Valeur des signes ©chographiques dans la pr©diction du potentiel malin des masses mammaires
Résumé
Objectifs : D©terminer les valeurs des signes ©chographiques dans la pr©diction du potentiel malin des masses mammaires.
Mat©riels et m©thodes : Il sâagissait dâune ©tude transversale r©alis©e de juillet  d©cembre 2012  lâH´pital Gyn©co-Obst©trique et P©diatrique de Yaound© (HGOPY). Les classifications ACR ©chographiques ont ©t© confront©es aux r©sultats cyto-histologiques de 141 l©sions mammaires afin de d©terminer la sensibilit©, la sp©cificit© et les valeurs pr©dictives de lâ©chographie dans le diagnostic de la malignit© des l©sions mammaires. Les signes ©chographiques de ces l©sions notamment la forme, lâorientation, lâaspect des contours, et le type de modification du faisceau ultrasonore post©rieur  la l©sion ont ©t© confront©s aux r©sultats cyto-histologiques pour calculer les valeurs pr©dictives de chaque signe dans la pr©diction de la malignit© des masses mammaires. Le test du Chi carr© a ©t© utilis© pour les comparaisons des fr©quences avec un seuil de significativit© fix©  p< 0,05.
R©sultats : Seize l©sions ©taient class©es ACR2, 57 ACR3, 27 ACR4 et 41 ACR5. Cinquante-huit des 141 l©sions ©taient malignes (41,1%). En confrontant la classification ©chographique au r©sultat cyto-histologique,6,2% des l©sions class©es ACR2 ©taient malignes, 3,5% parmi les l©sions ACR3, 59,3% parmi les ACR4 et 95,1% des l©sions ACR5. La sensibilit©, la sp©cificit©, la VPP et la VPN de lâ©chographie dans le diagnostic de la malignit© des l©sions ©tait respectivement de 94,8%, 84,3%, 80,9% et 95,9%. Les deux signes ©chographiques fortement pr©dictifs de la malignit© dâune l©sion solide ©taient lâorientation non parall¨le au plan cutan© (VPP=95%) et la forme irr©guli¨re (VPP=90%). Une l©sion solide ovale bien circonscrite est fortement pr©dictive de b©nignit© (95%).
Conclusion : Lâ©chographie mammaire a une sensibilit© et une VPN ©lev©es dans la diff©renciation entre masses b©nigne et maligne. Lâorientation non parall¨le au plan cutan© et la forme irr©guli¨re dâune l©sion mammaire solide sont des ©l©ments fortement pr©dicteurs de malignit©. Â
Mots-cl©s : Echographie, BIRADS-ACR, Valeur pr©dictive, Sensibilit©, Masse, Cancer du Sein.
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SUMMARY:
Objective: To determine the ability of breast ultrasonography signs in predicting malignity of breast masses.
Materials and Methods: It was a cross-sectional study conducted from July to December 2012 at the Yaound© Gynaeco-obstetric and Pediatric Hospital (YGOPH). Ultrasonography (US) BI-RADS classifications of 141 breast lesions were compared to their pathology results in order to determine the sensitivity, specificity and predictive values of US in the diagnosis of malignant breast lesions. The sonographic features of these lesions including the shape, orientation, aspect of contours, and the type of ultrasonic beam modification posterior to the lesion, were correlated to the pathology results o determine the predictive values of each sign in the prediction of malignant breast masses. Chi-square test was used for comparisons of frequencies with a significance level (±) set at 0.05.
Results: Sixteen lesions were classified ACR2, 57ACR3, 27 ACR4and 41 ACR5. Pathology showed that 58 (41.1%) lesions were malignant. By comparing US BI-RADS classifications with the pathology findings; 6.2% of the ACR2, 3.5% of the ACR3, 59.3% of the ACR4 and 95.1% of ACR5lesionswere malignant. The sensitivity, specificity, PPV and NPV of ultrasonography in the diagnosis of malignant lesions was respectively 94.8%, 84.3%, 80.9% and 95.9%. Non-parallel orientation with respect to the skin surface (PPV = 95%) and irregular shape (PPV = 90%) were highly predictive sonographic signs of malignant solid mass. A well-circumscribed oval shape was highly predictive of benign solid lesion (95%).
Conclusion: The sensitivity and negative predictive value of breast ultrasonography are high in differentiating benign from malignant masses. The non-parallel orientation with respect to the skin surface and the irregular shape of solid breast masses are highly predictive of malignancy.
Keywords: Ultrasonography, ACR-BIRADS, predictive value, sensitivity, Breast Mass, Breast Cancer.
Mots-clés
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