Application Value Of Nomogram Model Based On Ultrasound And Mammography Features In Breast BI-RADS 4 Lesions

Objective:1.To analyze the diagnostic value of breast ultrasound,mammography characteristics in predicting benign and malignant breast BI-RADS 4 lesions;2.To construct a nomogram model based on breast ultrasound,mammography features and age for predicting BI-RADS 4 benign and malignant breast lesions and verify its effectiveness.Methods:The data of patients with breast diseases first classified as BI-RADS 4 by ultrasonography and mammography in Shanxi Tumor Hospital from 2019 to 2021 were retrospectively analyzed.All patients had clear pathological diagnosis.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound,mammography and their combination were calculated with pathological results as the gold standard.The differences of AUC among ultrasound,mammography and their combination were compared by Delong test.The general characteristics of patients and the characteristics of ultrasound and mammography images were analyzed.The chi-square test was used to compare the characteristics of ultrasound and mammography images between benign and malignant groups of BI-RADS 4 breast tumors.Further,the subjects were randomly divided into two groups in a ratio of 7:3(n=642 in the training group and n=275 in the verification group).The independent predictors in the training group were screened out by binary Logistic regression,and the nomograms for predicting the four benign and malignant breast BIRADS lesions based on the characteristics of breast ultrasound and mammography as well as age were constructed.The nomograms predicting the benign and malignant lesions of BIRADS 4 breast lesions were evaluated by using receiver operating characteristic(ROC)curve,calibration curve and Hosmer-Lemeshow test goodness of fit for the training group and the verification group.Results:1.The AUC for the diagnosis of benign and malignant BI-RADS 4 nodules by ultrasound was 0.923(95%CI 0.904-0.942),and the AUC for the diagnosis of benign and malignant BI-RADS 4 nodules by mammography was 0.904(95%CI 0.883-0.926).The AUC of ultrasonography combined with mammography in the diagnosis of BI-RADS type4 tumors was 0.950(95% CI 0.936-0.965),which was higher than that of single diagnosis.The AUC of combined diagnosis of BI-RADS type 4 breast tumors was significantly different from that of ultrasound alone(Z=-5.65,P < 0.001)or mammography alone(Z=6.55,P < 0.001).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 84.8%,93.9%,95.9%,78.8% and 88.2%,respectively;2.Analysis of general data from benign and malignant breast BI-RADS 4 tumors showed that there were significant differences in age;3.The morphology,edge,boundary,calcification,internal echo and echo type in the ultrasonic image features of BI-RADS 4 benign and malignant breast tumors are statistically different;4.The shape,edge,density,calcification,skin thickening,retraction and nipple inversion of the masses in mammographic features of BI-RADS 4 benign and malignant tumors of the breast have statistical differences;5.In multivariate analysis,age;The edges,borders,internal echoes and calcifications in the ultrasound images;Shape,edge and density in mammography were independent risk factors for predicting the malignancy of BI-RADS 4 breast lesions;6.The nomogram model for predicting the benign and malignant lesions of BI-RADS4 breast lesions was constructed based on the above characteristics and subjected to external validation.The areas under the ROC curves of the training group and the validation group were 0.924 and 0.919,respectively.P-values of Hosmer-Lemeshow goodness-of-fit test were 0.561 and 0.844,respectively(P > 0.05).The calibration curves were generally consistent and showed high predictive power for nomograms constructed based on the above variables.Conclusion:1.Ultrasound combined with mammography has a higher diagnostic value than ultrasound or mammography alone in the diagnosis of category 4 lesions of breast BI-RADS.2.The nomograms constructed based on the characteristics of breast ultrasound,breast X-ray photography and age can be used to differentiate between benign and malignant breast BI-RADS lesions in four categories,with certain practicality.