多模态超声引导穿刺在BI-RADS 4类乳腺结节精准诊断中的价值

doi:10.3969/j.issn.1006-5725.2026.10.021

Abstract

Abstract:

Objective To discuss the clinical value of micro flow imaging （MFI） combined with real-time shear wave elastography （SWE） guided puncture in the precise diagnosis of BI-RADS type 4 breast nodules. Methods A total of 218 patients with breast nodules （224 nodules in total） admitted to the hospital from January 2020 to December 2024 were selected as the research subjects. MFI and SWE examinations were conducted to analyze the imaging features of benign and malignant breast nodules， evaluate the vascular blood flow grade and elastic hardness value of breast nodules， logistic regression was used to analyze the influencing factors of benign and malignant breast nodules， and analyze the diagnostic value of the two methods. Results All 224 nodules were pathologically confirmed， including 65 benign nodules and 159 malignant nodules. The number of malignant nodules with irregular morphology， incomplete edges and microcalcification was higher than that of benign nodules （P < 0.05）. The number of cases with blood flow grades 0 and I of malignant nodules was lower than that of benign nodules （P < 0.05）， while the number of cases with grades Ⅱand Ⅲ was higher than that of benign nodules （P < 0.05）. The SWE elastic ratio Eratio of malignant nodules was 3.25 ± 0.56， which was higher than that of benign nodules at 2.54 ± 0.22（P < 0.05）. The results of Logistic regression analysis showed that irregular nodule morphology， irregular nodule margins， microcalcification， MFI blood flow grade， and SWE elastic hardness value were all independent influencing factors for differentiating benign and malignant breast lesions （P < 0.05）. The consistency between the individual examinations of MFI and SWE and the pathological results was average （P < 0.05）， while the combined examination of MFI and SWE had a better consistency with the pathological results （P < 0.05）. The sensitivity， specificity， accuracy and negative predictive value of MFI combined with SWE in diagnosing benign and malignant breast nodules were higher than those of single detection （P < 0.05）. Conclusion MFI combined with SWE-guided puncture has a relatively high value in the precise diagnosis of BI-RADS type 4 breast nodules.

Key words: breast nodules, micro flow imaging, real-time shear wave elastography, diagnostic value

CLC Number:

R446.8

Kun TANG,Yanhua YIN,Jianguo QI,Xiaojun WAG. The clinical value of multimodal ultrasound guided puncture in the precise diagnosis of BI-RADS type 4 breast nodules[J]. The Journal of Practical Medicine, 2026, 42(10): 1858-1864.

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References 25

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项目	形态		边缘		内部回声		微钙化
项目	规则	不规则	光整	不光整	均匀	不均匀	有	无
恶性结节（n = 159）	20（12.58）	139（87.42）	15（9.43）	144（90.57）	80（50.31）	79（49.69）	65（40.88）	94（59.12）
良性结节（n = 65）	55（84.62）	10（15.38）	59（90.77）	6（9.23）	38（58.46）	27（41.54）	10（15.38）	55（84.62）
χ²值	107.503		137.973		1.228		12.873
P值	< 0.001		< 0.001		0.268		< 0.001
项目	生长方向		边界		后方回声衰减		纵横比
项目	与皮肤平行	与皮肤垂直	清晰	不清晰	有	无	< 1	≥ 1
恶性结节（n = 159）	17（10.69）	142（89.31）	70（44.03）	89（55.97）	42（26.42）	117（73.58）	39（24.53）	120（75.47）
良性结节（n = 65）	5（7.69）	60（92.31）	35（53.85）	30（46.15）	15（23.08）	50（76.92）	18（27.69）	47（72.31）
χ²值	0.469		1.787		0.271		0.243
P值	0.494		0.181		0.603		0.622

项目	血流分级
项目	0级	Ⅰ级	Ⅱ级	Ⅲ级
恶性结节(n = 159)	0（0.00）	10（6.29）	91（57.23）	58（36.48）
良性结节(n = 65)	11（16.92）	45（69.23）	8（12.31）	1（1.54）
χ²值	128.531
P值	< 0.001

项目	病理结果		合计	Kappa	P值
项目	恶性	良性	合计	Kappa	P值
合计	159	65	224
MFI				0.662	< 0.001
恶性	140	10	150
良性	19	55	74
合计	159	65	224
SWE				0.580	< 0.001
恶性	143	13	156
良性	16	52	68
合计	159	65	224
MFI联合SWE				0.895	< 0.001
恶性	155	5	160
良性	4	60	64

因素	B	SE	Wald	P值	OR	95%CI
结节形态	0.927	0.205	20.332	< 0.001	2.526	1.689 ~ 3.779
结节边缘	1.664	0.347	23.215	< 0.001	5.286	2.732 ~ 10.489
微钙化	0.037	0.010	12.960	< 0.001	1.037	1.017 ~ 1.058
MFI血流分级	1.007	0.230	19.227	< 0.001	2.738	1.746 ~ 4.296
SWE弹性硬度值	0.052	0.012	18.763	< 0.001	1.053	1.029 ~ 1.078

项目	AUC	敏感度	特异度	准确度	阳性预测值	阴性预测值
MFI	0.863	88.05（140/159）^*	84.62（55/65）^*	87.05（195/224）^*	93.33（140/150）	74.32（55/74）^*
SWE	0.888	89.94（143/159）^*	80.00（52/65）^*	87.05（195/224）^*	91.67（143/156）	76.47（52/68）^*
MFI联合SWE	0.949	97.48（155/159）	92.31（60/65）	95.98（215/224）	96.88（155/160）	93.75（60/64）
χ²值		10.555	6.122	13.263	3.964	9.836
P值		0.005	0.040	0.001	0.138	0.007

The clinical value of multimodal ultrasound guided puncture in the precise diagnosis of BI-RADS type 4 breast nodules

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