乳腺结节BI-RADS分级标准,看这篇就够了!

2022-05-10 网络 网络

乳腺结节分级,你真的懂了?

乳腺结节的发病率现在越来越高,大部分实性的乳腺结节主要是超声检查发现的低回声病灶,经常良性比较多。但也有一部分是乳腺癌,所以,乳腺结节分级尤为重要。

 

乳腺结节的分级是什么?

 

一旦彩超发现乳腺结节,就会根据乳腺结节的形状,进行一次面试进行评级,也即是对其的危险度进行评分,BI-RADS分级法将乳腺病变分为0~6级,一般来说,级别越高,恶性的可能性越大。

 

  • 边界比较清楚的、漂亮规整的会归类 2 级或 3 级,考虑为比较好的结节,危险性不高;

     

  • 边界没那么清楚、不漂亮的、形状没那么规则的可能归为 4A 级,表示这个结节有点轻微的怀疑,需要进一步检查证明它是不是好结节。当然随着形态的不好,危险度的升高,还有 4B 级,4C 级,5 级,6 级的评分。

 
今天我们就来聊一聊,BI-RADS分级。

 

BI-RADS是美国放射学会的乳腺影像报告和数据系统(Breast Imaging Reporting and Data System)的缩写。BI-RADS 分级标准是由美国国家癌肿研究所、美国疾病控制预防中心、美国食品药品管理局、美国医学会、美国外科医师学会和美国病理学家学会、美国放射学会共同努力制定的。这一标准的建立使描述乳腺病灶的特征性术语和评价病灶恶性程度的报告术语趋于标准化规范化,降低了解读乳腺影像学报告中出现误差和不确定性,尤其对乳腺癌复查诊断更为重要。

 

该分级主要从形态、方位、边缘、内部回声、后方特征、与周围组织关系、钙化等几方面描述乳腺肿物。

 

形态不规则、纵横比大于1、边缘模糊(成角、微小分叶、“蟹足状突起”)、不均质低回声、后方回声改变、结构紊乱侵犯周边组织、钙化均考虑为恶性标志

正常乳腺组织
 
BI-RADS分级标准
 
1级:阴性
 
无异常所见(如有发现乳内、腋前正常形态淋巴结,亦属于1类)。
建议常规体检(每年1次)。

 

2级:良性病变

 

  • 单纯性囊肿、积乳囊肿;乳房内移植物;

  • 稳定的术后改变;

  • 随访后无变化的纤维腺瘤。

如果把乳腺比作一串葡萄,乳腺囊肿就像里面有一颗葡萄全是葡萄汁,没有果肉了。
 
建议定期随访(每6个月至1年1次)。

 

3级:良性可能大
 
  • 包括边缘光整、呈圆形或椭圆形、横径大于高径的实性肿块,很可能是纤维腺瘤;

  • 触诊阴性的复杂囊肿和簇状微囊肿。

 
乳腺纤维腺瘤相当于发现一颗葡萄里面失去了原本的正常结构,只有干了的果肉了
 
建议短期随访(每3-6月一次),2年随访无变化者可降为2类

 

4级:可疑恶性
 
相当于我们发现有一颗葡萄坏掉了。
 
建议行病理学检查(如细针抽吸细胞学检查、空芯针穿刺活检、手术活检)以明确诊断。
 
4A:低度可疑恶性(≥2%-≤10%)。病理报告结果一般为非恶性,在获得良性的活检或细胞学检查结果后应进行6个月或常规的随访。例如可扪及的、局部界限清楚的实质性肿块,超声特征提示为纤维腺瘤;可扪及的复杂囊肿或可能的脓肿。
 
4B:中度可能恶性的病灶(>10%至≤50%)。需综合影像学检查与病理学结果。部分界限清楚部分界限不清的纤维腺瘤或脂肪坏死可进行随访,但乳头状瘤则可能需要切除活检。
 
4C:恶性可能较大(>50%至≤95%),但不像5级那样典型的恶性。例如边界不清的不规则实质性肿块或新出现的簇状细小多形性钙化。该级病灶很可能会是恶性的结果。
 

 

5级:高度可疑恶性
 
   
临床应采取适当措施(几乎肯定的恶性)。超声有特征性的异常征象,恶性的危险性大于95%。应开始进行确定性治疗。
 
考虑前哨淋巴结显像和新辅助化疗时,宜进行影像导引下空芯针穿刺活检,以取得组织学诊断。

 

6类:已行活检证实为恶性
 
临床应采取适当措施。这一分类用于活检已证实为恶性但还未进行治疗的影像评价上。主要是评价活检后的影像改变,或监测手术前新辅助化疗的影像改变。
 
总结一下,方便保存!
 
另附:乳腺结节风险分级量化评估表,更加精准的诊断乳腺结节的分级分类。

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    2022-09-03 江川靖瑶
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  5. [GetPortalCommentsPageByObjectIdResponse(id=2029551, encodeId=6bf2202955127, content=<a href='/topic/show?id=c4222014ff' target=_blank style='color:#2F92EE;'>#ADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2014, encryptionId=c4222014ff, topicName=ADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=38232500109, createdName=1249898am15暂无昵称, createdTime=Mon Aug 22 04:31:52 CST 2022, time=2022-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793013, encodeId=739e1e9301303, content=<a href='/topic/show?id=6d7e150911e' target=_blank style='color:#2F92EE;'>#RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15091, encryptionId=6d7e150911e, topicName=RADS)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK17mLkWpia3T92NlEWTkEhrhZa7XPNic2JqQumEicZXGYFG6Ww5SCIl0Uq62bhhPnibAqIZDHtRva92A/132, createdBy=e0752500025, createdName=江川靖瑶, createdTime=Sat Sep 03 04:31:52 CST 2022, time=2022-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479633, encodeId=df9f14e96337f, content=<a href='/topic/show?id=9754338920' target=_blank style='color:#2F92EE;'>#BI-RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3389, encryptionId=9754338920, topicName=BI-RADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e167558155, createdName=108807375_62823129, createdTime=Thu May 12 10:31:52 CST 2022, time=2022-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1599480, encodeId=25d01599480dc, content=<a href='/topic/show?id=4cdf23e9354' target=_blank style='color:#2F92EE;'>#乳腺结节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23793, encryptionId=4cdf23e9354, topicName=乳腺结节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3cd18724242, createdName=linne326, createdTime=Thu May 12 10:31:52 CST 2022, time=2022-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218631, encodeId=763e121863160, content=分类catogary 分级grade 这俩词还是有些微区别的吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=94265134457, createdName=14662268m47暂无昵称, createdTime=Wed May 11 06:18:10 CST 2022, time=2022-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218617, encodeId=6466121861eab, content=学习可, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d7555413795, createdName=籽樱, createdTime=Wed May 11 00:30:54 CST 2022, time=2022-05-11, status=1, ipAttribution=)]
    2022-05-11 14662268m47暂无昵称

    分类catogary 分级grade 这俩词还是有些微区别的吧

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2029551, encodeId=6bf2202955127, content=<a href='/topic/show?id=c4222014ff' target=_blank style='color:#2F92EE;'>#ADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2014, encryptionId=c4222014ff, topicName=ADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=38232500109, createdName=1249898am15暂无昵称, createdTime=Mon Aug 22 04:31:52 CST 2022, time=2022-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793013, encodeId=739e1e9301303, content=<a href='/topic/show?id=6d7e150911e' target=_blank style='color:#2F92EE;'>#RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15091, encryptionId=6d7e150911e, topicName=RADS)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK17mLkWpia3T92NlEWTkEhrhZa7XPNic2JqQumEicZXGYFG6Ww5SCIl0Uq62bhhPnibAqIZDHtRva92A/132, createdBy=e0752500025, createdName=江川靖瑶, createdTime=Sat Sep 03 04:31:52 CST 2022, time=2022-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479633, encodeId=df9f14e96337f, content=<a href='/topic/show?id=9754338920' target=_blank style='color:#2F92EE;'>#BI-RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3389, encryptionId=9754338920, topicName=BI-RADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e167558155, createdName=108807375_62823129, createdTime=Thu May 12 10:31:52 CST 2022, time=2022-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1599480, encodeId=25d01599480dc, content=<a href='/topic/show?id=4cdf23e9354' target=_blank style='color:#2F92EE;'>#乳腺结节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23793, encryptionId=4cdf23e9354, topicName=乳腺结节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3cd18724242, createdName=linne326, createdTime=Thu May 12 10:31:52 CST 2022, time=2022-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218631, encodeId=763e121863160, content=分类catogary 分级grade 这俩词还是有些微区别的吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=94265134457, createdName=14662268m47暂无昵称, createdTime=Wed May 11 06:18:10 CST 2022, time=2022-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218617, encodeId=6466121861eab, content=学习可, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d7555413795, createdName=籽樱, createdTime=Wed May 11 00:30:54 CST 2022, time=2022-05-11, status=1, ipAttribution=)]
    2022-05-11 籽樱

    学习可

    0

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