三维容积超声在小乳癌诊断中的临床应用价值  

Application value of three-dimensional volume ultrasound in the diagnosis of small breast cancer

作　　者：热西达·加帕尔[1] 马富成[1] 耿怡[1] 冷晓玲[1] 

机构地区：[1]新疆医科大学附属肿瘤医院超声诊断科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2017年第3期269-274,共6页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81260332)

摘　　要：目的根据小乳癌在二维和三维容积超声中表现出的多项声像图特征的不同,分析三维容积超声用于诊断小乳癌的应用价值。方法收集139例患者的小肿块(≤2cm)共计160枚,对肿块行二维及三维超声检查,分析6项二维超声图像特征及10项三维容积超声图像特征及两种检查方法的血流分级情况,对肿块良、恶性做出判断,并与术后或穿刺后的病理结果进行对比,计算出二维超声、三维容积超声对小肿块良、恶性诊断与病理结果的一致性及两种检查方法的符合率、灵敏度、特异度,探讨三维容积超声在小乳腺癌诊断中的临床应用价值。结果病理诊断160枚乳腺小肿块,恶性92枚,良性68枚。以病理结果为金标准得出:二维超声对小乳癌的灵敏度75%,特异度为79.4%,符合率为76.9%,一致性检验后卡方值为2.18,P值为0.139,Kappa值为0.535(0.404~0.665);三维容积超声对小乳癌的诊断灵敏度为89.1%,特异度为88.2%,符合率为88.8%,一致性检验后卡方值为0.22,P值为0.639,Kappa值为0.771(0.671~0.870)。二维超声、三维超声对小乳癌的诊断存在差异(P<0.05)。良、恶性肿块在二维与三维检查中的特征各不相同,其中二维声像中恶性特征的显示率低于三维声像,而三维冠状面上汇聚征诊断恶性的灵敏度为82.4%,特异度为85.9%,成角毛刺征诊断恶性的灵敏度为92.6%,特异度为75%,完整界面回声诊断良性的灵敏度为95.6%,特异度为77.2%。结论在二维超声的基础上加做三维容积超声,小乳癌的诊断更加准确。采用三维容积超声对小乳癌的诊断结果和病理结果具有良好的一致性。与二维超声相比,三维容积超声对小乳癌能提供更多的声像图特征,对良、恶性肿块的鉴别更加精准。Objective According to the different characteristics of the multiple ultrasound images of small breast cancer in two-dimensional and three-dimensional volume ultrasound, to analyze the application value of three-dimensional volume ultrasound in the diagnosis of small breast cancer. Methods 139 patients with 160 small lumps （less than 2cm） were collected and examined with two dimensional and three dimensional ultrasonography. 6 ultrasonographic features of two-dimensional and 10 image characteristics of three-di- mensional volume ultrasound, and blood flow classification in both ultrasound examinations were analyzed to judge the benign and malignant tumor, which were compared with the pathology results after surgery or puncture. The consistency, the coincidence rate, sensitivity and specificity of two-dimensional ultrasound and three-dimensional volume ultrasound were calculated to explore the clinical value of three dimensional ultrasound in the small breast cancer. Results In 160 small breast lumps, 92 were malignant and 68 were benign in the pathological diagnosis. The sensitivity in diagnosis of small breast with two-dimensional ultrasound was 75%, and the specificity was 79.4%, and the coincidence rate was 76.9%. Chi-square value was 2.18, and P was 0.139, and kappa was 0.535 （0.404--0.665） in the consistency test. With three-dimensional ultrasound, the sensitivity was 89.1%, and the specificity was 88.2% ,and the coincidence rate was 88.8%. In the consistency test, chi square value was 0.22, and P was 0.639, and kappa was 0.771 （0.671--0.870）. The difference was significant （P〈0.05）. Benign and malignant tumors can be seen in two-dimensional and three-dimensional volume ultrasound with different characteristics. The characteristics of two dimensional ultrasound in malignant rate was lower than that of the three-dimension- al image. The sensitivity was 82.4% and specificity was 85.9% of coronal convergence in three-dimensional sign in malignant lumps, and the sensitivity was 92.6% and specif

关 键 词：早发性 边缘带 病理参数 对照分析 强度曲线 预后差 弹性成像 侵袭性 不协调性 诊断评估 

分 类 号：R445.1[医药卫生—影像医学与核医学]