中华医学超声杂志(电子版)
中華醫學超聲雜誌(電子版)
중화의학초성잡지(전자판)
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2013年
8期
662-668
,共7页
周帅%胡敏霞%朱强%黄慧莲%荣雪余%赵汉学%陈宇
週帥%鬍敏霞%硃彊%黃慧蓮%榮雪餘%趙漢學%陳宇
주수%호민하%주강%황혜련%영설여%조한학%진우
乳腺肿瘤%超声检查%诊断
乳腺腫瘤%超聲檢查%診斷
유선종류%초성검사%진단
Breast neoplasm%Ultrasonography%Diagnosis
目的采用乳腺超声影像报告与数据系统(BI-RADS-US)征象术语分析≤2 cm的乳腺小结节,探讨其诊断一致性和在乳腺良恶性结节鉴别诊断中的应用价值。方法收集2009年1月至2011年12月首都医科大学附属北京同仁医院289例患者共317个经手术及穿刺病理证实、≤2 cm的乳腺结节。其中0~1 cm结节160个(146例),>1~2 cm结节157个(143例)。按照BI-RADS-US征象术语描述乳腺结节超声征象。采用Kappa检验分析3位医师评价超声征象的一致性。采用χ2检验分别比较0~1 cm、>1~2 cm乳腺良恶性结节BI-RADS-US征象术语差异。以病理诊断结果作为金标准,计算恶性超声征象诊断乳腺恶性结节的敏感度、特异度、准确性、阳性预测值(PPV)和阴性预测值(NPV)。结果160个0~1 cm的乳腺结节中,良性95个,恶性65个。157个>1~2 cm的乳腺结节中,良性91个,恶性66个。(1)对于0~1 cm的乳腺结节,3位评价者对形状、方位、边缘、内部回声、周围情况、钙化等6类BI-RADS-US征象术语评价的一致性为中等(κ值分别为0.44、0.57、0.48、0.43、0.51、0.57)。对于>1~2 cm的乳腺结节,3位评价者对形状、方位、边缘、内部回声等4类BI-RADS-US征象术语评价的一致性较好(κ值分别为0.65、0.61、0.64、0.63)。(2)0~1 cm的乳腺结节,恶性结节多表现为不规则形、非平行方位、边缘不光整、高回声晕及微钙化,与良性结节比较差异均有统计学意义[52.3%(34/65) vs 20.0%(19/95),38.5%(25/65) vs 13.7%(13/95),75.4%(49/65) vs 32.6%(31/95),18.6%(12/65)vs 0(0/95),10.8%(7/65)vs 2.1%(2/95);χ2值分别为18.19、13.08、28.22、16.39、3.95,P均<0.05],>1~2 cm的乳腺结节,恶性结节多表现为不规则形、非平行方位、边缘不光整、高回声晕、后方回声衰减、Cooper韧带改变及微钙化,与良性结节比较差异均有统计学意义[74.2%(49/66)vs 12.1%(11/91),36.4%(24/66)vs 5.5%(5/91),93.9%(62/66) vs 22.0%(20/91),37.9%(25/66) vs 3.3%(3/91),30.3%(20/66) vs 7.7%(7/91),15.2%(10/66) vs 0(0/91),16.7%(11/66) vs 4.4%(4/91);χ2值分别为62.59、24.21、79.40、31.22、13.73、12.30、6.67,P均=0.000]。(3)对于0~1 cm、>1~2 cm的乳腺结节,边缘不光整诊断恶性结节的敏感度为75.4%、93.9%,不规则形、非平行方位、高回声晕、微钙化、后方衰减和Cooper韧带改变诊断恶性结节的敏感度较低(10.8%~52.3%、15.2%~74.2%),而除边缘不光整诊断恶性结节的特异度较低外(67.4%、78.0%),其余征象诊断恶性结节的特异度均较高(80.0%~100%、87.9%~100%)。结论 BI-RADS-US征象术语应用于乳腺小结节描述的一致性较为满意。边缘不光整诊断乳腺恶性小结节的敏感度较高,是诊断小乳癌最重要的超声征象;不规则形、非平行方位、高回声晕、微钙化、后方衰减和Cooper韧带改变诊断乳腺恶性小结节的特异度较高,有利于活检或手术前诊断。
目的採用乳腺超聲影像報告與數據繫統(BI-RADS-US)徵象術語分析≤2 cm的乳腺小結節,探討其診斷一緻性和在乳腺良噁性結節鑒彆診斷中的應用價值。方法收集2009年1月至2011年12月首都醫科大學附屬北京同仁醫院289例患者共317箇經手術及穿刺病理證實、≤2 cm的乳腺結節。其中0~1 cm結節160箇(146例),>1~2 cm結節157箇(143例)。按照BI-RADS-US徵象術語描述乳腺結節超聲徵象。採用Kappa檢驗分析3位醫師評價超聲徵象的一緻性。採用χ2檢驗分彆比較0~1 cm、>1~2 cm乳腺良噁性結節BI-RADS-US徵象術語差異。以病理診斷結果作為金標準,計算噁性超聲徵象診斷乳腺噁性結節的敏感度、特異度、準確性、暘性預測值(PPV)和陰性預測值(NPV)。結果160箇0~1 cm的乳腺結節中,良性95箇,噁性65箇。157箇>1~2 cm的乳腺結節中,良性91箇,噁性66箇。(1)對于0~1 cm的乳腺結節,3位評價者對形狀、方位、邊緣、內部迴聲、週圍情況、鈣化等6類BI-RADS-US徵象術語評價的一緻性為中等(κ值分彆為0.44、0.57、0.48、0.43、0.51、0.57)。對于>1~2 cm的乳腺結節,3位評價者對形狀、方位、邊緣、內部迴聲等4類BI-RADS-US徵象術語評價的一緻性較好(κ值分彆為0.65、0.61、0.64、0.63)。(2)0~1 cm的乳腺結節,噁性結節多錶現為不規則形、非平行方位、邊緣不光整、高迴聲暈及微鈣化,與良性結節比較差異均有統計學意義[52.3%(34/65) vs 20.0%(19/95),38.5%(25/65) vs 13.7%(13/95),75.4%(49/65) vs 32.6%(31/95),18.6%(12/65)vs 0(0/95),10.8%(7/65)vs 2.1%(2/95);χ2值分彆為18.19、13.08、28.22、16.39、3.95,P均<0.05],>1~2 cm的乳腺結節,噁性結節多錶現為不規則形、非平行方位、邊緣不光整、高迴聲暈、後方迴聲衰減、Cooper韌帶改變及微鈣化,與良性結節比較差異均有統計學意義[74.2%(49/66)vs 12.1%(11/91),36.4%(24/66)vs 5.5%(5/91),93.9%(62/66) vs 22.0%(20/91),37.9%(25/66) vs 3.3%(3/91),30.3%(20/66) vs 7.7%(7/91),15.2%(10/66) vs 0(0/91),16.7%(11/66) vs 4.4%(4/91);χ2值分彆為62.59、24.21、79.40、31.22、13.73、12.30、6.67,P均=0.000]。(3)對于0~1 cm、>1~2 cm的乳腺結節,邊緣不光整診斷噁性結節的敏感度為75.4%、93.9%,不規則形、非平行方位、高迴聲暈、微鈣化、後方衰減和Cooper韌帶改變診斷噁性結節的敏感度較低(10.8%~52.3%、15.2%~74.2%),而除邊緣不光整診斷噁性結節的特異度較低外(67.4%、78.0%),其餘徵象診斷噁性結節的特異度均較高(80.0%~100%、87.9%~100%)。結論 BI-RADS-US徵象術語應用于乳腺小結節描述的一緻性較為滿意。邊緣不光整診斷乳腺噁性小結節的敏感度較高,是診斷小乳癌最重要的超聲徵象;不規則形、非平行方位、高迴聲暈、微鈣化、後方衰減和Cooper韌帶改變診斷乳腺噁性小結節的特異度較高,有利于活檢或手術前診斷。
목적채용유선초성영상보고여수거계통(BI-RADS-US)정상술어분석≤2 cm적유선소결절,탐토기진단일치성화재유선량악성결절감별진단중적응용개치。방법수집2009년1월지2011년12월수도의과대학부속북경동인의원289례환자공317개경수술급천자병리증실、≤2 cm적유선결절。기중0~1 cm결절160개(146례),>1~2 cm결절157개(143례)。안조BI-RADS-US정상술어묘술유선결절초성정상。채용Kappa검험분석3위의사평개초성정상적일치성。채용χ2검험분별비교0~1 cm、>1~2 cm유선량악성결절BI-RADS-US정상술어차이。이병리진단결과작위금표준,계산악성초성정상진단유선악성결절적민감도、특이도、준학성、양성예측치(PPV)화음성예측치(NPV)。결과160개0~1 cm적유선결절중,량성95개,악성65개。157개>1~2 cm적유선결절중,량성91개,악성66개。(1)대우0~1 cm적유선결절,3위평개자대형상、방위、변연、내부회성、주위정황、개화등6류BI-RADS-US정상술어평개적일치성위중등(κ치분별위0.44、0.57、0.48、0.43、0.51、0.57)。대우>1~2 cm적유선결절,3위평개자대형상、방위、변연、내부회성등4류BI-RADS-US정상술어평개적일치성교호(κ치분별위0.65、0.61、0.64、0.63)。(2)0~1 cm적유선결절,악성결절다표현위불규칙형、비평행방위、변연불광정、고회성훈급미개화,여량성결절비교차이균유통계학의의[52.3%(34/65) vs 20.0%(19/95),38.5%(25/65) vs 13.7%(13/95),75.4%(49/65) vs 32.6%(31/95),18.6%(12/65)vs 0(0/95),10.8%(7/65)vs 2.1%(2/95);χ2치분별위18.19、13.08、28.22、16.39、3.95,P균<0.05],>1~2 cm적유선결절,악성결절다표현위불규칙형、비평행방위、변연불광정、고회성훈、후방회성쇠감、Cooper인대개변급미개화,여량성결절비교차이균유통계학의의[74.2%(49/66)vs 12.1%(11/91),36.4%(24/66)vs 5.5%(5/91),93.9%(62/66) vs 22.0%(20/91),37.9%(25/66) vs 3.3%(3/91),30.3%(20/66) vs 7.7%(7/91),15.2%(10/66) vs 0(0/91),16.7%(11/66) vs 4.4%(4/91);χ2치분별위62.59、24.21、79.40、31.22、13.73、12.30、6.67,P균=0.000]。(3)대우0~1 cm、>1~2 cm적유선결절,변연불광정진단악성결절적민감도위75.4%、93.9%,불규칙형、비평행방위、고회성훈、미개화、후방쇠감화Cooper인대개변진단악성결절적민감도교저(10.8%~52.3%、15.2%~74.2%),이제변연불광정진단악성결절적특이도교저외(67.4%、78.0%),기여정상진단악성결절적특이도균교고(80.0%~100%、87.9%~100%)。결론 BI-RADS-US정상술어응용우유선소결절묘술적일치성교위만의。변연불광정진단유선악성소결절적민감도교고,시진단소유암최중요적초성정상;불규칙형、비평행방위、고회성훈、미개화、후방쇠감화Cooper인대개변진단유선악성소결절적특이도교고,유리우활검혹수술전진단。
Objective To study the interobserver variabilities and the differential diagnosis value of Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon for small ( ≤ 2 cm) breast nodules. Methods Between January 2009 and December 2011, 289 patients with small (≤2 cm) breast nodules (n=317) were included. According to sizes, the lesions were divided into two groups, i.e., 0-1 cm (n=160) group and 1-2 cm (n=157)group. Each lesion was described independently by 3 radiologists using BI-RADS-US lexicon. Interobserver variabilities were assessed by Kappa test. Chi-square test was used to compare the frequency difference of the descriptors between malignant and benign lesions. Sensitivity, speciifcity, accuracy, positive predictive value and negtive predictive value were calculated. Results (1)Moderate agreements were obtained for lesion shape, orientation, margin, echo pattern, surrounding tissue and calciifcations (κ=0.44, 0.57, 0.48, 0.43, 0.51 and 0.57) in 0-1 cm group. Substantial agreements were obtained for lesion shape, orientation, margin and echo pattern (κ=0.65, 0.61, 0.64 and 0.63) in 1-2 cm group. (2)Irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo and microcalciifcations were more frequently found in malignant nodules than in benign nodules in 0-1 cm group [52.3% (34/65) vs 20.0% (19/95), 38.5%(25/65) vs 13.7%(13/95), 75.4%(49/65) vs 32.6%(31/95), 18.6%(12/65) vs 0 (0/95) and 10.8%(7/65) vs 2.1%(2/95);χ2=18.19, 13.08, 28.22, 16.39 and 3.95;P=0.000, 0.000, 0.000, 0.000 and 0.047]. Similarly, irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were signiifcantly more frequent found in malignant nodules than in benign nodules in 1-2 cm group [74.2%(49/66) vs 12.1%(11/91), 36.3%(24/66) vs 5.5%(5/91), 93.9%(62/66) vs 22.0%(20/91), 37.9%(25/66) vs 3.3%(3/91), 30.3%(20/66) vs 7.7%(7/91), 15.2%(10/66) vs 0 (0/91) and 16.7%(11/66) vs 4.4%(4/91);χ2=62.59, 24.21, 79.40, 31.22, 13.73, 12.30 and 6.67;P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000 and 0.010]. (3)In both groups, a good sensitivity was demonstrated (75.4%&93.9%) when using the non-circumscribed margin as a criterion for malignancy, and high speciifcity was achieved in two groups (80.0%-100%and 87.9%-100%) when other descriptors including irregular shape, non-parallel orientation, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were used as differentiation criteria. Conclusions Good interobserver agreement can be achieved using the BI-RADS-US lexicon in the diagnosis of small breast nodules. Non-circumscribed margin are proved as the most valuable sign for screening malignant breast lesions ≤ 2 cm. High speciifcity was found for irregular shape, nonparallel orientation, echogenic halo, shadowing, Cooper′s ligament changes and microcalciifcations, which can help biopsy and preoperative diagnosis.