应变弹性成像及声触诊组织成像定量技术对肺癌患者颈部淋巴结性质判定的价值

The value of strain elastography and virtual touch tissue image quantification technique in assessing the nature of cervical lymph nodes in patients with lung cancer

目的探讨应变弹性成像(strain elastography,SE)及声触诊组织成像定量(virtual touch tissue image quantification,VTIQ)技术对肺癌患者颈部淋巴结性质判定的价值。方法选取124例肺癌合并颈部淋巴结肿大患者,行淋巴结常规超声检查,应用SE检测淋巴结并评分,VTIQ技术测量剪切波速度(shear wave velocity,SWV)。以病理结果为金标准,将非转移性淋巴结纳入良性组,转移性淋巴结纳入恶性组,绘制受试者操作特征(receiver operating characteristic,ROC)曲线,确定预测恶性淋巴结的SWV最佳截断值,比较SE及VTIQ技术的曲线下面积(area under curve,AUC),分析SE及VTIQ技术对良恶性淋巴结的诊断效能。结果在124例患者中,28例良性淋巴结SE评分在2~3分,59例恶性淋巴结SE评分在4~5分。SE诊断准确性、敏感性、特异性分别为70.2%、75.6%、60.9%。VTIQ技术检测中恶性淋巴结SWV最大值、最小值、中位值及平均值均显著高于良性淋巴结(均P<0.05)。据ROC曲线分析,SWV平均值诊断效能最高,以其截断值3.18 m/s为预测恶性淋巴结的诊断标准,VTIQ技术诊断恶性淋巴结的准确性、敏感性、特异性分别为85.5%、92.3%、73.9%。SE及VTIQ技术的AUC分别为0.713、0.896,VTIQ技术的诊断价值更高。结论SE及VTIQ技术对肺癌患者颈部淋巴结性质的判定均有较高的准确性,与SE相比,VTIQ技术显示出优越的诊断效能,且以SWV平均值诊断效能最优,或可为临床提供一种评估肺癌患者颈部淋巴结性质的无创检查新方法。

Objective To investigate the diagnostic value of strain elastography(SE)and virtual touch tissue image quantification(VTIQ)technique in determining the nature of cervical lymph nodes in patients with lung cancer.Methods A total of 124 patients with lung cancer combined with cervical lymph node enlargement were selected for this study.All patients underwent routine ultrasound examination,using SE to detect lymph nodes and scored them,and using VTIQ technique fro measurement of lymph node shear wave velocity(SWV).Pathological results were taken as gold standards.Non-metastatic lymph nodes were included in the benign group,while metastatic lymph nodes were included in the malignant group.Receiver operating characteristic(ROC)curve was generated.The optimal cutoff value of SWV was determined for predicting metastatic lymph nodes,the area under curve(AUC)of SE and VTIQ technique was compared,and the diagnostic efficacy of SE and VTIQ technique for benign and malignant lymph nodes was analyzed.Results Among the 124 patients,28 cases of benign lymph nodes had an SE score of 2-3,and 59 cases of malignant lymph nodes had an SE score of 4-5.The accuracy,sensitivity,and specificity of SE were 70.2%,75.6%,and 60.9%,respectively.The maximum,minimum,median,and mean values of SWV in the malignant lymph nodes were significantly higher than those in the benign lymph nodes in VTIQ technique testing(P<0.05).Based on the ROC curve analysis,the mean value of SWV had the highest diagnostic efficiency,and its cutoff value of 3.18 m/s was used as the diagnostic criterion for predicting malignant lymph nodes.The accuracy,sensitivity,and specificity of the VTIQ technique in diagnosing malignant lymph nodes were 85.5%,92.3%,and 73.9%,respectively.The AUC of SE and VTIQ technique were 0.713 and 0.896,respectively,indicating higher diagnostic value of VTIQ technique.Conclusions Both SE and VTIQ technique have high accuracy in determining the nature of cervical lymph nodes in lung cancer patients.Compared with SE,VTIQ technique showed superior diagnostic performance,and SWVmean has the best diagnostic performance.It can provide a new non-invasive examination method for evaluating the nature of cervical lymph nodes in lung cancer patients in clinical practice.