乳腺超声背景类型对妊娠相关性乳腺癌诊断效能的影响  

Effect of breast ultrasound background echotextures on diagnostic efficiency of pregnancy-associated breast cancer

作　　者：张悦 陈雅玲 马林晓曦[2,3] 高毅 刘隽颖 常才[1,2] Zhang Yue;Chen Yaling;Ma Linxiaoxi;Gao Yi;Liu Junying;Chang Cai(Department of Ultrasound,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Breast Surgery,Fudan University Shanghai Cancer Center,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院超声科,上海200032 [2]复旦大学上海医学院肿瘤学系,上海200032 [3]复旦大学附属肿瘤医院乳腺外科,上海200032

出　　处：《中华超声影像学杂志》2024年第3期223-228,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82202160);上海市卫生健康委员会科研项目(202240046)。

摘　　要：目的探索不同乳腺超声背景类型下妊娠相关性乳腺癌(PABC)的超声诊断效能。方法回顾性分析2016年1月至2023年9月于复旦大学附属肿瘤医院行乳腺外科手术、且发病时处于妊娠期或产后1年内的269例女性乳腺疾病患者的乳腺超声图像。对腺体背景作两种分型:第一种分型方法分为均匀脂肪背景、均匀纤维腺体背景和不均匀背景;第二种分型方法分为低回声为主背景和高回声为主背景。采用ROC曲线下面积(AUC)比较不同背景下超声对PABC的诊断价值。结果269例患者中,妊娠期67例(24.91%),哺乳期202例(75.09%)。最终术后病理结果良性47例(17.47%),恶性222例(82.53%)。术前乳腺超声背景按第一种分型方法,138例均匀纤维腺体背景病例和131例不均匀背景病例,超声诊断PABC的敏感性分别为88.70%、59.81%,特异性分别为91.30%、83.33%,AUC分别为0.940、0.826(P=0.022);按第二种分型方法,119例低回声为主型背景和150例高回声为主型背景,诊断敏感性为60.21%、85.27%,特异性为84.62%、90.48%,AUC为0.826、0.925(P=0.042)。结论乳腺组织的异质背景回声纹理可能降低超声对PABC的诊断效能,低回声为主的背景相较高回声背景更不利于PABC的诊断。Objective To investigate the diagnostic efficacy of ultrasound in pregnancy associated breast cancer(PABC)under different breast ultrasound background echotextures.Methods The ultrasonic images of 269 female patients with breast diseases who underwent breast surgery in Fudan University Shanghai Cancer Center from January 2016 to September 2023 and were pregnant or within one year postpartum at the time of onset were retrospectively reviewed.Breast ultrasound background echotextures were classified according to two criteria:the first classification was homogeneous-fat,homogeneous-fibroglandular,and heterogeneous;the other classification was hypoechoic dominated and hyperechoic dominated.The comparison of the diagnostic value of ultrasound in PABC under different backgrounds was conducted by the receiver operating characteristic(ROC)curves.Results Among 269 patients,67 patients(24.91%)were during pregnancy and 202 patients(75.09%)were within one year postpartum.Pathologically,47 patients(17.47%)were confirmed as benign,222 patients(82.53%)were malignant.According to the first classification,138 patients were homogeneous-fibroglandular and 131 patients were heterogeneous,with the diagnostic sensitivity of ultrasound in PABC were 88.70%and 59.81%respectively,and the specificity were 91.30%and 83.33%respectively,the areas under the ROC curves were 0.940 and 0.826 respectively(P=0.022).According to the second classification,119 were hypoechoic dominated and 150 patients were hyperechoic dominated,the sensitivity were 60.21%and 85.27%respectively,the specificity 84.62%and 90.48%respectively,the areas under the ROC curves were 0.826 and 0.925(P=0.042).Conclusions The heterogeneous background echotextures of the breast may cause decrease of the diagnostic efficiency of ultrasound in PABC,and hypoechoic dominated background was more unfavorable for the diagnosis of PABC compared to the hyperechoic dominated background.

关 键 词：超声检查 妊娠相关性乳腺癌 乳腺 背景回声 

分 类 号：R714.25[医药卫生—妇产科学] R737.9[医药卫生—临床医学]