超声光散射断层成像对不同大小乳腺病灶的血红蛋白浓度诊断阈值探讨

Study on different threshold value in different size breast lesions using ultrasound-guided diffused optical tomography

目的利用超声光散射断层成像（DOT）研究乳腺病灶的血红蛋白浓度（THC），探讨不同大小乳腺病灶的THC最佳诊断阈值。方法以进行乳腺病变切除活检术的500个病灶为研究对象，以术后病理结果作为金标准，比较两组不同大小良性病灶间及恶性病灶间THC差异、最佳诊断阈值及诊断效能。结果共500个乳腺病灶，其中良性病灶265个，恶性病灶235个。〈2cm组和≥2cm组的恶性病灶THC均值分别为（193．0±81．3）μmol／L，（249．3±73．6）μmol／L，恶性病灶两组间THC差异有统计学意义（P=0．000）；〈2cm组和≥2cm组的良性病灶THC均值分别为（117．8±62．0）μmol／L，（131．8±70．0）μmol／L，良性病灶两组间THC差异无统计学意义（P=0．13）；对〈2cm组的病灶，分别以THC146．9μmol／L，102．2μmol／L为鉴别诊断阈值，DOT的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为74．2％，70．0％，71．7％，62．9％，79．9％和86．7％，44．4％，61．60%，51．60%，83％。对≥2cm组的病灶，以THC210．4μmol／L为诊断阈值，DOT的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为74．0％，86．7％，79．1％，89．2％，69．2％。结论乳腺癌的THC随肿瘤增大而增高，故应采用不同的THC诊断阈值来提高诊断的敏感性、特异性及准确性。

Objective To measure total hemoglobin concentration （THC） of breast lesion using US- guided diffused optical tomography（DOT） and to investigate the THC optimal threshold value in different size breast lesions. Methods DOT was performed on 500 breast lesions and surgical pathology was as the gold standard. The optimal diagnostic threshold and the efficacy were figured out. Results There were 265 benign and 235 malignant lesions. In malignant iesions,THC of ≥2 cm lesion group was higher than that of 〈2 cm lesion group（ P = 0. 000）. In benign lesions, there was no statistical difference between ≥2 cm group and 〈2 cm group （ P = 0.13）. As for 〈2 cm breast lesions,when a THC threshold value of 146.9μmol/L and 102.2μmol/L were used, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 74.2%, 70.0%, 71.7%,62.9%, 79.9% and 86.7%, 44.4%, 61.6%, 51.6%, 83% ,respectively. As for ≥2 cm breast lesions,when a THC threshold value of 210.4μmol/L were used, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 74.0%, 86.7% ,79.1%,89.2%, 69.2%. Conclusions THC of breast cancer increased with the increasing size of lesions. The different diagnostic threshold value should be used according to different size lesions so as to enhance sensitivity, specificity and accuracy.