目的

寻找超声BI-RADS 4A 级乳腺病变良恶性鉴别的证据,从而探讨部分BI-RADS 4A级乳腺病变患者选择随访的可行性。

方法

回顾性分析2015 年1 月至2016 年4 月在新疆医科大学第五附属医院经乳腺超声诊断为BI-RADS 4A 级病变且完成手术治疗的63 例患者的超声图像特征及其相关临床资料。 其中,经病理证实的良性病变有48 例(良性病变组),恶性病变有15 例(恶性病变组)。分析患者的年龄、初潮年龄、流产史、病变部位、是否为多发病灶,超声图中病变的直径、边界、形态和内部血流,以及X 线检查结果与病变良恶性的关系。 先采用χ² 检验和Fisher 确切概率法分析患者乳腺病变性质与临床病理特征的关系(单因素分析),然后,采用逐步Logistic 回归方法进行多因素分析。

结果

单因素分析显示,在恶性病变组中,病变位于外上、外下、内上及内下象限者分别占11/15、4/15、0/15 和0/15,而在良性病变组中,病变位于外上、外下、内上及内下象限者分别占22.9%(11/48)、39.6%(19/48)、27.1% (13/48)和10.4% (5/48),两组比较,差异有统计学意义(χ² =13.111,P=0.003),其中外上象限病变为恶性的可能性大于内上象限病变(P＜0.008)。 并且,在恶性病变组中,超声显示病变直径≥2.0 cm、边界不清、内部存在血流,以及X 线检查提示可疑恶性者分别占9/15、14/15、10/15 和6/15,明显高于良性病变组的14.6%(7/48)、14.6%(7/48)、16.7%(8/48)和12.5%(6/48)(χ²=10.160、31.894、11.657、3.964,P 均＜0.050)。 逐步Logistic 回归分析显示,相对于直径＜2.0 cm、边界清晰、内部无血流的BI-RADS 4A 级病变而言,超声显示病变直径≥2.0 cm、边界不清、内部存在血流是超声BI-RADS 4A 级乳腺恶性病变的证据(OR=22.162,95%CI:2.083 ～235.756,P=0.010;OR=121.694,95%CI:8.670 ～1708.145,P＜0.001;OR=17.400,95%CI:1.779 ～170.218,P=0.014)。

结论

对于乳腺超声提示病变直径＜2.0 cm、边界清晰、内部无血流的BI-RADS 4A 级患者,可以进行密切随访、观察,不必立即行穿刺活组织检查或手术。

Objective

To search the evidences to differentiate benign from malignant breast lesions,and evaluate the feasibility of follow-up in some BI-RADS 4A patients.

Methods

We retrospectively analyzed the ultrasound characteristics and related clinical data of 63 patients who were diagnosed with BI-RADS 4A breast lesions by ultrasound and underwent surgery in the Fifth Affiliated Hospital, Xinjiang Medical University from January 2015 to April 2016. In these 63 patients, there were 48 patients with benign lesions (benign group) and 15 with malignant lesions (malignant group) confirmed by pathological diagnosis. Patients' age,age at menarche, abortion history, location of lesion, multiple lesions, diameter, margin, shape, internal blood flow of lesions in ultrasonography and X-ray characteristics were analyzed to evaluate their relationship with malignancy of breast lesions. χ² test and Fisher exact test were firstly used to analyze the relationship of lesion malignancy with clinicopathological characteristics for univariate analysis, and then stepwise Logistic regression was used for multivariate analysis.

Results

Univariate analysis showed that the lesions in upper outer quadrant, lower outer quadrant, upper inner quadrant and lower inner quadrant accounted for 11/15,4/15,0/15 and 0/15 in malignant group,22.9%(11/48),39.6%(19/48), 27.1%(13/48) and 10.4%(5/48)in benign group, indicating a significant difference between the two groups (χ²=13.111,P=0.003).The possibility of malignant lesions in upper outer quadrant was significantly higher than that in upper inner quadrant (P＜0.008). In malignant group, the proportion of malignant lesions in the patients with lesion diameter ≥2 cm, obscure boundary, blood flow within the lesions and malignancy indicated by X-ray was 9/15, 14/15, 10/15 and 6/15 respectively, significantly higher than 14.6% (7/48), 14.6% (7/48),16.7%(8/48)and 12.5%(6/48) in benign group (χ²=10.160, 31.894, 11.657, 3.964,all P＜0.050).Stepwise Logistic regression analysis showed that compared with BI-RADS 4A breast lesions with the lesion diameter ＜2.0 cm, clear margin and no blood flow inside, lesion diameter ≥2 cm, obscure margin and blood flow within the lesions in ultrasonography were the definite evidences of malignant BI-RADS 4A breast lesions(OR=22.162,95%CI:2.083-235.756,P=0.010;OR=121.694,95%CI:8.670-1708.145,P＜0.001;OR=17.400,95%CI:1.779-170.218,P=0.014).

Conclusion

The patients with BI-RADS 4A breast lesions with the diameter ＜2.0 cm, clear margin and no blood flow inside in ultrasonography should be monitored and followed up carefully, instead of immediate biopsy or surgery.