剪切波弹性成像评估乳腺良恶性肿瘤及其与乳腺癌预后因素的相关性  

Evaluation of shear wave elastography for benign and malignant breast tumors and its correlation with prognostic factors of breast cancer

作　　者：孟磊 潘晓芳 张博[1] 刘琳[1] 王坤[2] 王晶[1] 赵俊军 Meng Lei;Pan Xiaofang;Zhang Bo;Liu Lin;Wang Kun;Wang Jing;Zhao Junjun(Department of Ultrasound Imaging,Central Hospital of Dalian University of Technology,Dalian 116033,China;Department of Breast Surgery,Central Hospital of Dalian University of Technology,Dalian 116033,China;Department of Pathology,Central Hospital of Dalian University of Technology,Dalian 116033,China)

机构地区：[1]大连理工大学附属大连市中心医院超声影像科,辽宁大连116033 [2]大连理工大学附属大连市中心医院乳腺外科,辽宁大连116033 [3]大连理工大学附属大连市中心医院病理科,辽宁大连116033

出　　处：《实用肿瘤杂志》2022年第6期566-571,共6页Journal of Practical Oncology

摘　　要：目的探讨二维剪切波弹性成像(two-dimensional shear wave elastography,2D-SWE)定量参数在评估乳腺肿瘤良恶性中的临床应用价值,并研究其与乳腺癌预后因素的关系。方法选取自2019年11月至2020年4月期间于本院收治的乳腺肿瘤患者158例共184个结节。2D-SWE检查获得定量参数[平均弹性(mean elasticity,E_(mean))、最大弹性(maximum elasticity,E_(max))和弹性比(elasticity ratio,E_(ratio))]后,根据其最优截断值优化传统超声乳腺影像报告及数据系统(Breast Imaging Reporting And Data System,BI-RADS)分类,比较优化前后敏感度、特异度、准确度、阳性预测值和阴性预测值。分析SWE的定量参数E_(max)、E_(mean)及E_(ratio)与乳腺癌预后因素的关系及预测能力。结果2D-SWE定量参数E_(max)、E_(mean)和E_(ratio)鉴别乳腺肿瘤良恶性差异均具有统计学意义(均P<0.05)。E_(max)显示出最高的诊断效能(AUC为0.943,最优截断值55.13 kPa)。以E_(max)最佳截断值校正BI-RADS分类后,较优化前敏感度(95.3%vs 87.1%)、特异度(88.9%vs 63.6%)和准确度(91.8%vs 74.5%)均提高(均P<0.05),阴性预测值(95.7%vs 85.1%)和阳性预测值(88.0%vs 67.3%)也提高。分析85例乳腺恶性结节的2D-SWE定量参数与预后因素显示,腋窝淋巴结转移阳性者E_(max)、E_(mean)和E_(ratio)均高于阴性者,差异均具有统计学意义(均P<0.05);组织分级Ⅲ级者E_(ratio)值高于Ⅰ级和Ⅱ级者,差异均具有统计学意义(均P<0.05);组织分级Ⅰ级与Ⅱ级组间和分子分型组间E_(max)、E_(mean)和E_(ratio)比较,差异均无统计学意义(均P>0.05)。结论2D-SWE的定量参数优化方案能提高鉴别乳腺肿瘤良恶性的效能,且各参数中以E_(max)最佳。2D-SWE定量参数可预测乳腺癌腋窝淋巴结转移情况,E_(ratio)在乳腺癌组织分级中有一定的预测价值。Objective To investigate the clinical value of the quantitative parameters of two-dimensional shear wave elastography(2D-SWE)in evaluating benign and malignant breast tumors and its relationship with prognostic factors of breast cancer.Methods A total of 158 breast tumor patients with 184 nodules were selected from November 2019 to April 2020 in our hospital.The 2D-SWE exam-ination quantitative parameters,including maximum elasticity(E_(max)),mean elasticity(E_(mean)),and elasticity ratio(E_(ratio)),were obtained,and the traditional Breast Imaging Reporting And Data System(BI-RADS)classification was optimized according to the optimal cutoff values.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were compared before and after optimization.The relationship between the quantitative parameters(E_(max),E_(mean)and E_(ratio))of 2D-SWE and the prognostic factors of breast cancer and their predictive ability was analyzed.Results The quantitative parameters(E_(max),E_(mean)and E_(ratio))of 2D-SWE were significantly different in dif-ferentiating benign and malignant breast tumors(all P<0.05).E_(max)showed the highest diagnostic efficiency(AUC=0.943,optimal cutoff val-ue=55.13 kPa).After correcting BI-RADS category with E_(max)optimal cutoff value,the sensitivity(95.3%vs 87.1%),specificity(88.9%vs 63.6%),accuracy(91.8%vs 74.5%),negative predictive value(95.7%vs 85.1%)and positive predictive value(88.0%vs 67.3%)were all significantly improved(all P<0.05).The correlation and prediction analysis of 2D-SWE quantitative parameters and prognostic factors in 85 cases of breast malignant nodules showed that E_(max),E_(mean)and E_(ratio)in the positive axillary lymph node metastasis group were higher than those in the negative axillary lymph node metastasis group,and the differences were all statistically significant(all P<0.05).E_(ratio)of gradeⅢgroup was higher than those of gradeⅠand gradeⅡgroups,and the differences were both statistically significant(both P<0.05).There were no s

关 键 词：乳腺肿瘤 剪切波弹性成像 预后 

分 类 号：R737.9[医药卫生—肿瘤]