弹性成像在鉴别乳腺良恶性肿块中的价值及误漏诊因素分析
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摘要
目的:探讨弹性成像在鉴别乳腺良恶性肿块中的价值及误漏诊因素。方法:选取2015年2月-2018年9月间南方医科大学附属普宁华侨医院收治的92例乳腺肿块患者,对所有患者经病理学证实的共98个乳腺肿块进行回顾性分析,其中良性肿块共58个,恶性肿块共40个。所有患者均予以超声弹性成像应变率比值、5分评分法和B超检查,以病理学结果作为"金标准",应用受试者工作曲线(receiver operating characteristic curves,ROC)观察比较弹性成像应变率比值、5分评分法和B超在鉴别良恶性乳腺肿块中的效能。结果:弹性成像应变率比值共检出良性肿块51个,恶性肿块47个;5分评分法共检出良性肿块54个,恶性肿块44个;B超共检出良性肿块47个,恶性肿块51个;ROC曲线显示,弹性成像应变率比值诊断鉴别良恶性乳腺肿块的曲线下面积(Area under curve,AUC)最高(AUC=0.919,P=0.000),其次为弹性成像5分评分法和B超(AUC=0.889,0.736;P=0.000,0.000),其中应变率比值的AUC高于B超(Z=2.399,P=0.016 5);弹性成像应变率比值和5分评分法鉴别良恶性乳腺肿块的准确度均高于B超(X~2=11.025,7.202;P=0.001,0.007);两者灵敏度均高于B超(X~2=6.135,4.114;P=0.013,0.043);应变率比值特异度高于B超(X~2=5.841,P=0.016);应变率比值阳性预测值高于B超(X~2=5.017,P=0.025);两者阴性预测值均高于B超(X~2=6.652,4.443;P=0.010,0.035);92例患者共检出乳腺肿块98个,应用弹性成像应变率比值鉴别良恶性出现误漏诊9例(9.18%)。多因素Logistic回归分析表明,肿块直径与总体误漏诊率无显著相关性(P=0.913),肿块深度与总体误漏诊率有相关性,其中深度≤4 mm是乳腺肿块良恶性鉴别误漏诊的独立危险因素(OR=0.073,P=0.022)。结论:弹性成像应变率比值用于鉴别乳腺良恶性肿块中的恶性检出率较高,具有更好的诊断效能,值得临床推广应用,其中当肿块深度≤4 mm是弹性成像应变率比值鉴别乳腺肿块良恶性误漏诊的独立危险因素,临床应用时应注意。
Objective:To investigate the value of elastography in differentiating benign and malignant breast masses and the factors of misdiagnosis.Method:From February 2015 to September 2018,92 patients with breast tumors in Puning Overseas Chinese Hospital Affiliated to Southern Medical University were selected.A total of 98 breast tumors confirmed by pathology were retrospectively analyzed,including 58 benign tumors and40 malignant tumors.All patients were examined by ultrasound elastography strain rate ratio,5 points scoring and B-mode ultrasonography.Pathological results were used as the gold standard and receiver operating characteristic curves(ROC)were used to compare the effectiveness of elastography,B ultrasound and mammography in differentiating benign and malignant breast masses.Result:51 benign and 47 malignant breast masses were detected by elastography strain rate,54 benign and 44 malignant breast masses were detected by 5 points scoring, 47 benign and 51 malignant breast masses were detected by ultrasound,and the ROC curve showed that the area under the curve(Area under curve,AUC)of strain rate in differentiating benign and malignant breast masses was the highest(AUC=0.919,P=0.000)and followed by 5 points scoring and B-mode ultrasound(AUC=0.889,0.736;P=0.000,0.000).The AUC of strain ratio was higher than that of ultrasound(Z=2.399,P=0.016 5).The accuracy of elastography strain ratio and 5-point scoring in differentiating benign and malignant breast masses were higher than that of B-mode ultrasound( X~2=11.025,7.202;P=0.001,0.007).The sensitivity of both methods were higher than that of B-mode ultrasound( X~2=6.135,4.114;P=0.013,0.043).The specificity of strain ratio was higher than that of B-mode ultrasound( X~2=5.841,P=0.016).The positive predictive value of strain ratio was higher than that of B-mode ultrasound( X~2=5.017,P=0.025);The negative predictive value of both methods were higher than that of B-mode ultrasound( X~2=6.652,4.443;P=0.010,0.035).9 cases(9.18%)were misdiagnosed as benign or malignant.Multivariate logistic regression analysis showed that there was no significant correlation between the tumor diameter and the overall misdiagnosis rate(P=0.913),and the tumor depth was related to the overall misdiagnosis rate.The depth ≤4 mm was an independent risk factor for the differential misdiagnosis between benign and malignant breast masses(OR=0.073,P=0.022).Conclusion:Elastography strain ratio has a higher detection rate and better diagnostic efficiency in differentiating benign and malignant breast tumors.It is worthy of clinical application.When the depth of breast tumors is ≤4 mm,it is an independent risk factor for misdiagnosis of benign and malignant breast tumors.
Objective:To investigate the value of elastography in differentiating benign and malignant breast masses and the factors of misdiagnosis.Method:From February 2015 to September 2018,92 patients with breast tumors in Puning Overseas Chinese Hospital Affiliated to Southern Medical University were selected.A total of 98 breast tumors confirmed by pathology were retrospectively analyzed,including 58 benign tumors and40 malignant tumors.All patients were examined by ultrasound elastography strain rate ratio,5 points scoring and B-mode ultrasonography.Pathological results were used as the gold standard and receiver operating characteristic curves(ROC)were used to compare the effectiveness of elastography,B ultrasound and mammography in differentiating benign and malignant breast masses.Result:51 benign and 47 malignant breast masses were detected by elastography strain rate,54 benign and 44 malignant breast masses were detected by 5 points scoring, 47 benign and 51 malignant breast masses were detected by ultrasound,and the ROC curve showed that the area under the curve(Area under curve,AUC)of strain rate in differentiating benign and malignant breast masses was the highest(AUC=0.919,P=0.000)and followed by 5 points scoring and B-mode ultrasound(AUC=0.889,0.736;P=0.000,0.000).The AUC of strain ratio was higher than that of ultrasound(Z=2.399,P=0.016 5).The accuracy of elastography strain ratio and 5-point scoring in differentiating benign and malignant breast masses were higher than that of B-mode ultrasound( X~2=11.025,7.202;P=0.001,0.007).The sensitivity of both methods were higher than that of B-mode ultrasound( X~2=6.135,4.114;P=0.013,0.043).The specificity of strain ratio was higher than that of B-mode ultrasound( X~2=5.841,P=0.016).The positive predictive value of strain ratio was higher than that of B-mode ultrasound( X~2=5.017,P=0.025);The negative predictive value of both methods were higher than that of B-mode ultrasound( X~2=6.652,4.443;P=0.010,0.035).9 cases(9.18%)were misdiagnosed as benign or malignant.Multivariate logistic regression analysis showed that there was no significant correlation between the tumor diameter and the overall misdiagnosis rate(P=0.913),and the tumor depth was related to the overall misdiagnosis rate.The depth ≤4 mm was an independent risk factor for the differential misdiagnosis between benign and malignant breast masses(OR=0.073,P=0.022).Conclusion:Elastography strain ratio has a higher detection rate and better diagnostic efficiency in differentiating benign and malignant breast tumors.It is worthy of clinical application.When the depth of breast tumors is ≤4 mm,it is an independent risk factor for misdiagnosis of benign and malignant breast tumors.
引文
[1]周俊宇,沈理,詹维伟.乳腺肿块超声BI-RADS描述词的一致性及临床意义[J].中国医学影像学杂志,2013,21(9):672-674,678.
[2]陈潘桢,王继伟,余金明.乳腺癌和妇科恶性肿瘤生存者性健康影响因素及干预措施[J].中华全科医师杂志,2018,17(9):741-743.
[3]孟凡荣,韩洋,李亚洲,等.探讨超声引导下穿刺活检联合BI-RADS分级法弹性校正定量评估诊断乳腺癌的临床价值[J].中华保健医学杂志,2018,21(2):117-120.
[4]齐春凤.彩色多普勒超声与钼靶X线联合诊断早期乳腺癌的研究[J].中国实验诊断学,2018,15(7):1138-1139.
[5]王博娟,杨小欢,王兴华.乳腺背景超声分型与弹性成像联合诊断BI-RADS 4类病变[J].中国临床医学影像杂志,2018,29(8):571-574.
[6]吴淮宇,董发进,徐金锋.超声弹性成像预测浸润性乳腺癌的研究进展[J].医学综述,2018,21(14):2850-2854,2859.
[7]安显鸿,梁国欣,韩宪静,等.多普勒超声及钼靶X线检查在老年不可触及乳腺病灶诊断中价值[J].中国老年学杂志,2018,20(2):438-440.
[8]张润,刘双艳,李伶俐,等.乳腺超声造影与彩色多普勒超声在乳腺肿瘤良恶性诊断中应用[J].临床军医杂志,2018,12(6):648-649.
[9]牟霜,闵捷.常规超声联合弹性成像对非哺乳期乳腺癌的诊断价值分析[J].实用癌症杂志,2018,16(5):817-820.
[10]黄妮.超声成像新技术在乳腺癌诊疗中的应用进展[J].临床超声医学杂志,2018,19(6):405-408.
[11]贾美红,李海康,薛继平,等.乳腺癌剪切波弹性模量最大值与其免疫组化相关性研究[J].中华超声影像学杂志,2018,27(6):510-514.
[12]马玉峰,张昕,张微,等.剪切波弹性成像对乳腺癌新辅助化疗后残存癌的评估[J].中国临床医学影像杂志,2018,29(5):316-319.
[13]赵青,任静,纪甜甜,等.超声助力式弹性成像联合声触诊组织成像量化技术对BI-RADS 4类乳腺肿块的诊断价值[J].临床超声医学杂志,2018,10(2):90-93.
[14]朱桂敏,吴玉莲,陆永萍,等.实时剪切波弹性成像技术对不同年龄段正常乳腺硬度的定量研究[J].中国临床医学影像杂志,2018,29(4):295-297.
[15]赵亚楠,杨会,黄品同,等.剪切波弹性成像定量分析与硬环征在鉴别诊断乳腺肿块良恶性中的意义[J].中华超声影像学杂志,2017,26(12):1062-1068.
[16]周红梅,冉海涛,成涓.超声新技术结合超声乳腺影像报告和数据系统评估乳腺病变的应用现状[J].中国介入影像与治疗学,2018,15(3):188-191.
[17]李洪娥,郭周颖,于明,等.Q-analysis实时弹性成像技术对乳腺良恶性病变鉴别诊断的应用价值[J].医学影像学杂志,2018,15(1):73-77.
[18]张琼,王兴田.超声弹性成像技术及二维超声对乳腺癌腋窝淋巴结转移鉴别诊断价值[J].实用癌症杂志,2018,33(1):137-139.
[19]申凯凯,袁建军,刘祎斐,等.三维剪切波弹性成像在乳腺肿块良恶性鉴别诊断中的应用[J].中华超声影像学杂志,2017,26(12):1057-1061.
[20]赵敏,张步林,何冰玲,等.超声“萤火虫”成像技术在乳腺肿块微钙化检出中的价值及临床意义[J].中国超声医学杂志,2015,24(8):690-693.
[2]陈潘桢,王继伟,余金明.乳腺癌和妇科恶性肿瘤生存者性健康影响因素及干预措施[J].中华全科医师杂志,2018,17(9):741-743.
[3]孟凡荣,韩洋,李亚洲,等.探讨超声引导下穿刺活检联合BI-RADS分级法弹性校正定量评估诊断乳腺癌的临床价值[J].中华保健医学杂志,2018,21(2):117-120.
[4]齐春凤.彩色多普勒超声与钼靶X线联合诊断早期乳腺癌的研究[J].中国实验诊断学,2018,15(7):1138-1139.
[5]王博娟,杨小欢,王兴华.乳腺背景超声分型与弹性成像联合诊断BI-RADS 4类病变[J].中国临床医学影像杂志,2018,29(8):571-574.
[6]吴淮宇,董发进,徐金锋.超声弹性成像预测浸润性乳腺癌的研究进展[J].医学综述,2018,21(14):2850-2854,2859.
[7]安显鸿,梁国欣,韩宪静,等.多普勒超声及钼靶X线检查在老年不可触及乳腺病灶诊断中价值[J].中国老年学杂志,2018,20(2):438-440.
[8]张润,刘双艳,李伶俐,等.乳腺超声造影与彩色多普勒超声在乳腺肿瘤良恶性诊断中应用[J].临床军医杂志,2018,12(6):648-649.
[9]牟霜,闵捷.常规超声联合弹性成像对非哺乳期乳腺癌的诊断价值分析[J].实用癌症杂志,2018,16(5):817-820.
[10]黄妮.超声成像新技术在乳腺癌诊疗中的应用进展[J].临床超声医学杂志,2018,19(6):405-408.
[11]贾美红,李海康,薛继平,等.乳腺癌剪切波弹性模量最大值与其免疫组化相关性研究[J].中华超声影像学杂志,2018,27(6):510-514.
[12]马玉峰,张昕,张微,等.剪切波弹性成像对乳腺癌新辅助化疗后残存癌的评估[J].中国临床医学影像杂志,2018,29(5):316-319.
[13]赵青,任静,纪甜甜,等.超声助力式弹性成像联合声触诊组织成像量化技术对BI-RADS 4类乳腺肿块的诊断价值[J].临床超声医学杂志,2018,10(2):90-93.
[14]朱桂敏,吴玉莲,陆永萍,等.实时剪切波弹性成像技术对不同年龄段正常乳腺硬度的定量研究[J].中国临床医学影像杂志,2018,29(4):295-297.
[15]赵亚楠,杨会,黄品同,等.剪切波弹性成像定量分析与硬环征在鉴别诊断乳腺肿块良恶性中的意义[J].中华超声影像学杂志,2017,26(12):1062-1068.
[16]周红梅,冉海涛,成涓.超声新技术结合超声乳腺影像报告和数据系统评估乳腺病变的应用现状[J].中国介入影像与治疗学,2018,15(3):188-191.
[17]李洪娥,郭周颖,于明,等.Q-analysis实时弹性成像技术对乳腺良恶性病变鉴别诊断的应用价值[J].医学影像学杂志,2018,15(1):73-77.
[18]张琼,王兴田.超声弹性成像技术及二维超声对乳腺癌腋窝淋巴结转移鉴别诊断价值[J].实用癌症杂志,2018,33(1):137-139.
[19]申凯凯,袁建军,刘祎斐,等.三维剪切波弹性成像在乳腺肿块良恶性鉴别诊断中的应用[J].中华超声影像学杂志,2017,26(12):1057-1061.
[20]赵敏,张步林,何冰玲,等.超声“萤火虫”成像技术在乳腺肿块微钙化检出中的价值及临床意义[J].中国超声医学杂志,2015,24(8):690-693.