婴儿型纤维肉瘤与软组织血管瘤的超声鉴别诊断

The performance of ultrasound for differentiation of infantile fibrosarcoma and soft tissue hemangioma

目的探讨超声鉴别婴儿型纤维肉瘤(infantile fibrosarcoma,IFS)与软组织血管瘤的诊断价值。方法连续选取2012年1月至2019年1月于首都医科大学附属北京儿童医院经病理确诊的16例IFS作为IFS组,并根据IFS瘤灶大小,选取同期经病理确诊的26例软组织血管瘤(血管瘤组)作为对照。对比分析两组肿瘤的超声表现是否存在可供鉴别的差异性,并权重各种超声表现的诊断优势比(OR)建立联合诊断方程,采用ROC曲线评估具体鉴别效能。结果IFS组与血管瘤组的超声表现在"整体回声"、"病灶边缘"及"病灶血流"方面差异有统计学意义(P=0.013,0.002,0.005),鉴别效能以诊断曲线下面积(AUC)表示分别为0.695、0.740、0.700,而采用综合多因素的联合诊断方程,曲线下面积可提高至0.887,优于单一因素鉴别(P=0.017,0.035,0.003),其诊断IFS的敏感性为81.3%,特异性为96.2%。结论超声检查可用于鉴别IFS与软组织血管瘤;采用联合诊断可进一步改善鉴别效能,有更高的潜在应用价值。

Objective To investigate the differential performance of ultrasound between infantile fibrosarcoma(IFS)and soft tissue hemangioma.Methods The retrospective study was conducted from January 2012 to January 2019 in Beijing Children′s Hospital,Capital Medical University.A total of 16 patients with IFS were consecutively collected as IFS group,and 26 consecutive patients with soft tissue hemangioma(hemangioma group)were selected for comparison according to the tumor size of IFS.All the final diagnosis got confirmed by pathological analysis.The ultrasonographic features of IFS and hemangioma were compared and analyzed,and after weighting on the basis of the dominance ration(OR),the ultrasonic features with diagnostic value were used to establish the prediction equation.Then,the differential performance of every feature and the prediction equation was evaluated via the ROC analysis.Results There were differences in the lesion echo,margin and blood flow characteristics between IFS group and hemangioma group(P=0.013,0.002,0.005),the area under the ROC(AUC)of applying every ultrasonic feature with diagnostic value for differentiation were 0.695,0.740,and 0.700,respectively.Benefiting from the employment of the prediction equation,the AUC was improved to 0.887 with a sensitivity of 81.3%and a specificity of 96.2%,which were better than the diagnosis by any single feature(P=0.017,0.035,0.003).Conclusions Ultrasound can be utilized to discriminate infantile fibrosarcoma from soft tissue hemangioma.The use of prediction equation can further improve the differential performance with higher clinical value.