高频超声和剪切波弹性成像在基底细胞癌术前评估中的应用  

Application of high-frequency ultrasound and shear wave elastography in preoperative evaluation of basal cell carcinoma

作　　者：梁键锋[1] 冯明初 罗平平[1] 陈燕璇[1] 陈高飞[2] 吴树毅 王静[3] 封慕茵 Liang Jianfeng;Feng Mingchu;Luo Pingping;Chen Yanxuan;Chen Gaofei;Wu Shuyi;Wang Jing;Feng Muyin(Department of Ultrasound,Hospital of Traditional Chinese Medicine of Zhongshan,Guangdong 528400,China;Department of Dermatology,Hospital of Traditional Chinese Medicine of Zhongshan,Guangdong 528400,China;Department of Pathology,Hospital of Traditional Chinese Medicine of Zhongshan,Guangdong 528400,China)

机构地区：[1]广东省中山市中医院超声科,528400 [2]广东省中山市中医院皮肤科,528400 [3]广东省中山市中医院病理科,528400

出　　处：《中华皮肤科杂志》2021年第11期961-965,共5页Chinese Journal of Dermatology

基　　金：中山市第一批社会公益与基础研究项目(医疗卫生)(2020B1078)。

摘　　要：目的探讨高频超声和剪切波弹性成像在基底细胞癌(BCC)术前评估中的价值。方法回顾性分析2017年1月至2020年12月于广东省中山市中医院皮肤科就诊并经手术病理确诊的95例皮肤BCC病例的临床资料。所有病例术前均行常规超声和剪切波弹性成像检查,记录病变的常规超声测量指标(最大直径、最大浸润深度、最大血流速度及阻力指数)以及剪切波弹性成像测量指标(杨氏模量平均值Eave、杨氏模量标准差Esd及杨氏模量平均值比值Eratio)。以病理亚型为参考依据,进一步将病例分成高风险和低风险BCC组,通过配对t检验比较两组常规超声测量以及剪切波弹性成像测量结果。结果高风险BCC组15例,低风险组80例,两组间皮损最大浸润深度[(8.5±4.6)mm比(4.5±1.6)mm,t=6.150,P<0.001]、杨氏模量平均值Eave[(32.7±11.2)比(20.6±5.1)kPa,t=4.065,P=0.001]以及杨氏模量标准差Esd[(7.0±4.1)比(4.2±2.1)kPa,t=2.632,P=0.018]差异有统计学意义,其他测量指标差异无统计学意义(均P>0.05)。以最大浸润深度、Eave以及Esd诊断高风险BCC的受试者工作特征曲线下面积分别为0.775、0.909及0.822,其中以Eave的诊断效能最佳。以25.7 kPa作为截断值,使用Eave诊断高风险BCC的敏感度、特异度分别为86.7%、85.0%。结论应用高频超声和剪切波弹性成像有助于鉴别高风险与低风险BCC。Objective To investigate the value of high-frequency ultrasound and shear wave elastography in preoperative evaluation of basal cell carcinoma(BCC).Methods A total of 95 patients with histopathologically confirmed cutaneous BCC were enrolled from Department of Dermatology,Hospital of Traditional Chinese Medicine of Zhongshan from January 2017 to December 2020,all of whom had underwent preoperative conventional ultrasonography and shear wave elastography.Conventional ultrasonography parametres including the maximum diameter,maximum infiltration depth,maximum blood flow velocity and resistance index were recorded,so were shear wave elastography parametres including the average Young′s modulus(Eave),Young′s modulus standard deviation(Esd)and average Young′s modulus ratio(Eratio).All the patients were divided into high-and low-risk BCC groups according to pathologic subtypes.Paired t-test was used to compare conventional ultrasonography and shear wave elastography findings between the 2 groups.Results There were 15 cases in the high-risk BCC group and 80 cases in the low-risk BCC group.Compared with the low-risk BCC group,the high-risk BCC group showed significantly increased maximum depth of tumor infiltration(8.5±4.6 mm vs.4.5±1.6 mm,t=6.150,P<0.001),Eave(32.7±11.2 kPa vs.20.6±5.1 kPa,t=4.065,P=0.001)and Esd(7.0±4.1 kPa vs.4.2±2.1 kPa,t=2.632,P=0.018),while there were no significant differences in the other measurement data between the two groups(all P>0.05).The areas under the receiver operating characteristic curves of the maximum infiltration depth,Eave and Esd for the diagnosis of high-risk BCC were 0.775,0.909 and 0.822 respectively,and Eave showed the best diagnostic performance.Using 25.7 kPa as the cut-off value,the sensitivity and specificity of Eave were 86.7%and 85.0%for the diagnosis of high-risk BCC,respectively.Conclusion High-frequency ultrasound and shear wave elastography can facilitate differential diagnosis between high-and low-risk BCC.

关 键 词：肿瘤 基底细胞 超声检查 弹性成像技术 风险评估 高频超声 剪切波弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R739.5[医药卫生—诊断学]