CAJ | 학술논문

目的：探讨超声造影定量分析彩色图像半定量评分系统在乳腺结节鉴别诊断中的价值。方法对244个被二维超声诊断为 BI-RADS 4类的乳腺实性结节,在行粗针穿刺活检或手术切除前2 d 内行超声造影,应用 Qontrast 4.0造影分析软件进行定量分析得到彩色图像。从增强强度、增强均匀性、增强后病灶范围有无扩大、增强后边界及形态5个方面按照半定量评分标准给予评分,逐项分值相加得到总分,总分从0分到7分。以病理结果为金标准,评估其诊断价值。结果102个恶性病灶半定量评分总分的平均值(5.1±1.7)高于良性病灶(3.34±0.7),二者间的差异有统计学意义(P <0.05)。在102个恶性病灶中,81个病灶(79.41%)的总分≥4分,而在142个良性病灶中,89个病灶(62.67%)的总分<4分。采用Wilcox 秩和检验(Mann-Whitney)分析良恶性病灶间得分分布差异,二者间的差异有统计学意义(P <0.0001)。采用 ROC 曲线分析该评分系统的诊断截点及其价值,当总分为4分时,获得最大曲线下面积(0.749),以总分≥4分预测为恶性,其诊断敏感性、特异性和准确性分别为79.4%、62.7%和69.67%。结论超声造影定量分析彩色图像半定量评分系统表现出了乳腺良恶性病灶间的分值差异,有较好的敏感性,但特异性和准确性并不十分令人满意。
목적：탐토초성조영정량분석채색도상반정량평분계통재유선결절감별진단중적개치。방법대244개피이유초성진단위 BI-RADS 4류적유선실성결절,재행조침천자활검혹수술절제전2 d 내행초성조영,응용 Qontrast 4.0조영분석연건진행정량분석득도채색도상。종증강강도、증강균균성、증강후병조범위유무확대、증강후변계급형태5개방면안조반정량평분표준급여평분,축항분치상가득도총분,총분종0분도7분。이병리결과위금표준,평고기진단개치。결과102개악성병조반정량평분총분적평균치(5.1±1.7)고우량성병조(3.34±0.7),이자간적차이유통계학의의(P <0.05)。재102개악성병조중,81개병조(79.41%)적총분≥4분,이재142개량성병조중,89개병조(62.67%)적총분<4분。채용Wilcox 질화검험(Mann-Whitney)분석량악성병조간득분분포차이,이자간적차이유통계학의의(P <0.0001)。채용 ROC 곡선분석해평분계통적진단절점급기개치,당총분위4분시,획득최대곡선하면적(0.749),이총분≥4분예측위악성,기진단민감성、특이성화준학성분별위79.4%、62.7%화69.67%。결론초성조영정량분석채색도상반정량평분계통표현출료유선량악성병조간적분치차이,유교호적민감성,단특이성화준학성병불십분령인만의。
Objective To assess the feasibility of semi-quantitative scoring system for contrast-enhanced ultrasound (CEUS)quantitative analysis's color images in the differential diagnosis of breast nodules.Methods Totally 244 BI-RADS 4 breast solid lesions received CEUS before core needle biopsy or surgical resection were included.A semi-quantitative scoring system for color images of CEUS quantitative analysis were built.The scores were given as follows:1 )Color type and its distribution (0 to 4);2)Color scope (0 to 1 );3)Color margin (0 to 1 );4)Color shape (0 to1 ).The total score for each lesion would be from 0 to 7.And the differenital value between benign and malignant lesions were assessed.Results The total semi-quantitative scores of 102 malignant tumors (5.1 ±1 .7)was significant higher than that of benign lesions (3.34±0.7)(P < 0.05 ).In 102 malignant lesions,the total scores of 81 lesions (79.41 %)were more than 4 points,and in 142 benign lesions,the total scores of 89 lesions (62.67%)were less than 4 points.Depending on the Wilcox rank sum test (Mann-Whitney)analysis,the distribution of total scores between benign and malignant lesions was significant different (P <0.000 1).Total score 4 was selected as the best cutoff,the area under ROC curve was 0.749,on which the sensitivity,specificity and accuracy were 79.4%,62.7% and 69.67%,respectively.Conclusions The semi-quantitative scoring system of CEUS quantitative analysis color images showed good sensitivity but not satisfied specificity and accuracy in differential diagnosis between malignant and benign breast lesions.