| 摘要: |
| 目的 探讨参照Bosniak分级CT标准更新版（2019版）的超声造影CT-Bosniak分级标准及超声造影RJ-Bosniak分级标准在预测肾脏囊性病灶良恶性中的应用价值。方法 回顾性分析2015年6月至2020年7月在上海交通大学医学院附属瑞金医院及其无锡分院超声科进行超声造影检查的316例患者的347枚肾脏囊性病灶的超声造影声像图。参照2019版Bosniak分级CT标准和瑞金医院标准分别对超声造影声像图进行Bosniak分级，其中参照CT标准者定义为超声造影CT-Bosniak标准，按照瑞金医院临床实践经验总结所定分级标准定义为超声造影RJ-Bosniak分级标准。所有的入组病例最终由穿刺活检或手术病理学及增强CT或MRI等影像学检查随访证实。采用四格表计算2种超声造影Bosniak分级标准对肾脏囊性病灶良恶性诊断的准确度、灵敏度、特异度等。结果 以手术或穿刺活检所得病理结果及临床最终诊断结果为金标准，347枚肾脏囊性病灶中良性病灶308枚，恶性病灶39枚。347枚病灶中超声造影CT-Bosniak分级Ⅰ级198枚，Ⅱ级45枚，ⅡF级50枚，Ⅲ级26枚，Ⅳ级28枚；超声造影RJ-Bosniak分级Ⅰ级198枚，Ⅱ级28枚，ⅡF级66枚，Ⅲ级28枚，Ⅳ级27枚。以Bosniak Ⅲ级和Ⅳ级为恶性诊断标准，超声造影CT-Bosniak分级和RJ-Bosniak分级正确诊断良、恶性病灶分别290枚、36枚和292枚、38枚，判断肾囊性恶性病灶的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为93.95%（326/347）和95.10%（330/347）、92.31%（36/39）和97.44%（38/39）、94.16%（290/308）和94.81%（292/308）、66.67%（36/54）和70.37%（38/54）、98.98%（290/293）和99.66%（292/293）。该2种分级标准的诊断结果均与金标准结果高度一致（Kappa值分别为0.74和0.79）。结论 超声造影Bosniak分级标准对肾脏囊性病灶良恶性的鉴别诊断有较高的价值。瑞金医院所用的Bosniak分级标准使用简单、有效，值得在临床推广应用。 |
| 关键词: 肾肿瘤 肾脏囊性病灶 超声造影检查 Bosniak分级 |
| DOI：10.16781/j.0258-879x.2021.08.0840 |
| 投稿时间：2021-01-04修订日期：2021-03-12 |
| 基金项目: |
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| Value of contrast-enhanced ultrasound combined with Bosniak classification in predicting the risk stratification of benign and malignant cystic renal masses |
| REN Xin-ping1,2,ZHAN Wei-wei1*,ZHENG Li-li2,LIN Yan-yan1 |
(1. Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 210025, China;
2. Department of Ultrasound, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi 214028, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To explore the value of contrast-enhanced ultrasound (CEUS) computed tomography (CT)-Bosniak classification (refering to the update version of Bosniak classification [CT, 2019]) and CEUS Ruijin (RJ)-Bosniak classification in predicting benign and malignant cystic renal masses. Methods The CEUS images of 347 cystic renal masses from 316 patients who underwent CEUS in Ruijin Hospital or Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Jun. 2015 to Jul. 2020 were retrospectively analyzed. Classification according to the CT standard of Bosniak classification (version 2019) was defined as CEUS CT-Bosniak, and that of Ruijin Hospital clinical experience was defined as CEUS RJ-Bosniak. All the patients were confirmed by biopsy or surgical pathology, enhanced CT or magnetic resonance imaging (MRI). Four grid table was used to calculate the accuracy, sensitivity and specificity of the 2 CEUS Bosniak classifications in the diagnosis of benign and malignant cystic renal masses. Results In the 347 renal cystic foci, 308 benign foci and 39 malignant foci were diagnosed based on the gold standards (the pathological results of surgery or biopsy and the final clinical diagnosis). Of the 347 lesions, there were 198 cases of category Ⅰ, 45 cases of category Ⅱ, 50 cases of category ⅡF, 26 cases of category Ⅲ, and 28 cases of category Ⅳ according to CEUS CT-Bosniak classification; 198 cases of categoryⅠ, 28 cases of category Ⅱ, 66 cases of categoryⅡF, 28 cases of category Ⅲ, and 27 cases of category Ⅳ according to CEUS RJ-Bosniak classification. Whith Bosniak categories Ⅲ and Ⅳ as diagnostic criteria of malignant foci, 290 benign and 36 malignant foci were correctly diagnosed by CEUS CT-Bosniak classification, while 292 benign lesions and 38 malignant foci were correctly diagnosed by CEUS RJ-Bosniak classification. The accuracy, sensitivity, specificity, and positive and negative predictive values between the diagnostic results of CEUS CT-Bosniak and CEUS RJ-Bosniak classification were 93.95% (326/347) and 95.10% (330/347), 92.31% (36/39) and 97.44% (38/39), 94.16% (290/308) and 94.81% (292/308), 66.67% (36/54) and 70.37% (38/54), and 98.98% (290/293) and 99.66% (292/293), respectively. The diagnostic results of the 2 standards were highly consistent with the gold standard results (Kappa values were 0.74 and 0.79, respectively). Conclusion CEUS combined with Bosniak classification has high value in differential diagnosis of benign and malignant renal cystic masses. RJ-Bosniak classification is simple and effective, which is worthy of clinical application. |
| Key words: kidney neoplasms cystic renal mass contrast-enhanced ultrasonography Bosniak classification |
