本文選題：BI-RADS分類　切入點(diǎn)：乳腺腫塊　出處：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的探討2013版BI-RADS分類、單獨(dú)使用不同超聲彈性評估方法(2013版BI-RADS超聲彈性分級法、彈性應(yīng)變率比值法、面積比值法)以及兩者聯(lián)合的方法在乳腺腫塊良惡性鑒別中的診斷價(jià)值。方法選取98例患者,共計(jì)103個(gè)腫塊,所有腫塊均用常規(guī)超聲和彈性成像兩種方式進(jìn)行檢查,按照2013版BI-RADS分類標(biāo)準(zhǔn)進(jìn)行分類,所有病灶行穿刺活檢術(shù)或手術(shù)切除術(shù),獲取標(biāo)本送病理診斷,對照病理結(jié)果構(gòu)建ROC曲線確定兩種彈性評估方法(SR法和AR法)的最佳診斷截?cái)帱c(diǎn),用三種不同的彈性評估方法對腫塊的性質(zhì)進(jìn)行評判,再根據(jù)不同的彈性評估結(jié)果對BI-RADS分類進(jìn)行調(diào)整,比較不同方法之間的差異。結(jié)果1. BI-RADS分類在進(jìn)行乳腺腫塊良惡性診斷時(shí)的靈敏度是93. 85%,特異度是94. 74%,準(zhǔn)確度是 94. 17%。2.彈性分級法、應(yīng)變率比值法、面積比值法診斷乳腺腫塊良惡性的準(zhǔn)確度分別為 70. 87%,82. 52%,82. 52%;靈敏度分別為 90. 24%,90. 91%,90. 91%;特異度分別為 58. 06%,72. 92%,72. 92%。3. BI-RADS分類聯(lián)合三種不同彈性評估方法(分級法、SR法、AR法)診斷乳腺腫塊良惡性的準(zhǔn)確度分別為91. 26%,90.29%,89. 32%;靈敏度分別為93. 55%,93. 44%, 91.94%;特異度分別為87. 8%,85. 71%,85. 37%。4.構(gòu)建ROC曲線,BI-RADS分類、不同彈性評估方法(分級法、SR法、AR法)、BI-RADS分類聯(lián)合三種不同彈性評估方法(分級法、SR法、AR法)ROC曲線下的面移積分別為0. 952, 0. 778, 0. 843, 0. 892, 0. 951,0. 965, 0. 952。結(jié)論1. 2013版BI-RADS分類、單獨(dú)使用不同的彈性成像評估方法、兩種方法聯(lián)合在乳腺病灶良惡性鑒別中均具有診斷價(jià)值。2.單獨(dú)使用不同的彈性成像評估方法進(jìn)行診斷時(shí),超聲彈性分級法有一定的局限性,應(yīng)變率比值法、面積比值法作為一種半定量評價(jià)方法在一定程度可以避免醫(yī)師的主觀影響比其具有更高的診斷價(jià)值。3.二維超聲是診斷的基礎(chǔ),彈性成像技術(shù)可以作為常規(guī)超聲的補(bǔ)充,為BI-RADS分類提供更多的參考信息,提升超聲醫(yī)生的診斷信心,為臨床診療提供更好的服務(wù)。
[Abstract]:Objective to explore the diagnostic value of BI-RADS classification in 2013 edition, using different ultrasonic elastic assessment methods alone, and using the different ultrasound elastic classification method, elastic strain rate ratio method, area ratio method and combined method in the differential diagnosis of benign and malignant breast masses.Methods 98 patients with 103 masses were selected. All the masses were examined by conventional ultrasound and elastic imaging. The lesions were classified according to the 2013 BI-RADS classification standard, and all lesions were performed puncture biopsy or surgical excision.ROC curve was constructed to determine the best diagnostic cutoff point of two elastic evaluation methods: SR method and AR method. Three different elastic evaluation methods were used to evaluate the nature of the tumor.Then the BI-RADS classification is adjusted according to different elastic evaluation results, and the differences between different methods are compared.Result 1.The sensitivity of BI-RADS classification in the diagnosis of benign and malignant breast masses was 93. 3%.The specificity is 94.The accuracy is 94.17. 2.The accuracy of elastic grading method, strain rate ratio method and area ratio method in the diagnosis of benign and malignant breast masses were 70. 0% respectively.87s 82s.52 / 82.The sensitivity is 90.Two hundred and ninety.91s and 90s.The specificity was 58.06and 72s.Two hundred and seventy-two.Nine two and three.The accuracy of BI-RADS classification combined with three different elastic assessment methods (classification / SR / AR) in the diagnosis of benign and malignant breast masses was 91. 1% respectively.There are 90.29 and 89.The sensitivity is 93. 3% respectively.Five hundred and fifty three.The specificity was 87. 4% and 91. 94% respectively.Eight hundred and eighty-five.71s and 85s.370.4.BI-RADS classification of ROC curve was constructed. Different elastic evaluation methods (classification method / SR method / AR method / AR method) combined with three different elastic assessment methods (classification method / SR method / AR method / surface shift product under ROC curve were 0 respectively).952, 0.778, 0.843, 0.892, 0.951,0.965, 0.952.Conclusion 1.2013 version of BI-RADS classification, using different methods of elastography alone, the two methods combined in the diagnosis of benign and malignant breast lesions are of value. 2.The ultrasonic elastic classification method has some limitations when it is used in the diagnosis of different elastic imaging evaluation methods alone, the strain rate ratio method, the strain rate ratio method, the strain rate ratio method, the strain rate ratio method,As a semi-quantitative evaluation method, the area ratio method can avoid the subjective influence of doctors to a certain extent.Two-dimensional ultrasound is the basis of diagnosis, elastic imaging technology can be used as a supplement to conventional ultrasound, provide more reference information for BI-RADS classification, enhance the diagnosis confidence of ultrasound doctors, and provide a better service for clinical diagnosis and treatment.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R737.9

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