研究超声造影在乳腺BI-RADS 4A类结节诊断及穿刺活检中的应用价值。

回顾性分析2020年1月至2023年2月在浙江省嘉善县第一人民医院接受超声造影检查的126例BI-RADS 4A类乳腺结节患者的影像资料和粗针活检或手术病理结果。对126例乳腺BI-RADS 4A类结节超声造影模式进行单因素分析、多因素回归分析，筛选出超声造影预测乳腺结节恶性的独立危险因素。以病理结果为金标准绘制受试者工作特征（ROC）曲线，计算使用超声造影独立危险因素诊断良恶性结节的灵敏度、特异度及准确度，分析超声造影对乳腺BI-RADS 4A类结节的诊断效能。比较所有乳腺BI-RADS 4A类结节与超声造影后倾向恶性的乳腺BI-RADS 4A类结节的穿刺活检率、恶性结节检出率及漏检率。

在126例乳腺BI-RADS 4A类结节中，病理良性结节97例、恶性结节29例。多因素Logistic回归分析结果显示，增强后病灶范围扩大（OR=10.800，P=0.048）和“蟹足”征或滋养血管（OR=6.909，P=0.027）为乳腺恶性病变的独立危险因素。超声造影诊断乳腺BI-RADS 4A类结节良恶性的ROC曲线下面积为0.792，敏感度、特异度和准确度分别为86.2%、72.2%和75.4%。超声造影检查后，126例BI-RADS 4A类结节的活检率可由造影前的100.0%降低至41.2%（χ²=104.76，P<0.001），恶性结节检出率由23.0%升高至48.1%（χ²=10.93，P=0.001），漏检率仅3.1%（χ²=1.759，P=0.815）。

超声造影在乳腺BI-RADS 4A类结节的良恶性鉴别中具有较高的诊断效能，具有减少BI-RADS 4A类结节不必要的活检以及提高恶性结节检出率的潜力。

To assess the application value of contrast-enhanced ultrasound in the diagnosis and biopsy of American College of Radiology breast imaging reporting and data system (BI-RADS) category 4a breast nodules.

A retrospective analysis was performed on the imaging data and coarse needle biopsy or surgical pathological results of 126 patients with BI-RADS category 4a breast nodules who received contrast-enhanced ultrasound examination at the First People's Hospital of Jiashan County, Zhejiang Province from January 2020 to February 2023. Single factor analysis and multivariate regression analysis were conducted to identify independent risk factors for breast nodule malignancy. Using pathological results as the gold standard, receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity, specificity, and accuracy of contrast-enhanced ultrasound for diagnosing benign and malignant nodules, and analyze the diagnostic efficacy of contrast-enhanced ultrasound for BI-RADS category 4a breast nodules. The puncture biopsy rate, malignant nodule detection rate, and missed detection rate of all breast BI-RADS 4A nodules were compared with those of nodules that tended to be malignant after contrast-enhanced ultrasound.

Among the 126 cases of breast BI-RADS 4A nodules, there were 97 cases of pathologically benign nodules and 29 cases of pathological malignant nodules. The results of multivariate logistic regression analysis showed that the expansion of lesion size after enhancement (odds ratio [OR]=10.800, P=0.048) and the "crab foot" sign or nutrient vessels (OR=6.909, P=0.027) were independent risk factors for breast nodule malignancy. The area under the ROC curve of contrast-enhanced ultrasound in the diagnosis of benign and malignant BI-RADS category 4a breast nodules was 0.792, and the sensitivity, specificity, and accuracy were 86.2%, 72.2%, and 75.4%, respectively. After contrast-enhanced ultrasound examination, the biopsy rate for the 126 BI-RADS category 4a breast nodules decreased from 100.0% before contrast to 41.2% (χ²=104.76, P<0.001), and the detection rate of malignant nodules increased from 23.0% to 48.1% (χ²=10.93, P=0.001), with a missed detection rate of only 3.1% (χ²=1.759, P=0.815).

Contrast-enhanced ultrasound has high efficacy in the differential diagnosis of benign and malignant BI-RADS category 4a breast nodules, with the potential to reduce unnecessary biopsy of BI-RADS 4A nodules and improve the detection rate of malignant nodules.