双能量CT联合超声特征术前诊断乳腺癌淋巴血管侵犯的价值  

Application value of dual-energy CT combined with conventional ultrasonography in the diagnosis of lymphovascular invasion of breast cancer

作　　者：周宝鹤 林桂涵 陈春妙 华芬芬 程雪[1] 周海萍[3] 纪建松[1] ZHOU Baohe;LIN Guihan;CHEN Chunmiao;HUA Fenfen;CHENG Xue;ZHOU Haiping;JI Jiansong(Department of Radiology,Lishui Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院放射科、浙江省影像诊断与介入微创研究重点实验室,323000 [2]丽水市中心医院病理科,323000 [3]丽水市中心医院超声科,323000

出　　处：《浙江医学》2023年第3期256-260,I0005,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2022KY1424);丽水科技局公益性技术应用研究项目(2020GYX17)。

摘　　要：目的探讨双能量CT联合超声特征术前诊断乳腺癌淋巴血管侵犯(LVI)的价值。方法回顾2019年2月至2020年11月丽水市中心医院经病理检查证实的99例浸润性乳腺癌患者病例资料,其中LVI阳性患者41例,LVI阴性58例。所有患者行双能量CT动静脉期胸部增强扫描及超声检查。计算标准化碘浓度(NIC)、标准化有效原子序数(nZeff)、能谱曲线斜率(λ_(Hu)),并记录超声特征。比较两组病灶的NIC、nZeff及λHu,评价双能量定量参数、超声特征的单一诊断及联合诊断的效能。结果LVI阳性与阴性患者超声特征包括肿瘤形状、边界、毛刺征和微小钙化比较差异均有统计学意义(均P<0.05)。LVI阳性组动脉期NIC、nZeff及静脉期NIC、λHu、nZeff均高于LVI阴性组(均P<0.05)。其中当静脉期λHu以3.24为最佳截断值时,诊断效能最高,AUC为0.755,灵敏度为0.707,特异度为0.741。双能量参数、超声特征单一诊断的灵敏度为0.781、0.732,特异度为0.776、0.707,准确度为0.843、0.684。两者联合诊断的灵敏度为0.805,特异度为0.845,准确度为0.869。结论双能量CT在术前评估浸润性乳腺癌淋巴血管侵犯状态具有一定价值,联合超声特征后可进一步提升诊断效能。Objective To investigate the value of dual-energy CT quantitative parameters combined with ultrasound in predicting preoperative lymphovascular invasion(LVI)in breast cancer patients.Methods The case data of 99 patients with pathologically confirmed invasive breast cancer at the Lishui Central Hospital from February 2019 to November 2020 were retrospectively analyzed and classified into 41 LVI-positive patients and 58 LVI-negative patients based on pathological findings.All patients underwent dual-energy CT arteriovenous phase enhanced chest scan and ultrasonography.The normalized iodine concentration(NIC),the normalized effective atomic number(nZeff),the slope of the energy spectrum curve(λ_(Hu))were calculated,and the ultrasonic morphological characteristics were recorded.The NIC,nZeff andλHu of the two groups of lesions were compared,and the efficacy of dual-energy quantitative parameters and ultrasonic morphological features in independent diagnosis and combined diagnosis were evaluated.Results Ultrasound features including tumor shape,border,burr sign and microcalcifications were statistically significant between the two groups(all P<0.05).arterial stage NIC,nZeff and venous stage NIC,λHu,nZeff were higher in the LVI positive group than in the LVI negative group(all P<0.05).Among them,the highest diagnostic efficacy was achieved when the venous phaseλHu was used as the threshold value of 3.24,with an AUC of 0.755,sensitivity of 0.707,and specificity of 0.741.The sensitivity of independent diagnosis of dual energy parameters and ultrasound features was 0.781 and 0.732,the specificity was 0.776 and 0.707,and the accuracy was 0.843 and 0.684.The sensitivity of the combined diagnosis of both was 0.805,the specificity was 0.845,and the accuracy was 0.869.Conclusion Dual-energy CT has a certain value in evaluating the lymphatic invasion status of invasive breast cancer before surgery,and the combination of ultrasound features can further improve the diagnostic performance.

关 键 词：双能量CT 浸润性乳腺癌 淋巴血管侵犯 超声 

分 类 号：R737.9[医药卫生—肿瘤]