超声弹性成像对乳腺肿物BI-RADS分类的影响

摘要

目的 探讨超声弹性成像对乳腺肿物BI-RADS分类的诊断价值.方法 存储267个乳腺肿物的常规超声及超声弹性资料,由两位医师分别独立阅片诊断.根据乳腺常规超声图像进行BI-RADS分类诊断.1周后,对相同乳腺病变的弹性图进行评分,并结合常规超声分类情况,重新进行分类.将上述诊断与病理结果进行比较,构建ROC曲线,比较BI-RADS分类和结合弹性成像的BI-RADS分类对乳腺肿物恶性风险的评估能力.结果 ①超声医师A得到的BI-RADS分类的正确率和特异度分别为77.9％、74.11％;结合弹性成像后BI-RADS分类的正确率和特异度分别为88.64％、76.11％,两者间差异有统计学意义.超声医师B得到的BI-RADS分类的正确率和特异度分别为74.91％、71.06％;结合弹性成像后BI-RADS分类的正确率和特异度分别为83.15％、86.8％,两者间差异有统计学意义.②两名超声医师的诊断准确性无显著差异,且两者的诊断具有中等一致性(Kappa值分别为0.588、0.692).结论 在准确并熟练掌握乳腺超声弹性成像操作的基础上,加入弹性成像信息能提高超声BI-RADS分类对乳腺肿物恶性风险分层的评估能力.%Objective To evaluate the effect of ultrasound elastography on the performance of BI-RADS in diagnosing breast masses.Methods An individual physician stored all the conventional ultrasound and ultrasound elastography examinations.Two sonographers performed retrospective study of all images independently.The lesions were scored with BI-RADS according to gray scale images.The lesions were scored with BI-RADS combing the ultrasound elastography after one week.Pathological diagnosis was used as the gold standard,and ROC curve was performed,to compare the diagnostic performances between the two different standards.Results ①The accuracy and specificity of the BI-RADS scoring of sonographer A was 77.90％ and 74.11％,retrospectively; and the values was 88.64％,76.11％ when combing with the ultrasound elastography.The accuracy and specificity of the BI-RADS scoring of sonographer B was 74.91％,71.06％ without,and 83.15％,86.8％ with the assistance of ultrasound elastography.Statistical difference existsed between the two scoring systems for both the sonographers.②The diagnosis of two sonographers showed medium consistency (Kappa values were 0.558 and 0.692,respectively) and no significant difference was observed between their diagnosis accuracy.Conclusions Ultrasound elastography could improve the performance of BI-RADS in breast mass diagnosis when used properly.