超声光散射乳腺成像诊断乳腺癌的临床价值

Clinical value of diffused optical tomography with ultrasound in the diagnosis of breast cancer

目的 探讨运用超声光散射乳腺成像（OPTIMUS）系统对乳腺肿块的诊断价值。方法回顾经病理检查证实的136例乳腺肿瘤的OPTIMUS系统表现，与病理检查结果对比分析，同时用一致性检验评价其与病理、超声、钼靶X线检查的一致性，并绘制受试者工作特征（receiver operating characteristic，ROC）曲线，计算曲线下面积（area under the curve，Auc），判断三种检查手段的准确性，评价OPTIMUS系统的临床应用价值。结果136例患者术后病理诊断良性病变50例，恶性病变86例。OPTIMUS系统诊断良性病变34例，恶性病变102例，其中16例被过度诊断为恶性。其与超声及钼靶X线检查的一致性检验Kappa值分别为0．536、0．386。0PTIMUS系统、超声、钼靶X线与病理检查的一致性检验Kappa值分别为0．729、0．616、0．649。OPTIMUS系统、超声及钼靶X线检查的AUC分别为0．840（95％C10．764～0．916）、0．817（95％CI0．742～0．893）及0．837（95％CI0．771～0．902）。结论OPTIMUS系统对诊断乳腺恶性肿瘤的准确性及敏感性较高，可以提高乳腺癌患者的检出率，减低漏诊率。

Objective To study the value of diffused optical breast imaging with ultrasound （OPTIMUS ,OPTIMUS system） in the diagnosis of breast tumors. Methods The images of 136 breast tumors by OPTIMUS system were reviewed and compared with pathological results. Meanwhile ultrasound and X ray examinations were performed. Consistency checking was used to evaluate the consistency of pathological, ultrasound and X-ray examinations. The receiver operating characteristic （ROC） curve was done to calculate the area under the curve to evaluate the accuracy of OPTIMUS system and the clinical value of OPTIMUS system in the diagnosis of breast cancer. Results In the 136 cases, pathological diagnosis showed 50 cases were benign and 86 cases malignant. OPTIMUS system diagnosis showed 34 cases were benign and 102 cases malignant; among the 102 cases, 16 were overdiagnosed as cancer. Bases on the pathological results, the consistency checking Kappa value was 0. 536 and 0. 386 for ultrasound and X ray examinations respectively, and 0. 729, 0. 616, and 0. 649 for OPTIMUS system, ultrasound and X-ray examinations respectively. The area under ROC for OPTIMUS system, ultrasound and X ray examinations was 0. 840（95%CI 0. 758--0. 922）, 0. 817（95%CI 0. 739-- 0. 895） and 0. 837（95%CI O. 763--0. 910） respectively. Conclusion OPTIMUS system is a non-invasive and highly effective diagnostic tool for breast disease and it could be used as assistant diagnostic tool for breast tumors.