超声弹性成像在乳腺BI-RADS 4级肿块良恶性诊断中比值法与评分法的应用价值

摘要

目的：探讨超声弹性成像在乳腺BI-RADS 4级肿块良恶性诊断中比值法与评分法的应用价值。方法：选用2012年1月-2015年2月经常规超声诊断为BI-RADS 4级104例患者的106个肿块，并经手术病理证实。依据改良评分法对肿块进行弹性评分，以及测定肿块应变率比值。两种方法都以病理结果为标准，对乳腺BI-RADS 4级肿块良恶性的准确度进行分析，绘制受试者工作特征（ROC），并对比分析这两种方法对BI-RADS 4级肿块良恶性诊断的效果。结果：104例患者共有106个乳腺肿块，良性42个（39.6%），恶性64个（60.4%）。依据改良评分法，BI-RADS 4级肿块其评分法诊断良恶性的敏感性为73.4%，特异性为88.1%，准确性为79.2%；BI-RADS 4级肿块其应变率比值法诊断良恶性的敏感性为95.3%，特异性为92.8%，准确性为94.3%。构建ROC曲线后，两种方法的曲线下的面积（AUC）分别是：评分法0.929，95%可信区间（0.880，0.977），应变率比值0.941，95%可信区间（0.887，0.995），两种方法准确性的配对χ2检验（MecNemar检验）结果显示差异有统计学意义（P<0.05）。结论：对于诊断BI-RADS 4级肿块的良恶性，在准确性方面，比值法较评分法较高，具有较高临床应用价值。%Objective:To explore the application value of the ratio method and the scoring method in the diagnosis of benign and malignant breast BI-RADS 4 masses.Method:106 masses of 104 patients with BI-RADS 4 grade were selected and diagnosed from January 2012 to February 2015,and confirmed by operation and pathology. According to the improved scoring method,the elastic score of the mass was measured,and the ratio of mass to strain rate was measured.Two kinds of methods were based on pathological results as the standard,the BI-RADS 4 level of breast benign and malignant tumor and the accuracy of the analysis,the receiver operating characteristic (ROC),and comparative analysis of these two methods on the BI-RADS 4 grade effect of diagnosis of benign and malignant neoplasms.Result:A total of 104 patients with 106 breast tumors,42 benign(39.6%) and 64 malignant (60.4%).According to the improved scoring method,the sensitivity of BI-RADS 4 grade mass in the diagnosis of benign and malignant tumors was 73.4%,the specificity was 88.1%,and the accuracy was 79.2%,the mass strain ratio method in diagnosis of benign and malignant sensitivity 95.3%,specificity of 92.8%,accuracy of 94.3%.Construction of ROC curve,two kinds of methods of the area under the curve (AUC) were: 0.929,95%confidence interval (0.880,0.977),strain rate ratio 0.941,95% confidence interval(0.887,0.995),the accuracy of the two methods of paired χ2 test (MecNemar test) showed that there was statistically significant differences(P<0.05).Conclusion:For the diagnosis of benign and malignant tumors of the BI-RADS 4 grade,in terms of accuracy,the ratio method is higher than the score method,which has high clinical application value.