二维超声、剪切波弹性成像联合超声造影对Ⅰ期乳腺癌的诊断价值  

Value of Two Dimensional Ultrasound,Shear-Wave Elastic Imaging Combined with Contrast-Enhanced Ultrasound in Diagnosis of StageⅠBreast Cancer

作　　者：郭永丽 闫瑞芳[1] 李冉 郭丽娟[2] 范会军 袁红昌 GUO Yongli;YAN Ruifang;LI Ran;GUO Lijuan;FAN Huijun;YUAN Hongchang(Department of Magnetic Resonance,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China;Department of Ultrasonic Medicinethe First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China;Office of Clinical Pharmacist,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院磁共振科,河南新乡453100 [2]新乡医学院第一附属医院超声医学科,河南新乡453100 [3]新乡医学院第一附属医院临床药师办公室,河南新乡453100

出　　处：《河南医学研究》2025年第3期515-519,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划项目(LHGJ20200519)。

摘　　要：目的探讨二维超声(2D-US)、剪切波弹性成像(SWE)、超声造影(CEUS)及三者联合对Ⅰ期(T_(1)N0M0)乳腺癌的诊断价值。方法回顾性分析161例(共有177个病灶,其中良性136个,恶性41个)乳腺病变患者的2D-US、SWE和CEUS的影像资料,以病理结果为金标准,计算2D-US和CEUS诊断敏感度、特异度、准确度、阴性预测值(NPV)及阳性预测值(PPV),比较良、恶性病变间E_(max),E_(mean)和E_(min)值,并利用逻辑回归分析进行联合诊断。受试者工作特征(ROC)曲线和Delong检验被用于评估不同方法诊断效能及彼此间的差异。结果2D-US的诊断敏感度87.80%,特异度77.21%,准确度79.66%,PPV 53.73%,NPV 95.45%;SWE的诊断敏感度63.41%,特异度89.71%,准确度83.61%,PPV 65.00%,NPV 89.05%,CEUS的诊断敏感度为92.68%,特异度为79.41%,准确度为82.49%,PPV为57.56%,NPV为97.30%;三者联合的诊断敏感度95.12%,特异度79.41%,准确度83.05%,PPV 58.21%,NPV 98.18%。Delong分析显示三者联合的诊断效能[曲线下面积(AUC)=0.935]较2D-US(AUC=0.825)、SWE(AUC=0.802)和CEUS(AUC=0.860)显著增大(Z=4.271,3.312和4.274,P<0.001)。结论2D-US、SWE和CEUS均可用于Ⅰ期乳腺癌的诊断,且三者联合的诊断效能较单一技术显著提高。Objective To investigate the diagnostic value of two-dimensional ultrasound(2D-US),shear-wave elastography(SWE),contrast-enhanced ultrasound(CEUS)and the combination of all three for stage I(T_(1)N 0M 0)breast cancer.Methods Imaging data of 2D-US,SWE and CEUS of 161 patients(a total of 177 lesions,including 136 benign and 41 malignant)with breast lesions were retrospectively analysed,and pathological findings were used as the gold standard to calculate the diagnostic sensitivity,specificity,accuracy,negative predictive value(NPV)and positive predictive value(PPV)of 2D-US and CEUS,and to compare the values of E_(max),E_(mean)and E_(min)between benign and malignant lesions,as well as to carry out a joint diagnosis using logistic regression analysis.The receiver operating characteristic curve(ROC)and the Delong test were used to assess the diagnostic efficacy of the different methods and the differences between them.Results 2D-US had a diagnostic sensitivity of 87.80%,a specificity of 77.21%,an accuracy of 79.66%,a PPV of 53.73%,and an NPV of 95.45%.SWE had a diagnostic sensitivity of 63.41%,a specificity of 89.71%,an accuracy of 83.61%,a PPV of 65.00%,and an NPV of 89.05%;and CEUS had a diagnostic sensitivity of 92.68%,specificity 79.41%,accuracy 82.49%,PPV 57.56%,and NPV 97.30%;and the diagnostic sensitivity of the combination of the three was 95.12%,specificity 79.41%,accuracy 83.05%,PPV 58.21%,and NPV 98.18%.Delong analysis showed that the diagnostic efficacy of the combination of the three[area under the curve(AUC)=0.935]was significantly greater than that of 2D-US(AUC=0.825),SWE(AUC=0.802),and CEUS(AUC=0.860)(Z=4.271,3.312,and 4.274,P<0.001).Conclusion 2D-US,SWE and CEUS can all be used for the diagnosis of stageⅠbreast cancer,and the diagnostic efficacy of the combination of all three is significantly improved over a single technique.

关 键 词：Ⅰ期乳腺癌 剪切波弹性成像 超声造影 二维超声 

分 类 号：R445[医药卫生—影像医学与核医学]