超声造影在乳腺恶性病变诊断中的价值探讨及影响因素分析  

The value of contrast-enhanced ultrasound in the diagnosis of malignant breast lesions and analysis of its influencing factors

作　　者：李慧敏[1] 李金莲[1] 古红云 赖仕峰 LI Huimin;LI Jinlian;GU Hongyun;LAI Shifeng(Department of Ultrasound,the People’s Hospital of Jianyang City,Jianyang,Sichuan 641400,China)

机构地区：[1]简阳市人民医院超声科,四川简阳641400

出　　处：《中国优生与遗传杂志》2023年第2期350-354,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的探究超声造影(CEUS)在乳腺恶性病变诊断中的价值及影响因素。方法回顾性分析2018年1月至2021年2月在简阳市人民医院收治的乳腺病变患者(126例)的临床资料。以病理检查为金标准,对CEUS进行诊断效能、影像表现以及诊断结果一致性分析。Logistic回归分析影响CEUS局限性的相关因素,绘制森林图并进行模型评价。结果CEUS检查结果显示,乳腺良性病变的假阳性率(27.03%)显著高于乳腺恶性病变的假阴性率(11.54%)(P<0.05)。CEUS的诊断灵敏度、特异度和准确度分别为88.46%、72.97%和79.37%,其诊断效能较高。Logistic回归分析结果显示:年龄≤45岁、病变最大直径(LMD)≤10mm、病变到乳头距离(DtP)≤20mm以及高危病变均是CEUS诊断错误的独立危险因素(P<0.05)。预测模型的受试者操作特征(ROC)曲线的曲线下面积(AUC)、灵敏度和特异度分别为0.885(95%CI:0.832~0.943,P<0.01)、0.816和0.755,表明模型的区分度较好。预测模型的内部数据验证结果显示,预测情况与实际情况一致性良好。临床决策曲线(DCA)显示阈值概率在(0.01~0.90)时,净获益率>0,表明模型的精准度较好。结论CEUS诊断乳腺癌恶性病变的效能较高,但存在一定的局限性,CEUS诊断乳腺癌良性病变的假阳性率较诊断恶性病变的假阴性率高,CEUS的错误诊断与患者年龄、DtP、病变大小以及病理类型密切相关,临床检查时需注意合理应用。Objective To explore the value and influencing factors of contrast-enhanced ultrasound(CEUS)in the diagnosis of malignant breast lesions.Methods The clinical data of patients with breast lesions(126 cases)admitted to the People’s Hospital of Jianyang City from January 2018 to February 2021 were retrospectively analyzed.Pathological examination was used as the gold standard to analyze the diagnostic efficiency,imaging performance and consistency of diagnostic results of CEUS.Logistic regression was used to analyze the relevant factors affecting the limitations of CEUS,and forest plots were drawn to evaluate the models.Results CEUS examination results showed that the false positive rate of benign breast lesions(27.03%)was significantly higher than that of malignant breast lesions(11.54%)(P<0.05).The diagnostic sensitivity,specificity and accuracy of CEUS were 88.46%,72.97% and 79.37%,respectively,and its diagnostic efficiency was high.The results of Logistic regression analysis showed that:Age≤45 years old,lesion maximum diameter(LMD)≤10 mm,distance to the papilla(DtP)≤20 mm and high-risk lesions were independent risk factors for false-positive breast cancer diagnosis by CEUS(P<0.05).The area under curve(AUC),sensitivity and specificity of the receiver operating characteristic curve(ROC)of the prediction model were 0.885(95%CI:0.832-0.943,P<0.01),0.816 and 0.755,respectively,indicating that the model has good discrimination.The results of internal data validation of the forecast model show that the forecast is in good agreement with the actual situation.The decision curve analysis(DCA)shows that when the threshold probability is(0.01-0.90),the net benefit rate is>0,indicating that the accuracy of the model is better.Conclusion CEUS has high efficacy in diagnosing malignant breast cancer lesions,but it has certain limitations,and the false-positive rate of CEUS in diagnosing benign breast cancer is higher than that in diagnosing malignant lesions,and the misdiagnosis of CEUS is closely related to the patient

关 键 词：超声造影 乳腺癌 良性病变 恶性病变 局限性 

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]