Value of combined application of ultrasound elastography, color Doppler blood flow imaging and contrast-enhanced ultrasound in differential diagnosis of breast occupying lesions
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摘要:目的
探讨超声弹性成像(UE)、彩色多普勒血流显像(CDFI)及超声造影(CEUS)技术联合应用对乳腺占位性病变的鉴别诊断价值。
方法回顾性选取2022年1—12月收治的乳腺占位性病变患者95例，病灶数量共113个。治疗前对患者行UE、CDFI和CEUS检查; 对影像学图像进行分析，以病理检查为“金标准”，分析其诊断准确率; 采用受试者工作特征(ROC)曲线分析UE、CDFI和CEUS单独和联合检查对乳腺占位性病变的鉴别效能。
结果对95例乳腺占位性病变患者行病理组织活检，有38例患者存在共48个恶性结节, 57例患者无恶性结节。根据病理检查结果将患者分为恶性组和良性组。相较于良性组，恶性组患者的结节数量更多，最大肿瘤直径更大，差异有统计学意义(P < 0.05)。采用UE诊断出恶性病变52个，良性病变61个; 采用CDFI诊断出恶性病变62个，良性病变51个; 采用CEUS诊断出恶性病变57个，良性病变56个; 3种方法联合诊断出恶性病变56个，良性病变57个。CEUS对乳腺占位性病变的诊断灵敏度、特异度、准确率、阳性预测值以及阴性预测值均高于UE和CDFI, 指标联合诊断效能最高，差异有统计学意义(P < 0.05)。UE、CDFI和CEUS诊断乳腺占位性病变的曲线下面积(AUC)分别为0.750、0.639和0.840; Delong检验结果发现，联合诊断效能显著高于CDFI(Z=4.15, P < 0.01)、UE(Z=3.81, P < 0.01)、CEUS(Z=2.68, P=0.02), CEUS诊断效能显著高于CDFI(Z=3.17, P < 0.01)、UE(Z=2.31, P=0.02), UE诊断效能显著高于CDFI(Z=2.05, P=0.04)。
结论UE、CDFI和CEUS对于乳腺占位性病变的良恶性均有较高的鉴别诊断价值，且UE、CDFI和CEUS联合诊断的灵敏度和特异度均高于单独诊断。
Abstract:ObjectiveTo explore the value of combined application of ultrasound elastography (UE), color Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of breast occupying lesions.
MethodsA total of 95 patients with breast occupying lesions from January to December 2022 were retrospectively selected, with 113 lesions in total. Before treatment, UE, CDFI and CEUS examinations were performed for the patients; the images were analyzed, and pathological examination was used as the "gold standard" to analyze diagnostic accuracy of images; the receiver operating characteristic (ROC) curve was used to analyze the differential efficiencies of UE, CDFI, and CEUS examinations alone and their combination for breast occupying lesions.
ResultsPathological tissue biopsies were performed in 95 patients with breast occupying diseases, and 38 patients had 48 malignant nodules, while 57 patients had no malignant nodules. According to the pathological examination results, the patients were divided into malignant group and benign group. Compared with the benign group, the malignant group had more nodules and larger diameter of the largest tumor, and the difference were statistically significant (P < 0.05). A total of 52 malignant lesions and 61 benign lesions were diagnosed by UE; 62 malignant lesions and 51 benign lesions were diagnosed by CDFI; 57 malignant lesions and 56 benign lesions were diagnosed by CEUS; 56 malignant lesions and 57 benign lesions were diagnosed by the combination of the three methods. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in the diagnosis of breast occupying lesions were significantly higher than those of UE and CDFI, and the diagnostic efficacy of the three methods in combination was the highest (P < 0.05). The area under the curve (AUC) of UE, CDFI and CEUS for diagnosis of breast occupying lesions was 0.750, 0.639 and 0.840 respectively; the Delong test results showed that the combined diagnostic efficiency was significantly higher than CDFI (Z=4.15, P < 0.01), UE (Z=3.81, P < 0.01) and CEUS (Z=2.68, P=0.02), diagnostic efficiency of CEUS was significantly higher than that of CDFI (Z=3.17, P < 0.01) and UE (Z=2.31, P=0.02), and diagnostic efficiency of UE was significantly higher than that of CDFI (Z=2.05, P=0.04).
ConclusionUE, CDFI and CEUS have high differential diagnostic value for benign and malignant breast occupying lesions, and the sensitivity and specificity of the combined diagnosis of UE, CDFI and CEUS are higher than those of individual diagnosis.
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表 1 2组一般资料比较(x±s)
一般资料 恶性组(n=38) 良性组(n=57) 年龄/岁 44.63±5.73 46.31±5.89 体质量指数/(kg/m2) 23.49±3.14 23.24±3.02 结节数量/个 1.26±0.19* 1.14±0.14 最大肿瘤直径/cm 1.57±0.29* 1.45±0.20 与良性组比较, * P < 0.05。 
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表 2 UE、CDFI和CEUS对乳腺占位性病变的诊断结果
检查方式 检查结果 金标准 合计 恶性 良性 UE 恶性 36 16 52 良性 12 49 61 CDFI 恶性 34 28 62 良性 14 37 51 CEUS 恶性 43 14 57 良性 5 51 56 3个指标联合 恶性 45 11 56 良性 3 54 57
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表 3 UE、CDFI和CEUS对乳腺占位性病变的诊断效能
项目 灵敏度/% 特异度/% 准确率/% 阳性预测值/% 阴性预测值/% UE 75.00(36/48) 75.38(49/65) 75.22(85/113) 69.23(36/52) 80.33(49/61) CDFI 70.83(34/48) 56.92(37/65) 62.83(71/113) 54.84(34/62) 72.55(37/51) CEUS 89.58(43/48) 78.46(51/65) 83.18(94/113) 75.43(43/57) 91.07(51/56) 3个指标联合 93.75(45/48) 83.08(54/65) 87.61(99/113) 80.35(45/56) 94.74(54/57) χ2 12.15 13.16 25.29 10.37 13.02 P 0.01 < 0.01 < 0.01 0.02 < 0.01
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表 4 UE、CDFI和CEUS诊断乳腺占位性病变的ROC曲线指标
指标 AUC 95%CI 灵敏度/% 特异度/% P CDFI 0.639 0.536~0.742 70.83 56.92 0.01 UE 0.752 0.658~0.845 75.00 75.38 < 0.01 CEUS 0.840 0.763~0.918 89.58 78.46 < 0.01 联合诊断 0.884 0.817~0.951 93.75 83.08 < 0.01
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