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马　骥,张　艳,陈青青,等.常规超声联合ABVS在乳腺BI-RADS 4类小结节诊断中的价值[J].同济大学学报（医学版）,2021,42(6):825-830. [点击复制]
MA Ji,ZHANG Yan,CHEN Qing-qing,et al.Application of ultrasound combined with ABVS in diagnosis of BI-RADS category 4 small breast nodules[J].同济大学学报（医学版）,2021,42(6):825-830. [点击复制]

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常规超声联合ABVS在乳腺BI-RADS 4类小结节诊断中的价值
马　骥,张　艳,陈青青,朱玲斐,陆爱美
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(上海交通大学附属第一人民医院超声科,上海　200080; 宁波市鄞州区第二医院超声科，浙江宁波　315000)

摘要:

目的　探讨常规超声联合自动乳腺全容积成像(automated breast volume scan, ABVS)在乳腺BI-RADS 4类小结节诊断中的价值。方法　选取门诊常规超声普查筛查出的BI-RADS 4A类及以上，且结节最大径≤1 cm共102个乳腺小结节，对其再进行常规超声联合ABVS检查，观察结节ABVS冠状面成像特征，根据检查结果对乳腺小结节的BI-RADS分类进行调整，以手术病理结果为金标准，比较良恶性小结节的声像图特征差异；分析调整前后BI-RADS分类及其对恶性小结节的诊断符合率；比较常规超声、常规超声联合ABVS诊断乳腺BI-RADS 4类小结节的灵敏度、特异度、准确性。结果　102个乳腺小结节中，恶性结节31个，良性结节71个。声像图上乳腺BI-RADS 4类良恶性小结节在形态、边缘、高回声晕、生长方式、血流阻力指数、冠状面汇聚征、微钙化方面差异均有统计学意义（P＜005）；102个乳腺小结节，调整后BI-RADS 3类16个（4A类降级16个）、4A类49个（4B类降级4个）、4B类22个（4A类上调6个）、4C类14个（4A类上调2个，4B类上调4个）、5类1个，其中乳腺恶性结节诊断符合率分别为4A类82%（4/49)；4B类636%（14/22)；4C类857%(12/14)；常规超声诊断乳腺BI-RADS 4类小结节的灵敏度613%、特异度803%，准确度745%；常规超声联合ABVS诊断乳腺BI-RADS 4类小结节灵敏度871%、特异度859%，准确度863%；ROC曲线下面积分别为0708、0865，差异有统计学意义（Z=3720，P<0001）。结论　常规超声联合ABVS可以有效提高对乳腺BI-RADS 4类小结节的诊断效能。

关键词: 常规超声自动乳腺全容积成像乳腺 BI-RADS 4类

DOI：10.12289/j.issn.1008-0932.21378

投稿时间：2021-09-06

基金项目:

Application of ultrasound combined with ABVS in diagnosis of BI-RADS category 4 small breast nodules

MA Ji,ZHANG Yan,CHEN Qing-qing,ZHU Ling-fei,LU Ai-mei

(Dept. of Ultrasonography, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China; Dept. of Ultrasonography, Yinzhou District Second Hospital, Ningbo 315100, Zhejiang Province, China)

Abstract:

Objective　To investigate the value of conventional ultrasonography combined with automated breast volume scan（ABVS) in the diagnosis of BI-RADS category 4 small breast nodules. Methods　A total of 102 breast nodules with BI-RADS category 4A or above with the maximum diameter ≤1 cm were detected from 88 cases by routine ultrasonography in the outpatient clinic screening. Patients were further examined with conventional ultrasound combined with ABVS（US+ABVS) to observe the coronal imaging characteristics of ABVS nodules. The BI-RADS classification of breast nodules was adjusted based on the examination results, and the ultrasonographic characteristics between benign and malignant nodules were compared with surgical pathological findings as the gold standard. Moreover, BI-RADS classification before and after adjustment and its diagnostic coincidence rate for malignant nodules were analyzed, and the sensitivity, specificity, accuracy and area under curve（AUC) of conventional US and US+ABVS in the diagnosis of BI-RADS category 4 small breast nodules were compared. Results　Among the 102 breast nodules, 31 were malignant and 71 were benign. There were significant differences in the morphology, margin, hyperechoic halo, growth pattern, blood flow resistance index, coronal plane convergence sign and microcalcification on the ultrasonography between benign and malignant breast nodules（P<005). Among the 102 breast nodules, there were 16 lesions in BI-RADS category 3（16 lesions decrease in category 4A), 49 lesions in BI-RADS category 4A（4 lesions decrease in category 4B）, 22 lesions in BI-RADS category 4B（6 lesions increase in category 4A), 14 lesions in BI-RADS category 4C(2 lesions increase in category 4A and 4 lesions increase in category 4B), and 1 lesion in BI-RADS category 5 after adjustment. Among them, the probability of malignant breast nodules in types 3, 4A, 4B and 4C was 0（0/16), 82%（4/49), 636%（14/22) and 857%（12/14), respectively. The sensitivity, specificity and accuracy of conventional US in the diagnosis of BI-RADS category 4 breast nodules were 613%, 803% and 745% respectively, while those of US+ABVS in the diagnosis of BI-RADS category 4 breast nodules were 871%, 859% and 863%, respectively. The areas under the ROC curve were 0708 and 0865, respectively（Z=3720, P<0001). Conclusion　Conventional ultrasound combined with ABVS can effectively improve the diagnostic performance for BI-RADS category 4 small breast nodules.

Key words: conventional ultrasonography automated breast volume scanner breast BI-RADS 4 categories