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目的探讨超声剪切波定量参数在优化乳腺结节BI-RADS分类中的价值。方法穿刺或手术前对126例(132个)乳腺病灶行BI-RADS分类,再行剪切波弹性成像检测,获得乳腺良恶性病灶的剪切波定量参数,以病理结果为金标准,比较BI-RADS分类及其结合弹性最大值Emax评价乳腺良恶性病变的诊断效能,分析Emax对BI-RADS 4a类乳腺病变的诊断价值。结果 132个病灶中,良性病变82个(62.1%),恶性病变50个(37.9%)。恶性病灶组的剪切波定量参数均明显高于良性病灶组,差异具有统计学意义(P<0.001)。BI-RADS分类结合Emax评价乳腺良恶性病灶时ROC曲线面积最高;以Emax60.97kPa评价BI-RADS 4a类病变,可使92.3%4a类调整为3类,但通过降类后,可使BI-RADS 3类的假阴性率由0上升为4.23%。结论超声BI-RADS分类结合剪切波Emax有助于提高乳腺良恶性病变诊断的特异度、准确度,对于大多数4a类病变,可以减少不必要的穿刺活检或手术,但对于部分BI-RADS 4a类依据弹性成像降类的可疑小病灶,应综合判断,最大化降低假阴性病例。
Objective To investigate the value of quantitative ultrasound shear wave in the classification of breast nodules BI-RADS. Methods BI-RADS classification was performed on 126 cases (132) of breast lesions before or after puncture or operation. Quantitative shear-wave parameters of benign and malignant breast lesions were obtained by shear-wave elastography. The pathological results were taken as the gold standard. BI -RADS classification and the maximum elastic elastic modulus Emax to evaluate the diagnostic efficacy of benign and malignant breast lesions, and to analyze the diagnostic value of Emax on BI-RADS 4a breast lesions. Results Of the 132 lesions, 82 (62.1%) had benign lesions and 50 (37.9%) had malignant lesions. The quantitative parameters of shear wave in malignant group were significantly higher than those in benign group, the difference was statistically significant (P <0.001). BI-RADS classification combined with Emax evaluation of benign and malignant breast lesions when the ROC curve area highest; Emax60.97kPa evaluation of BI-RADS 4a class lesions, 92.3% 4a can be adjusted to 3 categories, but by lowering the class, BI- The false negative rate of RADS 3 increased from 0 to 4.23%. Conclusion The combination of ultrasound BI-RADS classification and shear wave Emax can help to improve the specificity and accuracy of diagnosis of benign and malignant breast lesions. It can reduce unnecessary biopsy or surgery for the majority of type 4a lesions. However, for some BI-RADS 4a class based on elastic imaging suspicious lesions, should be comprehensive judgments, to maximize the reduction of false-negative cases.