超声弹性成像ROIA值联合弹性评分诊断腋窝淋巴结的价值

Value of ultrasonic elastography ROIA value combined with elasticity scores in diagnosis of auxiliary lymph nodules

目的研究联合超声弹性成像感兴趣区A值(ROI A)与8分弹性评分构成的联合法对乳腺疾病引起的肿大腋窝淋巴结良恶性的诊断价值。方法 128位女性患者,共计136枚肿大的腋窝淋巴结行超声弹性成像检查,获得ROI A值并用8分弹性评分评价,以病理结果为标准,对比ROI A值、8分弹性评分以及联合两者后的联合法、核磁检查的诊断结果,用ROC曲线评价并寻找ROI A值的最佳诊断界点。结果联合法的敏感性、特异性和准确性分别为88.9%、77.7%和82.7%优于其他三种方法,差异有统计学意义(P<0.05);ROC曲线下面积为0.854,具有中等偏上诊断价值,ROI A值鉴别腋窝淋巴结良恶性的最佳界点为0.001 9。与核磁影像诊断结果对比,联合法诊断准确性更好(P=0.036),两者的特异性、敏感性、阳性预测值和阴性预测值均无显著差异性(P>0.05)。结论弹性成像ROI A值联合8分弹性评分组成的联合法对腋窝淋巴结良恶性有值得肯定的诊断价值,准确性优于核磁检查,是可信的诊断方法,为临床更快速准确地诊断腋窝淋巴结良恶性提供了新的参考。

Objective To assess the diagnostic value of ultrasound real-time tissue elastrography ROI A value combined with elasticity score system with 8 points in differential diagnosis of benign and malignant auxiliary lymph nodules. Methods A total of 128 female patients with 136 abnormal auxiliary lymph nodules underwent examinations with real-time ultrasonic elastography, then assessed by ROI A ratio and elasticity scores system. Compared the histopathology results and magnetic resonance imaging results with ROI A ratio, elasticity scores with 8-points, combined the two ways and a combination of both the methods and analyzed the diagnostic value of those methods by receiver operating characteristic（ROC） curves and looked for best cut off point for ROI A value. Results Specificity, sensitivity and accuracy of combination of both the methods were88.9%, 77.7%, 82.7% respectively, which were better than the others with statistically significant difference（P 〈 0.05）. The area under the ROC curve was 0.854 and the best diagnostic cut-off point of ROI A value was0.001 9 in differential diagnosis of benign and malignant auxiliary lymph nodules. With magnetic imaging diagnostic results, the combined methods obtained better diagnostic accuracy（P=0.036）, no significant differ-ences were found in the specificity, sensitivity, positive predictive value and negative predictive value between them（P 〉 0.05）. Conclusion ROI A value combined with elasticity scores has more accuracy than MRI in differential diagnosis of benign and malignant auxiliary lymph nodules, it is reliable way for faster accurate diagnosis and provides a new reference.