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目的对比常规超声、弹性成像、容积成像及联合应用在乳腺良恶性结节鉴别诊断中的应用。方法选取2014年1月至2015年8月间广州中医药大学第一附属医院收治的经手术病理证实的214例乳腺结节患者,均采用超声检查,部分患者联合乳腺MR、钼靶检查,以旋切术等手术获得样本病理检验作为金标准。结果高频超声检出结节病灶230例,手术证实恶性结节84个,良性结节146个。联合诊断敏感性、特异性、阳性预测值、阴性预测值和符合率分别为98.8%、91.1%、86.5%、99.3%和93.9%,常规超声为84.5%、69.2%、61.2%、88.6%和74.8%,弹性超声为76.2%、84.9%、74.4%、86.1%和81.7%,三维容积成像为83.3%、80.8%、71.4%、89.4%和81.7%。联合诊断敏感性、特异性、阳性预测值、阴性预测值和符合率均高于常规超声、弹性超声和三维容积成像,差异均有统计学意义(均P<0.05)。结论常规超声、弹性超声和容积成像单独应用时诊断效用差异不大,各有优劣,联合应用时可提高诊断效用。
Objective To compare the application of conventional ultrasound, elastography, volume imaging and combined application in the differential diagnosis of benign and malignant breast nodules. Methods Totally 214 cases of breast nodules confirmed by surgery and pathology admitted to the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January 2014 to August 2015 were examined by ultrasonography and some patients combined with MR and mammography Biopsy and other surgical specimens obtained pathological examination as the gold standard. Results 230 cases of nodular lesions were detected by high frequency ultrasound. 84 malignant nodules and 146 benign nodules were confirmed by operation. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of combined diagnosis were 98.8%, 91.1%, 86.5%, 99.3% and 93.9% respectively, while those of conventional ultrasound were 84.5%, 69.2%, 61.2% and 88.6% 74.8%, 76.2%, 84.9%, 74.4%, 86.1% and 81.7% for elastic ultrasound, and 83.3%, 80.8%, 71.4%, 89.4% and 81.7% for three-dimensional volume imaging. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of combined diagnosis were higher than those of conventional ultrasound, elastography and three-dimensional volume imaging (all P <0.05). Conclusion The diagnostic utility of conventional ultrasound, flexible ultrasound and volume imaging alone is not different, each has its own advantages and disadvantages, can improve diagnostic utility when combined.