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目的探讨超声弹性成像(UE)在BI-RADS 4A类乳腺肿块良恶性鉴别诊断中的应用价值。方法回顾性分析229例BI-RADS 4A类乳腺肿块患者的UE资料。结合病理分析弹性评分、病灶内最硬部分的弹性应变率比值R_1及病灶边缘最硬部分的弹性应变率比值R_2在良恶性肿块中的差别。构建R_1、R_2的ROC曲线。比较弹性评分、R_1、R_2单独使用或联合使用时的灵敏度、特异度及准确度之间的差异。结果恶性肿块的弹性评分、R_1及R_2均高于良性肿块(P<0.001)。R_1、R_2最佳截断点分别为2.5、2.02。R_2的灵敏度(100%)最高(P<0.05),弹性评分与R_2联合的特异度(91.8%)、准确度(90.8%)最高(P<0.05)。结论 UE在4A类乳腺肿块的良恶性诊断方面有较高临床价值。当弹性评分与R_2联合使用时可提高4A类乳腺肿块诊断特异度及准确度。
Objective To investigate the value of ultrasound elastography (UE) in differential diagnosis of benign and malignant tumors in BI-RADS 4A breast masses. Methods Retrospective analysis of UE data of 229 patients with BI-RADS type 4A breast mass. Combined with pathological analysis of elastic score, the ratio of the elastic strain rate R 1 of the hardest part of the lesion and the elastic strain ratio R 2 of the hardest part of the lesion in the benign and malignant tumors were compared. Build ROC curves of R_1 and R_2. Comparisons of differences in sensitivity, specificity, and accuracy of elastic scores, R_1, R_2 used alone or in combination. Results The elasticity scores of malignant masses were higher than those of benign masses (P <0.001). The best cutoff points of R_1 and R_2 are 2.5 and 2.02, respectively. The sensitivity (100%) of R_2 was the highest (P <0.05). The specificity of elasticity score was 91.8% and the accuracy was 90.8% (P <0.05). Conclusions UE has high clinical value in the diagnosis of benign and malignant tumors in category 4A breast tumors. When the elasticity score combined with R_2 can improve the diagnostic specificity and accuracy of 4A breast masses.