声触诊组织量化成像联合超声造影预测T1期乳腺癌腋窝淋巴结转移负荷的临床价值  

Clinical value of virtual touch tissue imaging quantification combined with contrast-enhanced ultrasound for predicting axillary lymph node metastasis load in T1 stage breast cancer

作　　者：陈庆庆 傅晓红[1] 胡姣姣 余小情 余炜佺 沈燕[1] CHEN Qingqing;FU Xiaohong;HU Jiaojiao;YU Xiaoqing;YU Weiquan;SHEN Yan(Department of Ultrasound,Gongli Hospital of Shanghai Pudong New Area,219 Miao Pu Road,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院超声科,200135

出　　处：《临床超声医学杂志》2024年第11期913-920,共8页Journal of Clinical Ultrasound in Medicine

基　　金：上海市卫健委面上项目(202040164);上海市浦东新区卫健委重点专科项目(PWZzk2022-18);上海市浦东新区公利医院青年基金项目(2024YQNJJ-11)。

摘　　要：目的 探讨声触诊组织量化成像(VTIQ)联合超声造影(CEUS)预测 T1期乳腺癌腋窝淋巴结转移(ALNM)负荷的临床价值并构建列线图,为临床个性化诊疗提供参考。方法 选取我院经病理证实的 167例 T1期乳腺癌患者,共175个肿块,依据美国外科医师学会肿瘤学组(ACOSOG)Z0011试验结果分为高负荷组(>2个ALNM)20个,低负荷组(≤2个ALNM)155 个,应用 VTIQ 获取剪切波速度最大值、最小值、平均值(SWVmax、SWVmin、SWVmean)及弹性成像(EI)评分,CEUS 获取达峰时间(TTP)、达峰强度(PI)、增强强度、增强模式、增强后范围变化、有无穿支血管征或充盈缺损征,比较两组上述参数及图像特征的差异。通过单因素、多因素 Logistic 回归分析筛选 T1期乳腺癌 ALNM 负荷的独立预测因素,以此构建列线图模型。绘制受试者工作特征(ROC)曲线评估模型的区分度,同时进行 Bootstrap1000次抽样验证;绘制校准曲线评估模型的校准度,采用 Hosmer-Lemeshow 检验评估模型的拟合度;绘制临床决策曲线评估模型的临床适用性。结果 VTIQ 检查结果显示,高负荷组 SWVmax、SWVmin、SWVmean 及 EI 评分≥4 分占比均较低负荷组高,差异均有统计学意义(均 P<0.05)。CEUS检查结果显示,与低负荷组比较,高负荷组 PI更大,TTP更短,高增强、增强后范围增大≥20%、充盈缺损征及穿支血管征占比均更高,差异均有统计学意义(均 P<0.05);两组增强模式比较差异无统计学意义。单因素 Logistic回归分析显示,SWVmax、SWVmin、SWVmean、EI评分、TTP、PI、增强强度、增强后范围变化、穿支血管征及充盈缺损征均为 T1期乳腺癌 ALNM 负荷的预测因素(均 P<0.05);多因素 Logistic 回归分析显示,SWVmax、穿支血管征及充盈缺损征均为 T1期乳腺癌 ALNM 负荷的独立预测因素(OR=2.749,14.794,10.206,均 P<0.05),基于此构建列线图模型。ROC 曲线分析显示,当列线图模型截断值为 0.171 时,预测 T1期乳腺�Objective To explore the clinical value of virtual touch tissue imaging quantification(VTIQ)combined with contrast-enhanced ultrasound(CEUS)for predicting axillary lymph node metastasis(ALNM)load in T1 stage breast cancer,and to construct a nomogram to guide personalized treatment.Methods A total 167 patients with T1 stage breast cancer who confirmed by pathology were selected(totally 175 tumors).According to American College of Surgeons Oncology Group(ACOSOG)Z0011 trial,patients were divided into a high-load group(>2 ALNMs,n=20)and a low burden group(≤2 ALNMs,n=155).VTIQ was used to obtain maximum,minimum and mean shear wave velocity(SWVmax,SWVmin,SWVmean),and elastography(EI)score.CEUS was used to obtain time-to-peak(TTP),peak intensity(PI),enhancement intensity,enhancement pattern,post-contrast volume change,and the presence of penetrating vessels or filling defects signs.The differences of above parameters and imaging features between the two groups were analyzed.Univariate and multivariate Logistic regression analysis were used to identify independent predictive factors for ALNM load,and a nomogram model was established.Receiver operating characteristic(ROC)curve was drawn to evaluate differentiation of the model,and the constructed nomogram was validated with 1000 Bootstrap resamples.Calibration curve was drawn to evaluate the calibration degree of the model,and the Hosmer-Lemeshow test was used to evaluate the fitting degree of the model.Clinical decision curve was drawn to evaluate clinical applicability of the model.Results VTIQ results showed that the SWVmax,SWVmin,SWVmean and the proportion of EI score≥4 in the high-load group were significantly higher than those in the low-load group(all P<0.05).CEUS results showed that compared with the low-load group,the high-load group had a larger PI,shorter TTP,higher enhancement on CEUS,post-enhancement volume increase≥20%,and a higher proportion of filling defects sign and penetrating vessels sign(all P<0.05).There was no statistically significant differe

关 键 词：超声检查 造影剂 声触诊组织量化成像 乳腺癌 腋窝淋巴结转移 列线图 

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]