超声弹性成像与彩色多普勒超声在乳腺癌鉴别诊断中的临床价值
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摘要
目的探讨超声弹性成像与彩色多普勒超声在乳腺癌鉴别诊断中的临床价值。方法收集54例乳腺占位性病变患者的临床资料,所有患者均有术前超声弹性成像和彩色多普勒超声检查结果,且均经术后病理学检查证实。以病理学检查结果为金标准,比较两种检查方法对乳腺癌的诊断效能,并分析两种检查方法对于不同年龄乳腺癌患者的诊断准确度。结果 54例乳腺占位性病变患者中,病理学检查共确诊57个病灶,其中,良性病灶31个,恶性病灶26个。与彩色多普勒超声相比,超声弹性成像诊断乳腺癌的灵敏度、特异度、阳性预测值、阴性预测值和准确度均较高,误诊率和漏诊率均较低,差异均有统计学意义(P﹤0.05)。在≤45岁的乳腺占位性病变患者中,超声弹性成像诊断乳腺癌的准确度高于彩色多普勒超声(P﹤0.05);在﹥45岁的乳腺占位性病变患者中,两种检查方式对乳腺癌诊断的准确度比较,差异无统计学意义(P﹥0.05)。结论超声弹性成像与彩色多普勒超声在乳腺癌的鉴别诊断中均具有较好的应用价值,但超声弹性成像的诊断效能优于彩色多普勒超声,值得临床推广应用。
Objective To investigate the clinical value of ultrasound elastography and color Doppler ultrasound in the differential diagnosis of breast cancer. Method The clinical data of 54 cases with space-occupying lesions in the breast were collected, all patients underwent preoperative ultrasound elastography and color Doppler ultrasound examination,and were confirmed pathologically after surgery. Using the pathological results as the gold standard, the diagnostic efficiency for breast cancer of the two examinations were compared, besides, and the diagnostic accuracy of the two methods for patients with breast cancer of different ages was analyzed. Result Among the 54 patients, 57 lesions were confirmed by pathological examination, in which there were 31 benign lesions and 26 malignant ones. The sensitivity, specificity,positive predictive value, negative predictive value and accuracy of ultrasound elastography in diagnosing breast cancer were significantly higher than those of color Doppler ultrasound, the misdiagnosis rate and missed diagnosis rate were significantly lower than those of color Doppler ultrasound, the differences were statistically significant(P<0.05). The diagnostic accuracy of ultrasound elastography was significantly higher than that of color Doppler ultrasound in patients ≤45 years old of space-occupying lesions in the breast(P<0.05); while it was similar between the two examinations when administered among those who were over 45 years old of space-occupying lesions in the breast(P>0.05). Conclusion Ultrasound elastography and color Doppler ultrasound are fairly applicable in the differential diagnosis of breast cancer, but the diagnostic efficiency of ultrasound elastography is better compared to color Doppler ultrasound.
Objective To investigate the clinical value of ultrasound elastography and color Doppler ultrasound in the differential diagnosis of breast cancer. Method The clinical data of 54 cases with space-occupying lesions in the breast were collected, all patients underwent preoperative ultrasound elastography and color Doppler ultrasound examination,and were confirmed pathologically after surgery. Using the pathological results as the gold standard, the diagnostic efficiency for breast cancer of the two examinations were compared, besides, and the diagnostic accuracy of the two methods for patients with breast cancer of different ages was analyzed. Result Among the 54 patients, 57 lesions were confirmed by pathological examination, in which there were 31 benign lesions and 26 malignant ones. The sensitivity, specificity,positive predictive value, negative predictive value and accuracy of ultrasound elastography in diagnosing breast cancer were significantly higher than those of color Doppler ultrasound, the misdiagnosis rate and missed diagnosis rate were significantly lower than those of color Doppler ultrasound, the differences were statistically significant(P<0.05). The diagnostic accuracy of ultrasound elastography was significantly higher than that of color Doppler ultrasound in patients ≤45 years old of space-occupying lesions in the breast(P<0.05); while it was similar between the two examinations when administered among those who were over 45 years old of space-occupying lesions in the breast(P>0.05). Conclusion Ultrasound elastography and color Doppler ultrasound are fairly applicable in the differential diagnosis of breast cancer, but the diagnostic efficiency of ultrasound elastography is better compared to color Doppler ultrasound.
引文
[1]黄杰峰,林晓榕,吴智勇. NSABP近十年乳腺癌临床试验进展[J].国际肿瘤学杂志, 2017, 44(7):547-549.
[2] Zeng Z, Jiang X, Li X, et al. Conjugated equine estrogen and medroxyprogesterone acetate are associated with decreased risk of breast cancer relative to bioidentical hormone therapy and controls[J]. PLo S One, 2018, 13(5):e0197064.
[3]靳凤梅,马苏美,王惠,等.乳腺病灶超声学检查方法的现状与展望[J].中国医学影像技术, 2017, 33(10):1562-1565.
[4]梁平,赖胜坤,何立红,等.超声综合检查对乳腺癌筛查的临床诊断价值分析[J].医学影像学杂志, 2015, 25(6):1121-1124.
[5] Moon WK, Chang SC, Chang JM, et al. Classification of breast tumors using elastographic and B-mode features:comparison of automatic selection of representative slice and physician-selected slice of images[J]. Ultrasound Med Biol, 2013, 39(7):1147-1157.
[6]郭碧萍,李艳宁,徐丽芳,等.超声弹性成像联合常规超声评分对乳腺癌腋窝淋巴结转移的诊断价值[J].广西医科大学学报, 2017, 34(6):832-834.
[7] Uematsu T. Ultrasonographic findings of missed breast cancer:pitfalls and pearls[J]. Breast Cancer, 2014, 21(1):10-19.
[8]段学宁.乳腺良性疾病诊治共识与争议[J].中国实用外科杂志, 2016, 36(7):713-715.
[9]张纾,袁建军.高频彩色多普勒超声诊断乳腺癌漏误诊因素分析[J].医学影像学杂志, 2013, 23(4):616-617.
[10]杜燕然,陈曼,唐蕾,等.乳腺小肿块BI-RADS及超声弹性成像的临床研究[J].中国超声医学杂志, 2016, 32(1):22-25.
[11] Guo R, Lu G, Qin B, et al. Ultrasound imaging technologies for breast cancer detection and management:a review[J]. Ultrasound Med Biol, 2018, 44(1):37-70.
[12] Redling K, Schwab F, Siebert M, et al. Elastography complements ultrasound as principle modality in breast lesion assessment[J]. Gynecol Obstet Invest, 2017, 82(2):119-124.
[13] Slimi T, Moussa IM, Kraiem T, et al. Improvement of displacement estimation of breast tissue in ultrasound elastography using the monogenic signal[J]. Biomed Eng Online,2017, 16(1):19.
[14]石燕清,乌兰,赵梦婷,等.超声弹性成像技术联合常规超声诊断乳腺癌的准确性[J].癌症进展, 2017, 15(4):454-456; 462.
[15] Fleury EFC, Gianini AC, Marcomini K, et al. The feasibility of classifying breast masses using a computer-assisted diagnosis(CAD)system based on ultrasound elastography and BI-RADS lexicon[J]. Technol Cancer Res Treat,2018, 17:1533033818763461.
[2] Zeng Z, Jiang X, Li X, et al. Conjugated equine estrogen and medroxyprogesterone acetate are associated with decreased risk of breast cancer relative to bioidentical hormone therapy and controls[J]. PLo S One, 2018, 13(5):e0197064.
[3]靳凤梅,马苏美,王惠,等.乳腺病灶超声学检查方法的现状与展望[J].中国医学影像技术, 2017, 33(10):1562-1565.
[4]梁平,赖胜坤,何立红,等.超声综合检查对乳腺癌筛查的临床诊断价值分析[J].医学影像学杂志, 2015, 25(6):1121-1124.
[5] Moon WK, Chang SC, Chang JM, et al. Classification of breast tumors using elastographic and B-mode features:comparison of automatic selection of representative slice and physician-selected slice of images[J]. Ultrasound Med Biol, 2013, 39(7):1147-1157.
[6]郭碧萍,李艳宁,徐丽芳,等.超声弹性成像联合常规超声评分对乳腺癌腋窝淋巴结转移的诊断价值[J].广西医科大学学报, 2017, 34(6):832-834.
[7] Uematsu T. Ultrasonographic findings of missed breast cancer:pitfalls and pearls[J]. Breast Cancer, 2014, 21(1):10-19.
[8]段学宁.乳腺良性疾病诊治共识与争议[J].中国实用外科杂志, 2016, 36(7):713-715.
[9]张纾,袁建军.高频彩色多普勒超声诊断乳腺癌漏误诊因素分析[J].医学影像学杂志, 2013, 23(4):616-617.
[10]杜燕然,陈曼,唐蕾,等.乳腺小肿块BI-RADS及超声弹性成像的临床研究[J].中国超声医学杂志, 2016, 32(1):22-25.
[11] Guo R, Lu G, Qin B, et al. Ultrasound imaging technologies for breast cancer detection and management:a review[J]. Ultrasound Med Biol, 2018, 44(1):37-70.
[12] Redling K, Schwab F, Siebert M, et al. Elastography complements ultrasound as principle modality in breast lesion assessment[J]. Gynecol Obstet Invest, 2017, 82(2):119-124.
[13] Slimi T, Moussa IM, Kraiem T, et al. Improvement of displacement estimation of breast tissue in ultrasound elastography using the monogenic signal[J]. Biomed Eng Online,2017, 16(1):19.
[14]石燕清,乌兰,赵梦婷,等.超声弹性成像技术联合常规超声诊断乳腺癌的准确性[J].癌症进展, 2017, 15(4):454-456; 462.
[15] Fleury EFC, Gianini AC, Marcomini K, et al. The feasibility of classifying breast masses using a computer-assisted diagnosis(CAD)system based on ultrasound elastography and BI-RADS lexicon[J]. Technol Cancer Res Treat,2018, 17:1533033818763461.