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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (06) : 459 -465. doi: 10.3877/cma.j.issn.1672-6448.2016.06.012

所属专题： 乳腺超声； 文献；

浅表器官超声影像学

乳腺良恶性病灶超声造影预测模型在乳腺影像报告与数据系统4类乳腺病灶恶性风险评估中的应用价值
罗俊1, 陈吉东1, 陈琴1,†(), 岳林先1, 周果1, 兰橙1, 李一2, 吴池华2, 苏学智3, 卢旌乔4   
  1. 1. 610072　成都，四川省人民医院超声科
    2. 610072　成都，四川省人民医院乳腺外科
    3. 610072　成都，四川省人民医院病理科
    4. 30322　佐治亚州亚特兰大，美国埃默理大学医学院耳鼻咽喉科
  • 收稿日期:2015-09-27 出版日期:2016-06-01
  • 通信作者: 陈琴

Application value of predictive models of contrast-enhanced ultrasound in the evaluation of breast imaging reporting and data system 4 breast lesions

Jun Luo1, Jidong Chen1, Qing Chen1,†(), Linxian Yue1, Guo Zhou1, Cheng Lan1, Yi Li2, Chihua Wu2, Xuezhi Su3, Jingqiao Lu4   

  1. 1. Department of Ultrasound, Sichuan Provincial People’s Hospital, Chengdu 610072, China
    2. Department of Breast Surgery, Sichuan Provincial People’s Hospital, Chengdu 610072, China
    3. Department of Pathology, Sichuan Provincial People’s Hospital, Chengdu 610072, China
    4. Department of Otolaryngology, School of Medicine, Emory University, Atlanta, GA 30322, USA
  • Received:2015-09-27 Published:2016-06-01
  • Corresponding author: Qing Chen
  • About author:
    Corresponding author: Chen qin, Email:
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引用本文：

罗俊, 陈吉东, 陈琴, 岳林先, 周果, 兰橙, 李一, 吴池华, 苏学智, 卢旌乔. 乳腺良恶性病灶超声造影预测模型在乳腺影像报告与数据系统4类乳腺病灶恶性风险评估中的应用价值[J]. 中华医学超声杂志（电子版）, 2016, 13(06): 459-465.

Jun Luo, Jidong Chen, Qing Chen, Linxian Yue, Guo Zhou, Cheng Lan, Yi Li, Chihua Wu, Xuezhi Su, Jingqiao Lu. Application value of predictive models of contrast-enhanced ultrasound in the evaluation of breast imaging reporting and data system 4 breast lesions[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(06): 459-465.

目的

构建乳腺良恶性病灶超声造影预测模型，评价其在乳腺影像报告与数据系统（BI-RADS）4类乳腺病灶恶性风险评估中的应用价值。

方法

2013年1月至2014年7月在四川省人民医院接受乳腺超声造影检查的230例患者，共235个乳腺实性结节。所有患者经最终穿刺活检或者手术病理结果确诊。通过对既往文献关于乳腺良恶性病灶超声造影模式的分析及本课题组的前期研究和临床经验总结，构建乳腺良恶性病灶超声造影预测模型。以穿刺活检或手术病理结果作为金标准，计算预测乳腺良恶性病灶的超声造影模型鉴别诊断乳腺良恶性病灶的敏感度、特异度、准确性。

结果

本组235个乳腺结节，其中乳腺良性结节139个（59.2%），乳腺恶性结节96个（40.8%）。乳腺良恶性病灶超声造影预测模型鉴别诊断乳腺良恶性病灶的敏感度、特异度及准确性分别为87.01%、86.92%和86.99%。

结论

乳腺良恶性病灶超声造影模式存在差异。乳腺良恶性病灶超声造影预测模型可以更好地评估乳腺病灶恶性风险，尤其对BI-RADS 4类乳腺病灶评估更准确。

关键词: 超声检查, 造影剂, 乳腺疾病
Objective

To build breast contrast-enhanced ultrasound (CEUS) predictive models of benign and malignant lesions, and evaluate its value in malignant risk assessment.

Methods

Breast CEUS predictive models of benign and malignant lesions was build depending on the analysis of published papers, conclusion of the previous study results and the clinical experience. With final pathology results as the gold standard, the predictive value was evaluated in totally 235 nodules which were classified as breast imaging reporting and data system (BI-RADS) 4.

Results

There were 139 benign nodules (59.2%) and 96 malignant nodules (40.8%) in this study. Diagnostic sensitivity, specificity and accuracy of three malignant CEUS models and three benign CEUS models were 87.01%, 86.92% and 86.99%, respectively.

Conclusions

The contrast-enhanced patterns of benign and malignant breast tumors are different. The breast CEUS models can predict malignant risk of breast lesions more accurately, may lead to the decrease of false-positive biopsy and better BI-RADS used nowadays.

Key words: Ultrasonography, Contrast media, Breast diseases
图1~13 乳腺恶性病灶的超声造影预测模型。图1~3　分别为A模型示意图、二维超声表现、超声造影表现，示病灶高增强，增强后病灶范围增大，有或无增强后病灶形态不规则；图4~6　分别为B模型示意图、二维超声表现、超声造影表现，示病灶高增强，向心性增强，有充盈缺损（箭头所示），有或无增强后病灶范围增大；图7　为C模型示意图。图8、9分别为二维超声表现、超声造影表现示病灶快进高增强，有滋养血管（箭头所示）；图10、11　分别为二维超声表现、超声造影表现示病灶快进高增强，有蟹足征（箭头所示）；图12、13　分别为二维超声表现、超声造影表现示病灶同进等增强，伴充盈缺损（箭头所示）
图14~24 乳腺良性病灶的超声造影预测模型。图14~16　分别为D模型示意图、二维超声表现、超声造影表现，示病灶高增强，增强后病灶大小不变，形态规则，无滋养血管；图17~19　分别为E模型示意图、二维超声表现、超声造影表现，病灶慢进或同进等增强，不能分辨病灶边界及形态，无充盈缺损和滋养血管征；图20　为E模型病灶时间-强度曲线，呈同进等增强；图21~23　分别为F模型示意图、二维超声表现、超声造影表现，病灶慢进或同进低增强，增强后大小不变或缩小，无滋养血管；图24　为F模型病灶时间-强度曲线，呈慢进低增强
表1 乳腺良恶性病灶超声造影预测模型鉴别诊断乳腺良恶性病灶的价值（个）
预测模型 病理结果 合计
恶性 良性
恶性 81 17 98
良性 12 113 125
合计 93 130 223
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