超微血管成像、超声弹性成像联合高频超声在微小乳腺癌中的诊断价值及相关高危超声特征的筛选

doi:10.16150/j.1671-2870.2020.04.013

诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (04): 391-396.doi: 10.16150/j.1671-2870.2020.04.013

超微血管成像、超声弹性成像联合高频超声在微小乳腺癌中的诊断价值及相关高危超声特征的筛选

卢叶君^a, 陈卉^a(), 张剑^a, 徐斌^b, 王冲^a, 贺烨^a

苏州大学附属第三医院 a. 超声科,b. 肿瘤生物诊疗中心,江苏常州 213000

收稿日期:2020-03-03 出版日期:2020-08-25 发布日期:2022-07-15
通讯作者: 陈卉 E-mail:chenhui9138@163.com
基金资助:
常州市卫生计生委青年人才科技项目(QN20 1705)

Superb microvascular imaging in combination with ultrasonic elastography and high-frequency ultrasound in micro breast cancer:an assessment on the diagnostic efficacy and screening for high-risk features on ultrasound

LU Yejun^a, CHEN Hui^a(), ZHANG Jian^a, XU Bin^b, WANG Chong^a, HE Ye^a

a. Department of Ultrasound, b. Department of Tumor Biotherapy, The Third Affiliated Hospital of Suzhou University, Jiangsu Changzhou 213000, China

Received:2020-03-03 Online:2020-08-25 Published:2022-07-15
Contact: CHEN Hui E-mail:chenhui9138@163.com

摘要/Abstract

摘要：

目的： 分析超微血管成像（superb microvascular imaging,SMI）、超声弹性成像（ultrasounic elastography,UE）联合高频超声检查在微小乳腺癌诊断中的价值,并筛选相关的高危超声特征。方法： 选取乳腺影像报告和数据系统（Breast Imaging Reporting and Data System,BI-RADS）分类为4类的乳腺微小病灶（最大径≤1 cm）87个,病灶来自85例患者。根据术后病理结果将其分为良性组和恶性组,分析2组间病灶的灰阶超声特征、彩色多普勒血流图(color Doppler flow imaging,CDFI）特征、SMI分级及弹性评分,筛选微小乳腺癌的高危超声特征。结果： 单因素分析显示,乳腺微小病灶良性组与恶性组间的病灶形态、边缘、钙化情况、弹性评分、SMI及CDFI分级方面差异有统计学意义（P<0.05）;多因素Logistic回归分析显示,病灶边缘不光整、弹性评分≥4分及SMI的Adler分级≥Ⅱ级是预测微小乳腺癌的独立影响因素,而三者联合诊断微小乳腺癌准确率最高（81.61%）。结论： SMI检查显示Adler分级≥Ⅱ级及弹性评分≥4分是诊断微小乳腺癌的高危超声特征,两者与病灶边缘不光整的超声特征联合时诊断的效能较高,可为临床提供重要的影像学依据。

关键词: 微小乳腺癌, 超微血管成像, 弹性评分, 乳腺影像报告和数据系统

Abstract:

Objective: To analyze the diagnostic value of superb microvascular imaging (SMI) in combination with ultrasonic elastography (UE) and high-frequency ultrasonography on micro breast cancer and screening for high-risk features on ultrasound. Methods: A total of 87 breast lesions from 85 patients were collected. The maximum diameters of the lesions were no more than 1 cm,and all lesions were classified as BI-RADS （Breast Imaging Reporting and Data System） 4. The lesions were grouped into benign and malignant groups based on results of postoperative pathology. The characteristics of grey-scale ultrasound and color Doppler flow imaging(CDFI), SMI and elasticity scores of the lesions were compared between 2 groups and high-risk features on ultrasound for micro breast cancer were screened. Results: Univariate analysis showed that lesion morphology, margin, calcification status, elasticity score, SMI and CDFI classification were statistically different between benign and malignant groups (P<0.05). Multivariate Logistic regression analysis revealed that lesions with ill-defined margin, elasticity score ≥4 or Adler scale of SMI ≥Ⅱ were independently predicting factors for micro breast cancer. The accuracy of combining the three indices for diagnosing micro breast cancer was 81.61%, higher than any single one. Conclusions: High-risk features of micro breast cancer on ultrasound include Adler scale SMI≥Ⅱ and elasticity score ≥4. Both features in combination with ill-defined margin show good diagnostic efficiency for micro breast cancer, which may provide an important reference for clinical diagnosis.

Key words: Micro breast cancer, Superb microvascular imaging, Elasticity score, Breast Imaging Reporting and Data System

中图分类号:

R737.7

卢叶君, 陈卉, 张剑, 徐斌, 王冲, 贺烨. 超微血管成像、超声弹性成像联合高频超声在微小乳腺癌中的诊断价值及相关高危超声特征的筛选[J]. 诊断学理论与实践, 2020, 19(04): 391-396.

LU Yejun, CHEN Hui, ZHANG Jian, XU Bin, WANG Chong, HE Ye. Superb microvascular imaging in combination with ultrasonic elastography and high-frequency ultrasound in micro breast cancer:an assessment on the diagnostic efficacy and screening for high-risk features on ultrasound[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(04): 391-396.

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参考文献 22

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超声特征参数	灵敏度	特异度	阳性预测值	阴性预测值	准确率
纵横比≥1	46.34	71.74	59.38	60.00	59.77
形态不规则	80.49	39.13	54.10	69.23	58.62
边缘不光整	73.17	58.70	61.22	71.05	65.52
钙化	56.10	65.22	58.97	62.50	60.92
弹性评分≥4分	63.41	89.13	83.87	73.21	77.01
Adler（CDFI）≥Ⅰ级	78.05	54.35	60.38	73.53	65.52
Adler(SMI)≥Ⅱ级	78.05	69.57	69.57	78.05	73.56

超声特征参数	偏回归系数	Wald χ²	OR(95%CI)	P值
边缘不光整	0.955	2.723	2.598(0.836~8.075)	0.099
弹性评分≥4分	2.509	14.537	12.296(3.385~44.662)	<0.001
Adler(SMI)≥Ⅱ级	2.013	11.359	7.489(2.322~24.151)	0.001

超微血管成像、超声弹性成像联合高频超声在微小乳腺癌中的诊断价值及相关高危超声特征的筛选

Superb microvascular imaging in combination with ultrasonic elastography and high-frequency ultrasound in micro breast cancer:an assessment on the diagnostic efficacy and screening for high-risk features on ultrasound

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超声特征	病理诊断			χ²值	P值
超声特征	良性	恶性	个	χ²值	P值
纵横比				3.048	0.081
<1	33	22	55
≥1	13	19	32
形态				3.982	0.046
规则	18	8	26
不规则	28	33	61
边缘				8.948	0.003
光整	27	11	38
不光整	19	30	49
钙化				3.982	0.046
无	30	18	48
有	16	23	39
弹性评分				26.096	<0.001
<4分	41	15	56
≥4分	5	26	31
Adler（CDFI）				9.557	0.002
<Ⅰ级	25	9	34
≥Ⅰ级	21	32	53
Adler(SMI)				19.724	<0.001
<Ⅰ级	32	9	41
≥Ⅱ级	14	32	46