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目的探讨对超声乳腺影像报告及数据系统(BI-RADS-US)4类病灶细化分为4a、4b、4c的方法及意义,以便更客观、准确地评价分析BI-RADS-US 4类病变,提高超声诊断的准确性。方法回顾性分析我院2014年1月至2014年8月期间经病理证实的BI-RADS-US 4类乳腺病灶共288个,分别以病灶的形态、纵横比、边缘、钙化、周围组织改变、边界、血流特征、后方回声及内部回声这些超声征象进行细化对比分析,根据这些超声征象将BI-RADS-US 4类病变进一步分为4a、4b、4c,并进行统计学分析。结果 288个BI-RADS-US 4类乳腺病灶中恶性192个,良性96个。良、恶性病变的形态、纵横比、边缘、钙化、周围组织改变、边界间的比较,差异均有统计学意义(P<0.05),即恶性病变中以形态不规则、纵横比>1、边缘不清晰、微钙化、周围组织有改变、边界不清晰所占比例较高;而血流特征、肿瘤内部回声及后方回声改变间比较,差异均无统计学意义(P>0.05)。根据差异有统计学意义的超声征象进一步细化分类后,4a、4b、4c类病变的恶性肿瘤阳性预测值分别为21.74%、58.90%及91.78%,且差异有统计学意义(χ~2=106.09,P=0.000)。结论对BI-RADS-US 4类乳腺病变进行细化分类诊断,能更准确地对乳腺肿块良、恶性风险进行评估,对诊断和治疗均具有重要临床意义。
Objective To investigate the method and significance of classifying 4 types of lesions in 4 cases of BI-RADS-US, and to evaluate objectively and accurately the BI-RADS-US class 4 lesions , Improve the accuracy of ultrasound diagnosis. Methods A total of 288 BI-RADS-US type 4 breast lesions confirmed by pathology in our hospital from January 2014 to August 2014 were retrospectively analyzed. The changes of lesion morphology, aspect ratio, margin, calcification, surrounding tissues, Borderline, blood flow characteristics, back echo and internal echo were compared and analyzed. Based on these ultrasound signs, BI-RADS-US type 4 lesions were further divided into 4a, 4b, 4c and analyzed statistically. Results Among the 288 BI-RADS-US type 4 breast lesions, 192 were malignant and 96 were benign. The difference of morphology, aspect ratio, margin, calcification, surrounding tissue changes and borderline between benign and malignant lesions were statistically significant (P <0.05), that is, malignant lesions were characterized by irregular shape, aspect ratio> 1, Unclear, micro-calcification, the surrounding tissue has changed, the border is not clear accounted for a higher proportion; and blood flow characteristics, internal tumor echo and echo changes between the rear, no significant difference (P> 0.05). According to the statistical difference of ultrasound signs, the positive predictive values of malignant tumors in categories 4a, 4b, 4c were 21.74%, 58.90% and 91.78%, respectively, and the difference was statistically significant (χ ~ 2 = 106.09, P = 0.000). Conclusion The classification and classification of BI-RADS-US type 4 breast lesions can be more accurate assessment of benign and malignant breast tumor risk, diagnosis and treatment of great clinical significance.