乳腺癌超声造影特征与血管生成拟态的相关性分析

Relationships between contrast enhanced ultrasound and vascular mimicry in breast cancer

目的探讨乳腺癌超声造影特征与血管生成拟态(VM)的相关性及在鉴别诊断中的价值。方法选取经手术病理证实为乳腺浸润性导管癌患者152例,术前均行常规超声和超声造影检查,术后标本行病理检查。记录患者临床病理特征(年龄、肿瘤大小、临床分期、是否淋巴结转移)和超声造影特征(均匀性、是否存在灌注缺损、增强强度、增强形态、边界等),分析VM阳性与阴性的乳腺癌超声造影特征的差异。绘制受试者工作特征(ROC)曲线分析各因素鉴别VM阳性的诊断效能。结果152乳腺癌患者中,经病理确诊VM阳性率为26.3%。病灶直径>2 cm、临床分期为Ⅲ期及Ⅳ期、腋窝淋巴结转移与VM阳性相关(均P<0.05)。超声造影结果显示病灶增强形态不规整、边界不清晰、增强模式为快进快退和快进慢退与VM阳性相关(均P<0.05)。其中病灶增强边界不清晰鉴别VM阳性的价值最高,曲线下面积为0.764,准确率、敏感性、特异性分别为85.0%、66.7%、90.3%。结论超声造影特征与VM阳性存在一定的相关性,超声造影表现为形态不规整、边界不清晰、快进快退征象可作为诊断乳腺癌VM阳性的有效辅助手段。

Objective To analyze the relationships between the contrast enhanced ultrasound(CEUS)features and vascular mimicry(VM)in breast cancer,and to explore its value in differential diagnosis.Methods A total of 152 breast cancer patients confirmed as invasive ductal carcinoma by pathology were enrolled.The conventional ultrasound and contrast enhanced ultrasound were performed before surgery.Pathological examinations were conducted with the specimens after surgery.The clinicopathologic parameters(age,tumor size,clinical stage,lymph node metastasis)and contrast enhanced ultrasound features(homogeneity,with or without perfusion defect,enhancement intensity,enhancement morphology,enhancement margin type,ect)were recorded.The differences of contrast enhanced ultrasound features of breast tumor in VM positive or negative statues were analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of various factors to identify VM positive.ResultsAmong 152 breast cancer patients,the VM positive rate was 26.3%.The tumors with diameter>2 cm,clinical stage ofⅢandⅣ,and axillary lymph node metastasis were associated with VM positive lesions(all P<0.05).The contrast enhanced ultrasound features of tumors with irregular enhancement morphology of the lesions,irregular unclear margin,fast-in and fast-out,fast-in and slow-out pattern were associated with VM positive lesions(all P<0.05).The enhancement irregular unclear margin had the highest value in clearly distinguishing VM-positive,the area under the curve(AUC)was 0.764,and the accuracy,sensitivity and specificity were 85.0%,66.7%and 90.3%,respectively.Conclusion Contrast enhanced ultrasound features have a certain correlation with VM positive statue.The features of tumors with irregular enhancement morphology,irregular unclear margin,fast-in and fast-out pattern can be a useful supplementary method for the diagnosis of VM positive breast cancer.