超微血管成像、高级动态血流显像、彩色多普勒血流显像对乳腺微小癌的诊断价值及其与病理肿瘤微血管密度的相关性研究

Study on the diagnostic value of superb microvascular imaging, advanced dynamic flow and color Doppler flow imaging in breast microcarcinoma and their correlation with pathological microvessel density

目的探讨超微血管成像(superb microvascular imaging,SMI)、高级动态血流显像(advanced dynamic flow,ADF)与彩色多普勒血流显像(color Doppler flow imaging,CDFI)对乳腺微小癌的诊断价值并分析三者与术后病理肿瘤微血管密度(microvessel density,MVD)的相关性。方法选取乳腺影像报告及数据系统(breast imaging reporting and data system,BI-RADS)分类为4类、最大径≤1 cm的乳腺微小肿块患者85例,共87个病灶,其中良性病灶46个(良性组),恶性病灶41个(恶性组),分别行SMI、ADF、CDFI检查,对图像采用Adler半定量法进行血流分级,比较三者显示乳腺微小癌血流情况的差异;检测术后病理MVD表达水平,并分析其与三种检测技术Adler分级的相关性。结果以病理诊断为金标准,CDFI、ADF、SMI在提示乳腺微小病灶血流的ROC曲线下面积分别为0.694、0.705、0.776。CDFI评估血流情况的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为78.0%、54.3%、60.4%、73.5%和65.5%,ADF分别为75.6%、60.9%、63.3%、73.7%和67.8%,SMI分别为78.0%、69.6%、69.6%、78.0%和73.6%。CDFI、ADF、SMI的Adler分级与肿瘤病理MVD呈正相关(P<0.05),其中SMI与病理MVD相关性最高(r=0.430,P<0.001)。结论SMI提示乳腺微小癌血流程度的能力优于ADF、CDFI,并且其与肿瘤病理MVD相关性较好,可用于辅助鉴别诊断乳腺微小癌,间接评价患者预后情况。

Objective To investigate the diagnostic value of superb microvascular imaging(SMI), advanced dynamic flow(ADF) and color Doppler flow imaging(CDFI) in breast microcarcinoma, and to compare the correlation coefficients between these three indicators and postoperative pathological tumor microvascular density(MVD). Methods A total of 85 patients(87 lesions) with BI-RADS 4 and the maximum diameter≤1 cm were selected, of which, 46 lesions were benign(benign group) and 41 lesions were malignant(malignant group). All the patients and the corresponding lesions were examined by SMI, ADF and CDFI. Blood flow grading was performed on the images using Adler grade of blood flow, and the difference of blood flow among the 3 methods was compared. The expression level of MVD in pathological tumor tissues was detected and analyzed for its correlation with Adler classification by three detection techniques. Results The areas under the ROC curve(AUR) of CDFI, ADF and SMI were 0.694, 0.705 and 0.776 respectively based on the gold standard with pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CDFI were 78.0%, 54.3%, 60.4%, 73.5%, and 65.5%, respectively;those of ADF were 75.6%, 60.9%, 63.3%, 73.7% and 67.8%, respectively;and those of SMI were 78.0%, 69.6%, 69.6%, 78.0% and 73.6%, respectively. The Adler grades of CDFI, ADF and SMI were positively correlated with MVD(P<0.05), which the highest correlation coefficient between SMI and MVD (r=0.430, P<0.001). Conclusions SMI is superior to ADF and CDFI in detecting the abundance of breast microcarcinoma, and has the highest correlation coefficient among those 3 detection techniques with tumor pathological MVD, which indicates that SMI may be used for differential diagnosis of breast microcarcinoma and indirectly evaluate the prognosis of patients.