多模态超声预测乳腺癌腋窝淋巴结转移的价值  

Value of multimodal ultrasound for predicting axillary lymph node metastasis of breast cancer

作　　者：成静[1] 李文肖[1] 吴芳[1] 曹春莉 侯吉学[1] 李军[1] CHENG Jing;LI Wen-xiao;WU Fang(Department of Ultrasound,the First Affiliated Hospital of Medical College of Shihezi University,Xinjiang 832008,China)

机构地区：[1]石河子大学医学院第一附属医院超声科,新疆832008

出　　处：《放射学实践》2023年第11期1447-1451,共5页Radiologic Practice

基　　金：石河子大学科研课题项目(ZZZC201955A);国家自然科学基金项目(82060318、81860498、81560433、82260105);石河子大学第一附属医院青年基金项目(QN202126)。

摘　　要：目的:探讨乳腺癌原发病灶的常规超声(CUS)、声触诊组织量化成像技术(VTIQ)、声辐射力成像(VTI)及超声造影(CEUS)特征参数在术前评估乳腺癌腋窝淋巴结转移中的临床价值。方法:收集2018年1月-2021年12月本院的乳腺癌患者,共91例患者94个病灶。所有患者术前均行CUS、VTIQ、VTI、CEUS检查,术后完善病理结果。根据术后病理结果分为腋窝淋巴结转移组与未转移组,通过单因素及多因素筛选出有意义的超声特征参数,建立Logistic预测模型,并对模型进行一致性检验。结果:多因素分析筛选出有意义的超声特征参数为Alder血流分级、增强速度、最大剪切波速度(SWV_(max)),曲线下面积(AUC)分别为0.690(95%CI:0.568~0.795)、0.643(95%CI:0.520~0.754)、0.681(95%CI:0.559~0.788)。基于以上三个超声特征参数建立预测模型方程Y=-6.903+2.100×Alder血流分级+1.790×增强速度+0.423×SWV_(max),该预测模型AUC为0.814(95%CI:0.703~0.897),敏感度为82.76%,特异度为78.05%。一致性检验(Kappa=0.625,P=0.002),预测模型与病理结果检验中高度一致。结论:CUS、VTIQ联合CEUS检查对乳腺癌腋窝淋巴结转移具有较高的预测价值,可为乳腺癌术前腋窝淋巴结状态的评估提供可靠依据。Objective:To investigate the value of conventional ultrasound(CUS),virtual touch tissue imaging and quantification(VTIQ),virtual touch tissue imaging(VTI)and contrast-enhanced ultrasound(CEUS)in preoperative evaluation of axillary lymph node metastasis in breast cancer.Methods:Totally,91 patients with 94 lesions of breast cancer with pathological results were collected from 2017-11 to 2022-05.All patients performed CUS,VTIQ,VTI and CEUS examination before operation.According to the postoperative pathological results,the patients were divided into axillary lymph node metastatic group and non-metastatic group.The significant ultrasonic characteristic parameters were screened through single factor and multiple factors,and the logistic prediction model was established.Results:The significant parameters were Alder blood flow classification,enhancement velocity,max shear wave velocity(SWV_(max)),areas under curve(AUC)were 0.690(95%CI:0.568~0.795),0.643(95%CI:0.520~0.754),and 0.681(95%CI:0.559~0.788),respectively.Combining the above three parameters to establish the prediction model equation Y=-6.903+2.100×Alder blood flow grade+1.790×Increase Speed+0.423×SWV_(max),the AUC,sensitivity,and specificity is 0.814(95%CI:0.703~0.897),82.76%,and 78.05%,respectively.The consistency test(Kappa=0.625,P=0.002)showed high consistency between the prediction model and pathological results.Conclusion:CUS,VTIQ combined with CEUS can improve the diagnostic efficacy of axillary lymph node metastasis in breast cancer,and provide a reliable basis for preoperative evaluation of axillary lymph nodes in breast cancer.

关 键 词：乳腺肿瘤 腋窝淋巴结 声触诊组织量化成像技术 声辐射力成像 超声造影 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]