二维彩色多普勒超声与声脉冲辐射力成像技术鉴别乳腺肿块良恶性的临床研究  

Clinical Research of the Application of Two- dimensional Ultrasound and Acoustic Radiation Force Impulse Imaging Technology in the Differential Diagnosis of Benign and Malignant Breast Masses

作　　者：吴芳[1] 崔凤荣[1] 卢桂林[1] 姚兰辉[2] 李建国[3] 

机构地区：[1]石河子大学医学院第一附属医院功能科,新疆石河子市832000 [2]新疆医科大学第一附属医院超声科 [3]北京大学人民医院超声科

出　　处：《中国全科医学》2014年第29期3487-3490,共4页Chinese General Practice

摘　　要：目的探讨二维彩色多普勒超声与声脉冲辐射力成像(ARFI)技术对鉴别乳腺肿块良恶性的临床应用价值。方法选取2012年10月—2013年10月在石河子大学医学院第一附属医院乳腺外科行手术的81例乳腺肿块患者,肿块均经术后病理(金标准)证实,其中良性42例(47个病灶,良性组),恶性39例(39个病灶,恶性组)。分析病灶二维彩色多普勒超声及ARFI技术声像图特征,选取超声征象:肿块形态、边缘毛刺、内部回声、微钙化、纵横比、血流分级、阻力指数(RI)、声触诊组织成像(VTI)及声触诊组织量化(VTQ),采用Kappa检验分析超声征象与病理结果的一致性。结果两组肿块形态、边缘毛刺、纵横比、血流分级、RI分布情况比较,差异有统计学意义(P<0.05)。恶性组肿块纵横比为(0.71±0.23),高于良性组的(0.56±0.17),差异有统计学意义(t=5.134,P<0.05)。恶性组RI为(0.78±0.13),高于良性组的(0.64±0.12),差异有统计学意义(t=6.348,P<0.05)。两组肿块VTI评分及VTQ分布情况比较,差异有统计学意义(P<0.05)。两组VTI评分及VTQ值比较,差异均有统计学意义(Z=-6.490,t=8.178;P<0.05)。VTQ值以4 m/s作为诊断乳腺恶性结节的截点,灵敏度为76.9%(30/39),特异度为93.6%(44/47)。VTI评分以4分作为诊断乳腺恶性结节的截点,灵敏度为89.7%(35/39),特异度为68.1%(32/47)。综合分析二维彩色多普勒超声与ARFI技术诊断乳腺癌的灵敏度为89.7%(35/39)、特异度为93.6%(44/47)、准确性为91.8%。联合超声诊断结果与病理结果比较,Kappa值为0.835。结论单独使用二维彩色多普勒超声或ARFI技术鉴别诊断乳腺肿块的良恶性临床价值低,综合分析二维彩色多普勒超声与ARFI技术对鉴别诊断乳腺肿块良恶性有重要临床价值。Objective To explore the clinical application value of two-dimensional ultrasound and acoustic radiation force impulse（ ARFI） imaging technology in the differential diagnosis of benign and malignant breast masses. Methods From October 2012 to October 2013,eighty- one patients received breast surgical operation in the First Affiliated Hospital of Shihezi University Medical College and postoperative pathological examinations（ gold standard） showed the masses of 42 cases were benign（ 47 lesions,benign group）,39 cases were malignant（ 39 lesions,malignant group）. The features of two- dimensional Ultrasound and ARFI impulse image photos of the lesions were analyzed. Ultrasound features including shape,speculated margin,internal echo,micro- calcification,aspect ration,grade of blood flow,resistance index（ RI）,virtual touch tissue imaging（ VTI） and virtual touch tissue quantification（ VTQ） were selected to be compared with pathological results by Kappa. Results There were statistical significances of shape,speculated margin,aspect ratio、grade of blood flow,resistance index distribution between the two groups（ P 0. 05）. The aspect ratio of malignant group was（ 0. 71 ± 0. 23）,which was higher than that of benign group（ 0. 56 ± 0. 17）,and the difference was significant（ t = 5. 134,P 0. 05）. RI of malignant group was（ 0.78 ±0.13）,which was higher than that of benign group（ 0.64 ±0. 12）,and the difference was significant（ t =6. 348,P 0. 05）. The differences of VTI evaluation score and VTQ distribution of the masses were statistically different between the two groups（ Z =- 6. 490,t = 8. 178; P 0. 05）. When VTQ = 4 m /s was used as the cut point for separating benign from malignant,sensitivity was 76. 9%（ 30 /39） and specificity was 93. 6%（ 44 /47）. When VTI = 4 was used as the cut point for the separation,sensitivity was 89. 7%（ 35 /39） and specificity was 68. 1%（ 32 /47）. Comprehensive analysis showed that the sensitivity of two- dimensional ult

关 键 词：乳腺肿块 二维超声 超声检查 多普勒 彩色 声脉冲辐射力成像技术 诊断 鉴别 

分 类 号：R737.9[医药卫生—肿瘤]