超声造影在乳腺良恶性肿瘤鉴别诊断中的应用
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摘要
目的:探讨超声造影技术在乳腺良恶性肿瘤鉴别诊断中的价值。方法:回顾性分析215例乳腺肿瘤患者232个病灶的超声造影特征。比较乳腺良恶性肿瘤的下述超声造影特征:造影后肿块的增强程度、边界、形态、灌注是否均匀、是否有内部灌注缺损及是否有穿支血管。结果:以术后病理学检查结果为金标准,232个病灶中131个病灶诊断为良性,101个诊断为恶性。而对应的超声造影结果显示,26例良性病灶诊断错误,5例恶性病灶诊断错误。以此计算出灵敏度为95.0%,特异度为80.2%,准确率为86.6%,阳性似然比为4.80,阴性似然比为0.062。结论:乳腺良恶性肿瘤在超声造影后表现出不同的特征。基于超声造影技术对乳腺良恶性肿瘤进行鉴别诊断的方法具有较高的灵敏度、特异度和准确率,可作为乳腺肿瘤良恶性快速、有效的鉴别诊断方法。
Objective: To investigate the value of contrast-enhanced ultrasound(CEUS) technology in the differential diagnosis of benign and malignant breast tumors. Methods: A total of 215 cases with 232 lesions that had been proved by pathological diagnosis results were studied. All the patients were examined by CEUS. The following contrast-enhanced ultrasonography characteristics of benign and malignant breast tumors was compared: the degree of enhancement of the tumor, the boundary and the shape of tumor, the uniform of perfusion, the internal perfusion defect, the perforator vessel. Results: According to the postoperative pathological results as the gold standard, 131 of the 232 lesions were diagnosed as benign and 101 were diagnosed as malignant. The dynamic responses of benign and malignant breast tumors were signi?cantly different under the CEUS. By observing the characteristics of lesions, 26 cases of benign lesions were misdiagnosed, and 5 cases of malignant lesions were misdiagnosed. The calculated sensitivity, speci?city, accuracy, positive likelihood ratio and negative likelihood ratio were 95.0%, 80.2%, 86.6%, 4.80 and 0.062 respectively. Conclusion: Benign and malignant breast tumors show different characteristics after contrast-enhanced ultrasonography. The CEUS method has high sensitivity, speci?city and accuracy in the differential diagnosis of benign and malignant breast tumors, and it can be used as a rapid and effective method in diagnosis of breast tumors.
Objective: To investigate the value of contrast-enhanced ultrasound(CEUS) technology in the differential diagnosis of benign and malignant breast tumors. Methods: A total of 215 cases with 232 lesions that had been proved by pathological diagnosis results were studied. All the patients were examined by CEUS. The following contrast-enhanced ultrasonography characteristics of benign and malignant breast tumors was compared: the degree of enhancement of the tumor, the boundary and the shape of tumor, the uniform of perfusion, the internal perfusion defect, the perforator vessel. Results: According to the postoperative pathological results as the gold standard, 131 of the 232 lesions were diagnosed as benign and 101 were diagnosed as malignant. The dynamic responses of benign and malignant breast tumors were signi?cantly different under the CEUS. By observing the characteristics of lesions, 26 cases of benign lesions were misdiagnosed, and 5 cases of malignant lesions were misdiagnosed. The calculated sensitivity, speci?city, accuracy, positive likelihood ratio and negative likelihood ratio were 95.0%, 80.2%, 86.6%, 4.80 and 0.062 respectively. Conclusion: Benign and malignant breast tumors show different characteristics after contrast-enhanced ultrasonography. The CEUS method has high sensitivity, speci?city and accuracy in the differential diagnosis of benign and malignant breast tumors, and it can be used as a rapid and effective method in diagnosis of breast tumors.
引文
[1]陈万青,孙可欣,郑荣寿,等. 2014年中国分地区恶性肿瘤发病和死亡分析[J].中国肿瘤, 2018, 27(1):l-14.
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[3]乐坚,常才,陈敏,等.常规超声联合超声造影与单纯常规超声对乳腺良恶性肿瘤鉴别价值的比较[J].上海医学影像, 2012, 21(3):182-185.
[4]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, 46(6):648-649.
[5]张晓光.超声造影对乳腺良恶性肿瘤鉴别诊断价值的系统评价[D].乌鲁木齐:新疆医科大学, 2014.
[6]刘健.超声造影对乳腺实体肿瘤的诊断效能评价[D].重庆:第三军医大学, 2015.
[7]SARACCO A, SZABóB K, ASPELIN P, et al. Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound[J].Acta Radiol, 2012, 53(4):382-388.
[8]吕文豪,聂芳,张雪云,等.超声造影评价乳腺癌病灶增强区域扩大程度与免疫指标的相关性分析[J].中国超声医学杂志, 2018, 34(6):485-487.
[9]李颖嘉,文戈,何洁.超声造影对乳腺良恶性病变及其相关预后评价的研究进展[J].中国医学影像学杂志,2011, 19(2):155-157.
[10]方建强,单世胜,赵维安,等.超声造影及常规超声在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值[J].肿瘤影像学,2018, 27(5):421-425.
[11]蔡小平.彩色多普勒超声对乳腺良恶性肿块的鉴别诊断价值[J].泰山医学院学报, 2019, 40(2):126-127.
[12]KETTENBACH J, HELBICH T H, HUBER S, et al. Computer-assisted quantitative assessment of power Doppler US:effects of microbubble contrast agent in the differentiation of breast tumors[J]. Eur J Radiol, 2005, 53(2):238-244.
[2]钱小霞.超声造影诊断乳腺肿瘤的临床应用进展[J].临床肿瘤学杂志, 2011, 16(7):648-651.
[3]乐坚,常才,陈敏,等.常规超声联合超声造影与单纯常规超声对乳腺良恶性肿瘤鉴别价值的比较[J].上海医学影像, 2012, 21(3):182-185.
[4]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, 46(6):648-649.
[5]张晓光.超声造影对乳腺良恶性肿瘤鉴别诊断价值的系统评价[D].乌鲁木齐:新疆医科大学, 2014.
[6]刘健.超声造影对乳腺实体肿瘤的诊断效能评价[D].重庆:第三军医大学, 2015.
[7]SARACCO A, SZABóB K, ASPELIN P, et al. Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound[J].Acta Radiol, 2012, 53(4):382-388.
[8]吕文豪,聂芳,张雪云,等.超声造影评价乳腺癌病灶增强区域扩大程度与免疫指标的相关性分析[J].中国超声医学杂志, 2018, 34(6):485-487.
[9]李颖嘉,文戈,何洁.超声造影对乳腺良恶性病变及其相关预后评价的研究进展[J].中国医学影像学杂志,2011, 19(2):155-157.
[10]方建强,单世胜,赵维安,等.超声造影及常规超声在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值[J].肿瘤影像学,2018, 27(5):421-425.
[11]蔡小平.彩色多普勒超声对乳腺良恶性肿块的鉴别诊断价值[J].泰山医学院学报, 2019, 40(2):126-127.
[12]KETTENBACH J, HELBICH T H, HUBER S, et al. Computer-assisted quantitative assessment of power Doppler US:effects of microbubble contrast agent in the differentiation of breast tumors[J]. Eur J Radiol, 2005, 53(2):238-244.