多模态超声鉴别非肿块型乳腺原位癌与浸润癌的临床价值  

Clinical value of multimodal ultrasound in differentiating non-mass breast carcinoma in situ from invasive carcinoma

作　　者：谢芸 何佳丽 骆韵青 XIE Yun;HE Jiali;LUO Yunqing(Department of Ultrasound,Fuyang District Hospital of Traditional Chinese Medicine,Hangzhou 311400,China)

机构地区：[1]杭州市富阳区中医院超声科,311400

出　　处：《临床超声医学杂志》2023年第2期148-152,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨多模态超声在鉴别非肿块型乳腺原位癌与浸润癌中的临床价值。方法选取我院经手术病理确诊的单侧非肿块型乳腺癌患者52例,共59个病灶,其中原位癌31个,浸润癌28个;应用单因素分析二者常规超声、超声造影、超声弹性成像特征,将单因素分析中差异有统计学意义的超声特征纳入Logistic回归分析筛选相关影响因素,并建立Logistic回归模型。绘制受试者工作特征(ROC)曲线分析Logistic回归模型鉴别非肿块型乳腺原位癌与浸润癌的诊断效能。结果非肿块型乳腺原位癌与浸润癌病灶最大径、方位、形态、后方回声、边缘、淋巴结形态、微钙化、血流分级,造影后有无放射性增强或穿入血管及片状低回声区范围变化、形态、边界、增强水平,以及弹性成像评分比较差异均有统计学意义(均P<0.05)。Logistic回归分析显示,病灶边缘不光整、非平行位、微钙化、血流分级(Ⅱ/Ⅲ级)、造影后片状低回声区范围扩大及放射性增强或穿入血管、弹性成像评分4~5分是鉴别非肿块型乳腺原位癌与浸润癌的影响因素(OR=14.749、3.750、8.849、3.156、8.301、6.467、5.468,均P<0.05)。建立多模态超声诊断模型:Logit(P)=-18.544+边缘不光整×2.691+非平行位×1.321+微钙化×2.185+血流分级(Ⅱ/Ⅲ级)×1.152+造影后放射性增强或穿入血管×1.868+造影后片状低回声区范围扩大×2.118+弹性成像评分(4~5分)×1.698。多模态超声诊断模型鉴别非肿块型乳腺原位癌与浸润癌的灵敏度、特异度、准确率、曲线下面积分别为84.5%、73.5%、86.4%、0.836。结论多模态超声在鉴别非肿块型乳腺原位癌与浸润癌中有一定的临床价值。Objective To explore the clinical value of multimodal ultrasound in differentiating non-mass breast carcinoma in situ from invasive carcinoma.Methods Fifty-two patients with unilateral non-mass breast cancer diagnosed surgically and pathologically in our hospital were selected,with a total of 59 lesions,including 31 lesions of carcinoma in situ and 28 lesions of invasive carcinoma.The characteristics of multi-modal ultrasound,such as conventional ultrasound,contrastenhanced ultrasound and ultrasonic elastic imaging were analyzed by univariate analysis.The factors with significant differences were screened by Logistic regression analysis,and the Logistic regression model was established.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of Logistic regression model in differentiating non-mass breast carcinoma in situ from invasive carcinoma.Results The maximum diameter,orientation,shape,posterior echo,margin,lymph node shape,microcalcification,blood flow grading in conventional ultrasound,changes in the range of lamellar hypoechoic area,radioaction enhancement and penetrated blood vessels,shape,boundary,enhancement level in contrastenhanced ultrasound,and the score of elastography were significantly different between non-mass breast carcinoma in situ and invasive carcinoma(all P<0.05).Logistic regression analysis showed that irregular edge of the lesion,non-parallel position,microcalcification,blood flow grading(gradeⅡ/Ⅲ),expansion of the lamellar hypoechoic area,radiation enhancement and penetrated blood vessels and the score of elastography(4~5 points)were the influence factors in differentiating non-mass breast carcinoma in situ from invasive carcinoma(OR=14.749,3.750,8.849,3.156,8.301,6.467,5.468,all P<0.05).Logistic regression model was established:Logit(P)=-18.544+irregular edge×2.691+non-parallel position×1.321+microcalcification×2.185+blood flow grading(gradeⅡ/Ⅲ)×1.152+radiation enhancement and penetrated blood vessels×1.868+expansion of the lamellar hypoe

关 键 词：超声检查 浸润癌 原位癌 乳腺肿瘤 恶性 非肿块型 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]