while 48 were benign.Pathological results confirmed that there were 72 malignant lesions and 51 benign.The proportions of malignant lesions in 4A category,4B category and 4C category were 16.2 ％,58.5 ％ and 93.3 ％ respectively.The accuracy,sensitivity,specificity,positive predictive value,and negative and positive predictive value of CEUS for the diagnosis of BI-RADS-US 4 lesions were calculated as 92.7％,95.8％,88.2％,92.0％ and 93.7 ％ respectively.Lesions showing false positive in CEUS mainly needed surgical treatment,such as fibroma with active growth mesen-chyme,intraductal papilloma and granulomatous mastitts.Conclusions Surgical treatment rather than aspiration biopsy are suggested for those diagnosed being malignant in CEUS of the BI-RADS-US-4 lesions,as they can be treated as BI-RADS5 lesions.Short-term visit or aspiration biopsy are suggested for BI-RADS-US-4 lesions diagnosed being benign in CEUS.%目的 探讨超声造影(CEUS)对超声乳腺影像和数据报告系统(BI-RADS-US)4类病灶的鉴别诊断价值.方法 对123个BI-RADS-US 4类病灶行CEUS检查,依据病灶CEUS特征分别纳入5个恶性及良性指标,具备其中任意两项分别判为恶性或良性,以病理结果为金标准计算CEUS对BI-RADS 4类病灶的诊断效能.结果 123个BI-RADS-US 4类病灶CEUS提示恶性75个,良性48个;病理结果证实恶性72个,良性51个.4A类恶性占比16.2％,4B类恶性占比58.5％,4C恶性占比93.3％.CEUS诊断BI-RADS-US 4类病灶准确率、敏感性、特异性、阳性预测值及阴性预测值分别为92.7％、95.8％、88.2％、92.0％、93.7％.CEUS呈假阳性病灶在临床上是需要外科治疗的病灶,如间质生长活跃的纤维瘤、导管内乳头状瘤以及肉芽肿性乳腺炎等.结论 对于CEUS提示恶性的BI-RADS-US4类病灶可视为BI-RADIUS5类病灶,直接手术治疗,无需进行穿刺活检,CEUS提示良性的BI-RADS-US 4类病灶建议密切随访或穿刺活检.
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