常规超声、超声弹性成像及超声增强造影对乳腺癌的诊断价值比较

Comparison of routine ultrasonography, ultrasonic elastography and contrastenhanced ultrasound in diagnostic values for breast cancer

目的探讨常规超声检查(US)、超声弹性成像(UE)及超声增强造影(CEUS)对乳腺癌的诊断价值。方法回顾性分析205例乳腺肿块患者(共226个病灶)的临床资料。以穿刺活检或手术病理结果为金标准,比较乳腺良恶性肿块US、UE、CEUS诊断及三者联合诊断的价值。结果 226个病灶中,恶性肿块病灶95个,良性肿块病灶131个。US声像图特征中乳腺良性肿块形态不规则、边界不清晰、钙化、后方回声衰减、血流信号2～3级的比例均明显低于恶性肿块,差异均有统计学意义(P﹤0.01);乳腺良性肿块纵横比﹤1的比例明显高于恶性肿块,差异有统计学意义(P﹤0.01)。乳腺良性肿块和乳腺恶性肿块的UE评分比较,差异有统计学意义(P﹤0.01)。乳腺良性肿块和乳腺恶性肿块的CEUS声像图特征中无增强、均匀增强、不均匀增强的比例组间比较,差异有统计学意义(P﹤0.01);CEUS声像图特征中乳腺良性肿块边界不清晰的比例明显高于恶性肿块,差异有统计学意义(P﹤0.01);CEUS声像图特征中乳腺良性肿块增强不规则的比例低于恶性肿块,差异有统计学意义(P﹤0.05)。乳腺良恶性肿块的US诊断的准确率为81.42%,UE诊断的准确率为73.45%,CEUS诊断的准确率为75.66%,三者联合诊断的准确率为94.69%。US、UE及CEUS三者联合诊断的灵敏度、特异度、准确率、阳性预测值及阴性预测值均高于单独诊断,差异均有统计学意义(P﹤0.05)。结论 US、UE及CEUS对乳腺癌的诊断均具有一定的价值,三者联合诊断有助于提高鉴别乳腺良恶性肿块的准确率和灵敏度。

Objective To explore the diagnostic values of routine ultrasonography(US),ultrasonic elastography(UE)and contrast-enhanced ultrasound(CEUS)in breast cancer.Method The clinical data of205cases of patients with breast lumps(226lesions)treated were analyzed retrospectively.The puncture biopsy or surgical pathology results were taken as the gold standard,and the values of US,UE,CEUS and combination of the three kinds of examinations in the diagnosis for benign and malignant breast lumps were compared.Result Among226lesions,there were95malignant lumps and131benign lumps.By US,the ratios of irregular shape,unclear boundary,calcification,posterior echo attenuation,2~3grade of blood flow signal in malignant breast lumps were significantly higher than those in benign lumps(P<0.01);and the proportion of mass with aspect ratio<1in benign lumps was significantly higher than that in malignant lumps(P<0.01).There was statistically difference in UE score between malignant and benign lumps(P<0.01).By CEUS,there were statistically differences in the proportions of unenhancement,even enhancement and uneven enhancement between malignant and benign lumps(P<0.01);the proportion of unclear boundary in benign lumps was significantly higher than that in malignant lumps(P<0.01);and the proportion of uneven enhancement in benign lumps was significantly lower than that in malignant lumps(P<0.05).The accuracy of diagnosis of benign and malignant breast lumps was81.42%by US,73.45%by UE,75.66%by CEUS and94.69%by three kinds of the examinations combined.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of combination of the three kinds of examinations were all higher than those of single diagnosis(P<0.05).Conclusion US,UE and CEUS are valuable for the diagnosis of breast cancer,but the combined diagnosis of the three can help improve the accuracy and sensitivity of identifying benign and malignant breast lumps.