基于BI-RADS分级与可疑超声征象的综合评判规则对乳腺肿块良恶性的诊断效能OA

Objective To evaluate the diagnostic value of an integrated assessment rule based on Breast Imaging Reporting and Data System(BI-RADS)categories and suspicious ultrasound features for differentiating benign and malignant breast masses.Methods A total of 72 patients with breast masses,comprising 72 lesions,who were treated at Zhengzhou Third People's Hospital from January 2024 to December 2025 were retrospectively included.Patients underwent conventional ultrasonography before pathological sampling.Lesion morphology,margins,internal echogenicity,calcifications,posterior acoustic features,and orientation were recorded,and lesions were categorized according to the American College of Radiology(ACR)BI-RADS Ultrasound Lexicon,6th edition,released in 2025.Postoperative pathology or core needle biopsy findings were used as the reference standard.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value for diagnosing malignant breast masses were calculated for conventional ultrasonography alone,using BI-RADS category 4 or higher as the threshold for malignancy,and for the integrated assessment rule.Results Among the 72 lesions,34(47.22%)were pathologically confirmed as malignant and 38(52.78%)as benign.The proportions of irregular morphology,indistinct margins,hypoechogenicity,microcalcifications,and posterior acoustic shadowing were higher in malignant lesions than in benign lesions,with statistically significant differences(P＜0.05).Using BI-RADS category 4 or higher as the threshold for malignancy,conventional ultrasonography alone yielded a sensitivity of 79.41%(27/34),specificity of 84.21%(32/38),accuracy of 81.94%(59/72),positive predictive value of 81.82%(27/33),and negative predictive value of 82.05%(32/39).The corresponding values for the integrated assessment were 91.18%(31/34),89.47%(34/38),90.28%(65/72),88.57%(31/35),and 91.89%(34/37),respectively.The integrated assessment improved overall diagnostic accuracy by 8.34 percentage points compared with conventional ultrasonography alone(paired exact McNemar test,P=0.031).Conclusion In this study sample,a rule-based integrated assessment incorporating BI-RADS categories and suspicious ultrasound features improved the overall accuracy of differentiating benign and malignant breast masses compared with conventional ultrasonography alone,with higher point estimates for both sensitivity and specificity.This approach may serve as a supplementary tool to routine ultrasound assessment.However,given the single-center,retrospective design and small sample size,the rule cannot replace histopathological diagnosis,and its clinical applicability requires further confirmation through standardized stratification,blinded image interpretation,and external validation.