CAJ | 학술논문

目的：探讨直径≤1 cm乳腺小肿块超声乳腺影像报告与数据系统（breast imaging reporting and data system ，BI‐RADS）的应用价值。方法参照超声BI‐RADS对219例患者共230个最大直径≤1 cm的小肿块进行描述与分级，评价超声BI‐RADS中所描述的各超声征象及最终分级和病理之间的关系。结果经病理证实良性肿块158个（687．％），恶性肿块72个（313．％）。超声BI‐RADS描述指标中形态、边缘、方向、后方回声及微钙化在良、恶性小肿块的差别具有统计学意义（P ＜0.05），形态不规则、边缘不清晰、方向垂直、后方回声衰减、微钙化为恶性征象，对恶性肿块诊断的阳性预测值为533．％～100％、敏感性为28．％～750．％、特异性为823．％～100％、准确性为696．％～809．％。评估为BI‐RADS 3、4、5级的小肿块分别有152个（661．％）、62个（270．％）、16个（70．％），恶性肿块诊断的阳性预测值分别为105．％（16／152）、645．％（40／62）、100％（16／16）。术前评估为BI‐RADS 3级而病理结果显示为恶性者中875．％（14／16）为导管内癌和特殊类型浸润性癌，良性小肿块术前诊断为BI‐RADS 4级的病例中909．％（20／22）为增生病和导管内乳头状瘤。结论直径≤1 cm的乳腺小肿块中，由于恶性征象敏感性不高、良恶性病变征象重叠及病理类型等影响，BI‐RADS 3级的阳性预测值偏高，故小肿块的超声BI‐RADS 分级有待进一步细化研究。
목적：탐토직경≤1 cm유선소종괴초성유선영상보고여수거계통（breast imaging reporting and data system ，BI‐RADS）적응용개치。방법삼조초성BI‐RADS대219례환자공230개최대직경≤1 cm적소종괴진행묘술여분급，평개초성BI‐RADS중소묘술적각초성정상급최종분급화병리지간적관계。결과경병리증실량성종괴158개（687．％），악성종괴72개（313．％）。초성BI‐RADS묘술지표중형태、변연、방향、후방회성급미개화재량、악성소종괴적차별구유통계학의의（P ＜0.05），형태불규칙、변연불청석、방향수직、후방회성쇠감、미개화위악성정상，대악성종괴진단적양성예측치위533．％～100％、민감성위28．％～750．％、특이성위823．％～100％、준학성위696．％～809．％。평고위BI‐RADS 3、4、5급적소종괴분별유152개（661．％）、62개（270．％）、16개（70．％），악성종괴진단적양성예측치분별위105．％（16／152）、645．％（40／62）、100％（16／16）。술전평고위BI‐RADS 3급이병리결과현시위악성자중875．％（14／16）위도관내암화특수류형침윤성암，량성소종괴술전진단위BI‐RADS 4급적병례중909．％（20／22）위증생병화도관내유두상류。결론직경≤1 cm적유선소종괴중，유우악성정상민감성불고、량악성병변정상중첩급병리류형등영향，BI‐RADS 3급적양성예측치편고，고소종괴적초성BI‐RADS 분급유대진일보세화연구。
Objective To evaluate the clinical value of ultrasound breast imaging reporting and data system (BI‐RADS) in small solid breast masses with diameter ≤1 cm. Methods The ultrasound features of 230 solid breast masses with diameter ≤ 1 cm were described by ultrasound BI‐RADS, the relationship between ultrasound features, BI‐RADS final assesment and pathology were analyzed. Results Of these 230 masses, 72 (31 3.% ) were pathologically confirmed to be malignant and 158 (68 7.% ) to be benign. The ultrasound BI‐RADS features of mass shape, margin, orientation, posterior acoustic features, and microcalcificaition were significantly different between malignant and benign masses( P < 0.05). Irregular shape, noncircumscribed, nonparallel orientation, postrior shadowing, microcalcifications were regarded as malignant ultrasound features, their positive predictive values(PPV), sensitivity, specificity and accuracy for malignancy were 53 3.% -100%, 2 8.% -75 0.%, 82 3.% -100%, 69 6.% -80 9.%, respectively. One hundred and fifty‐two(66.1% ), 62(27 0.% ), 16(7 0.% ) masses were classified into grade 3, 4, and 5, respectively. The PPV for grade 3, 4 and 5 were 10 5.%, 64 5.%, 100% respectively. Among BI‐RADS grade 3 cases, 87 5.%malignant masses were intraductal carcinoma in situ and special type of invasive cancer, among pathological benign BI‐RADS grade 4 masses, 90 9.% were hyperplasia and intraductal papilloma. Conclusions In small breast masses with diameter ≤ 1 cm, due to the sensitivity of malignant signs are not high, the overlap between signs of benign and malignant lesions, pathological type and other factors, the positive predictive value of BI‐RADS grade 3 is higher than criteria of American College of Radiology, so BI‐RADS classification requires further detailed study.