袁月欢 唐诗 李玉娟 杨波 余勇

【摘要】 目的：分析BI-RADS分級系统在临床触诊阴性乳腺病灶微创活检术前评估中的应用，以探讨手术活检与BI-RADS分级、年龄段风险的相关性意义。方法：选择2016年1月-2019年3月东莞市妇幼保健院住院诊治的500例超声诊断BI-RADS分级3级448例、4级52例临床触诊阴性乳腺病例，采用超声引导下麦默通旋切系统旋切活检术并行常规病理检查。分析超声BI-RADS分级在诊断乳腺肿块病变危险程度方面的诊断效能（诊断符合率、特异度、敏感度、阴性预测值及阳性预测值）;分析以35岁为分界线，观察年龄<35岁与年龄≥35岁中临床触诊阴性乳腺病灶但病理恶性的差异。结果：超声BI-RADS分级诊断乳腺肿块高危病变的敏感度为70.83%、特异度为92.65%、阳性预测值为32.69%、阴性预测值为98.44%及诊断符合率为91.60%;年龄≥35岁恶性病变患者数多于<35岁，差异有统计学意义（字2=10.304，P=0.001）。结论：年龄<35岁BI-RADS分级3级及大部分4级患者，可选择定期复查，不需要急于行有创操作活检;超声BI-RADS分级3级且年龄≥35岁，可考虑活检;BI-RADS分级4级且年龄≥35岁，建议活检，以及时明确诊断，提高乳腺癌早诊早治率;年龄≥35岁的患者患乳腺癌风险系数增大;依据BI-RADS评估标准及结合年龄段选择活检的病例，减少盲目性。

【关键词】 触诊阴性乳腺病灶 微创活检术 年龄段

[Abstract] Objective： To analyze the application of BI-RADS grade system for clinical palpation of nonpalpable breast lesions for preoperative evaluation of minimally invasive biopsy， and to explore explore the significance of correlation between surgical biopsy and BI-RADS classification， age risk. Method： From January 2016 to March 2019， 500 clinical palpation of nonpalpable breast cases diagnosis and treatment in Dongguan City Maternal & Child Health Hospital， 448 cases with BI-RADS grade 3 and 52 cases with BI-RADS grade 4 were selected， rotary biopsy with Maimotong Rotary System and routine pathological examination were used. The diagnostic efficacy of ultrasound BI-RADS classification in diagnosing the risk of breast mass lesions （diagnostic coincidence rate， specificity， sensitivity， negative predictive value and positive predictive value） were analyzed. The cutoff line at age 35， the differences of clinical palpation of nonpalpable breast lesions but pathological examination malignant between <35 years old and ≥35 years old were observed. Result： The sensitivity of ultrasound BI-RADS classification in the diagnosis of high-risk breast mass lesions was 70.83%， specificity was 92.65%， positive predictive value was 32.69%， negative predictive value was 98.44%， and diagnostic coincidence rate was 91.60%. The number of patients with malignant diseases aged ≥35 years old was more than <35 years old， the difference was statistically significant （字2=10.304， P=0.001）. Conclusion： Patients with BI-RADS of age <35 years old with BI-RADS grade 3 or most of grade 4 can choose to have regular re-examination， and do not need to do invasive biopsy in a hurry. Patients with BI-RADS grade 3 and age ≥35 years old， biopsy may be considered. Patients with BI-RADS grade 4 and age ≥35 years old， biopsy is recommended to improve the early diagnosis and early treatment rate of mammary cancer. Patients age ≥35 years old have an increased risk of breast cancer. Selection of biopsies cases according to BI-RADS assessment criteria and age-related selection can reduce blindness.

近年来随着女性自我保健意识的提高及我国女性健康普查工作广泛开展，乳腺超声普查设备的应用，越来越多的临床触诊阴性病灶（指通过彩超、钼靶等检查发现，而临床体查未能触及的乳腺病灶）被检出[1-2]。但超声提示BI-RADS 3级和4级临床触诊阴性肿物因其良恶性难以区分，故应对其行手术切除还是定期观察一直让外科医生难以抉择[3-5]。本次研究主要探讨BI-RADS分级3、4级在不同年龄段临床触诊阴性乳腺病灶微创活检术前评估的应用价值，现报道如下。

1 资料与方法

1.1 一般资料 选择2016年1月-2019年3月东莞市妇幼保健院住院诊治的500例超声临床触诊阴性乳腺病灶患者。纳入标准：所有患者按照美国放射学会2003年创立并推荐的BI-RADS“乳腺影像报告和数据系统”中采用的表示乳腺改变的标准（BI-RADS分级：0级是指评估不完全，需要补充其他……