不同影像技术评估乳腺癌病变大小的准确性及其影响因素分析  

Accuracy of different imaging techniques in evaluating size of breast cancer focus and its influencing factors

作　　者：刘亚[1] 丁关保 代山山 LIU Ya;DING Guan-bao;DAI Shan-shan(Department of Ultrasound,Wanbei General Hospital,Suzhou 234000,Anhui Province,China)

机构地区：[1]皖北煤电集团总医院超声科,安徽宿州234000

出　　处：《医疗卫生装备》2020年第3期18-22,共5页Chinese Medical Equipment Journal

基　　金：蚌埠医学院第三附属医院专项科研计划(BYZX201601)。

摘　　要：目的:探讨术前二维超声(two-dimensional ultrasound,2D-US)、声辐射力应变弹性成像(virtual touch imaging,VTI)、全视野数字乳腺X射线摄影(full-field digital mammography,FFDM)评估乳腺癌病变大小的准确性,分析其影响因素。方法:选取某院收治的经影像学检查显示乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)分级为Ⅳ级以上的80例乳腺癌患者作为研究对象,所有患者均进行2D-US、VTI及FFDM检查。以病理学检查结果为金标准,运用组内相关系数(intraclass correlation coefficient,ICC)比较病变最大径病理测量值与3种影像技术测量值之间的一致性,并探讨影响3种影像技术评估病变大小准确性的因素。结果:2D-US、VTI、FFDM测量值与病理测量值的ICC分别为0.82、0.79、0.58(P均<0.01);2D-US、VTI、FFDM对病变最大径的测量准确率分别为81.25%、80.00%、65.00%。2D-US的影响因素:病理类型、乳腺浸润性导管癌(invasive ductal carcinoma,IDC)伴乳腺导管原位癌(ductal carcinoma in situ,DCIS)(IDC-DCIS)、病变大小、有无微钙化及病变边缘是否清晰;VTI的影响因素:IDC-DCIS、病变大小、有无微钙化、病变边缘是否清晰;FFDM的影响因素:病理分级,雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER2)表达,乳腺密度,病变类型,距皮深度,病变边缘是否清晰。结论:2D-US和VTI技术评估乳腺癌大小比FFDM更准确,根据患者的影像特征和病理特征选择更优的影像技术评估乳腺癌病变大小有利于精准实施临床个体化治疗。Objective To explore the accuracy of two-dimensional ultrasound(2D-US),virtual touch imaging(VTI)and full-field digital mammography(FFDM)for evaluating the size of the breast cancer focus,and to analyze its influencing factors.Methods Eighty breast cancer patients graded asⅣor above by breast imaging reporting and data system(BI-RADS)were selected as the study subjects.All the subjects were examined with 2D-US,VTI and FFDM,and the results of pathological examination were taken as the gold standard.The consistencies between the pathological measurements of the maximum diameter of lesions and those by the three imaging techniques were compared by using intra group correlation coefficient(ICC).The factors of the accuracy of the lesion size evaluated by the three imaging techniques were discussed.Results The ICCs between 2D-US,VTI,FFDM and pathological measurements were 0.82,0.79,and 0.58,respectively(P<0.01),and 2D-US,VTI and FFDM had the accuracies for measuring the maximum diameter of lesions being 81.25%,80.00%and 65.00%respectively;2D-US had the influencing factors as pathological type,invasive ductal carcinoma(IDC)combined with ductal carcinoma in situ(DCIS),lesion size,microcalcification and lesion boundary clearness;VTI had the factors being IDC-DCIS,lesion size,microcalcification and lesion boundary clearness;FFDM had the factors ass pathological grading,estrogen receptor,progesterone receptor,expression of human epidermal growth factor receptor 2,breast density,lesion type,depth from the skin and lesion boundary clearness.Conclusion 2D-US and VTI gain higher accuracies than FFDM in evaluating the size of breast cancer.Choosing a better image technieque to evaluate the size of breast cancer lesions according to the image characteristics and pathological characteristics of the patients is conducive to the accurate implementation of clinical individualized treatment.

关 键 词：超声 声辐射力应变弹性成像 全视野数字乳腺X射线摄影 乳腺癌 病变最大径 

分 类 号：R318[医药卫生—生物医学工程] R445[医药卫生—基础医学]