新版超声BI-RADS分类诊断乳腺癌的回顾性分析及临床意义

Retrospective analysis and clinical significance of the fifth edition of the BI-RADS ultrasound lexicon in the diagnosis of breast cancer

摘要:

目的：探讨新版（2013年更新版）超声（ultrasound，US）乳腺影像报告数据系统（breast imaging report and data system，BI-RADS）中罗列的指标结合相关临床资料在诊断乳腺癌中的应用情况，评估新版超声BI-RADS（ＢＩ－ＲＡＤＳ－ＵＳ）在乳腺癌诊断中的临床应用价值。方法：3名超声医师结合收集的临床资料共同对2 860个肿块的声像图进行回顾性分析，按照新版BI-RADS超声影像学词典记录、分类。以病理结果为金标准，运用ROC曲线计算新版BI-RADS-US分类的诊断效能。并对记录的超声指标及收集的临床资料先行单因素分析，具有统计学意义的指标再运用多因素logistic回归分析进行分析。结果：新版BI-RADS-US诊断乳腺癌BI-RADS 2类的恶性率为0.66%，3类的恶性率0.99%，4a类的恶性率为9.57%，4b类的恶性率为32.31%，4c类的恶性率为88.36%，5类的恶性率为94.19%。以4a类为截断点，新版BI-RADS-US诊断乳腺癌的敏感性为88.55％，特异性为92.17％，准确性为91.75％，AUC为0.948，Youden指数为0.81。结论：新版BI-RADS-US诊断乳腺癌风险分层的准确率高。以4a类作为截断点，新版BI-RADS-US诊断乳腺癌具有较高的诊断效能。肿块形态、边缘、钙化、血流是重要的超声变量，结合患者年龄和腋窝淋巴结转移情况可指导临床进行明确的诊断和精确的治疗。

Abstract:

Objective：To explore the application of the ultrasonographic descriptors in the fifth edition（2013 update） of the Breast Imaging Reporting and Data System（BI-RADS） ultrasound（US） lexicon combined with relevant clinical data in the diagnosis of breast cancer，and to evaluate the diagnostic value of the new edition of the BI-RADS US lexicon for breast cancer. Methods：The ultrasono－grams of 2 860 masses were retrospectively reviewed by three independent sonographers with reference to the collected clinical data，and the masses were classified into different categories according to the new edition of the BI-RADS US lexicon. The diagnostic efficacy of the new edition of BI-RADS-US classification was calculated using the receiver operating characteristic（ROC） curve with pathological results as the gold standard，and the recorded ultrasonographic descriptors and collected clinical data were first analyzed by univariate analysis，and the indicators of statistical significance were further analyzed by multivariate logistic regression analysis. Results：According to the new edition of BI-RADS-US for the diagnosis of breast cancer，the malignancy rate was 0.66% in BI-RADS category 2，0.99% in BI-RADS category 3，9.57% in BI-RADS category 4a，32.31% in BI-RADS category 4b，88.36% in BI-RADS category 4c，and 94.19% in BI-RADS category 5. With BI-RADS category 4a as the cut-off point，the new edition of BI-RADS-US for the diagnosis of breast cancer had a sensitivity of 88.55%，a specificity of 92.17%，an accuracy of 91.75%，an AUC of 0.948，and a Youden index of 0.81. Conclusions：The new edition of BI-RADS-US has a high accuracy in the diagnosis and risk stratification of breast cancer. With BI-RADS category 4a as the cut-off point，the new edition of BI-RADS-US has high diagnostic efficacy for breast cancer. The shape，margin，calcification，and blood flow of the mass are important ultrasonographic variables，which clinicians can use for clinical diagnosis and precise treatment with refer－ence to patients’ age and axillary lymph node metastasis.