多模态超声成像评分法在BI-RADS 4类乳腺肿块中的应用价值

Application Value of Multimodal Ultrasound Imaging Scoring Method in BI-RADS 4 Breast Masses

摘要: 目的：探讨多模态超声成像评分法在BI-RADS 4类肿块中的应用价值。方法：选取189个灰阶超声(US)诊断为BI-RADS 4类乳腺肿块，病理结果均由手术方式获得。所有肿块均经微血管血流成像、弹性超声获得血管指数(VI)、弹性应变比(SR)定量参数。以病理结果为金标准构建相应ROC曲线，获取截断值。参考相关文献对灰阶超声(US)、多模态超声(US + VI + SR)进行评分构建ROC曲线并比较诊断效能。结果：灰阶超声及多模态超声的灵敏性、特异性、准确性及AUC分别为：93.7%、79.8%、85.7%、0.868；88.7%、89.9%、89.4%、0.935。相较于灰阶超声，多模态超声AUC、特异性明显上升，具有统计学差异(P < 0.05)，准确性上升、灵敏性下降，不具有统计学差异(P > 0.05)。结论：多模态超声成像评分法可为鉴别4类乳腺肿块良恶性提供一种简单有效的定量诊断方法，进一步提高超声诊断效能，可在一定程度上减少不必要活检。

Abstract: Objective: To evaluate the application value of multimodal ultrasound imaging scoring method in BI-RADS4 masses. Methods: A total of 189 breast masses diagnosed as BI-RADS category 4 by gray-scale ultrasound (US) were selected, and pathological findings were obtained by surgical ap-proach. All masses were imaged by micro-vascular flow imaging and elastic ultrasound to obtain quantitative parameters of vascular index (VI) and elastography strain ratio (SR). The pathological findings were used as the gold standard to construct the corresponding ROC curves and obtain the cut-off values. The ROC curves were constructed by scoring gray-scale ultrasound (US) and multi-modal ultrasound (US + VI + SR) with reference to relevant literature and comparing the diagnostic efficacy. Results: The sensitivity, specificity, accuracy and AUC of gray-scale ultrasound and multi-modal ultrasound were 93.7%, 79.8%, 85.7%, 0.868 and 88.7%, 89.9%, 89.4%, 0.935, respectively. Compared with gray-scale ultrasound, the AUC and specificity of multimodal ultrasound increased significantly (P < 0.05), but the accuracy increased and sensitivity decreased, there was no statisti-cal difference (P > 0.05). Conclusion: Multimodal ultrasound imaging scoring method can provide a simple and effective quantitative diagnosis method for distinguishing benign and malignant breast mass, further improve the diagnostic efficiency of ultrasound and reduce unnecessary biopsy to a certain extent.