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目的评价改良Fischer评分对乳腺肿块的BI-RADS-MRI分类及鉴别良恶性的临床价值。方法回顾性分析298例患者(307个乳腺肿块)的MRI形态和动态增强曲线特征。按照征象得分标准,对肿块行Fischer评分和改良Fischer评分。以病理为金标准,分别统计两种评分每个分值的乳腺癌阳性预测值(PPV)并对每个肿块行BI-RADS-MRI分类。绘制两种评分的ROC曲线并应用Z检验比较曲线下面积,比较两种评分在鉴别良恶性的价值。结果 307个肿块,恶性132个,PPV为43.0%。Fischer评分范围0~8分。以4分以上为恶性标准,其敏感性、特异性分别为86.5%、71.0%,诊断准确性为75.1%。改良Fischer评分范围0~11分,4~6分为BI-RADSMRI 4类,4分为4a类,5分为4b类,6分为4c类。以5分以上为恶性标准,其敏感性、特异性及诊断准确性分别为94.3%、83.7%和89.5%。Fischer评分的ROC曲线下面积为0.764,改良Fischer评分的ROC曲线下面积为0.902,两者差异有统计学意义(Z=2.051,P<0.05)。结论改良Fischer评分对乳腺肿块BI-RADS-MRI分类及鉴别良恶性价值均较Fischer高。改良Fischer评分还可行4类的亚分类,临床上可考虑代替Fischer评分。
Objective To evaluate the clinical value of modified Fischer score in the classification of breast masses by BI-RADS-MRI and the identification of benign and malignant lesions. Methods The MRI features and dynamic enhancement curves of 298 patients (307 breast masses) were retrospectively analyzed. The Fischer score and the modified Fischer score were applied to the lumps according to the symptom score criteria. With pathology as the gold standard, the positive predictive value of breast cancer (PPV) was calculated for each of the two scores for each of the two scores and the BI-RADS-MRI classification was performed for each mass. Two ROC curves were plotted and the Z-test was used to compare the area under the curve to compare the two scores in the identification of benign and malignant values. Results 307 masses, 132 malignant, PPV 43.0%. Fischer score range 0 ~ 8 points. To 4 points or more as a malignant standard, the sensitivity and specificity were 86.5%, 71.0%, diagnostic accuracy was 75.1%. The modified Fischer score ranged from 0 to 11, with 4 to 6 being classified as BI-RADSMRI 4, 4 as 4a, 5 as 4b, and 6 as 4c. The sensitivity, specificity and diagnostic accuracy were 94.3%, 83.7% and 89.5% with the score of 5 or more as the malignant standard. The area under the ROC curve of the Fischer score was 0.764, and the area under the ROC curve of the modified Fischer score was 0.902. The difference was statistically significant (Z = 2.051, P <0.05). Conclusion The modified Fischer score is better than Fischer in the classification and identification of benign and malignant tumors in BI-RADS-MRI. The improved Fischer score is also available in 4 subcategories, and may be clinically replaced by Fischer score.