剪切波弹性成像对乳腺癌良恶性的鉴别诊断及误诊分析

Differential diagnosis and misdiagnosis of benign and malignant breast cancer by shear wave elastography

目的近年来,乳腺癌的发病率越来越高,但临床中对于乳腺癌的诊断缺乏特异性的方法,因此本研究旨在分析剪切波弹性成像对乳腺癌良恶性的鉴别诊断及误诊情况。方法选取2017年1月-2019年1月期间于宁波市奉化区人民医院进行诊治的146例乳腺微小病变的患者为研究对象,其中恶性肿瘤为48例,良性肿瘤为98例,所有患者均进行剪切波弹性成像、超声检查,对比2种方法对良恶性乳腺病变的诊断效能;并应用单因素和多因素logistic回归模型分析影响剪切波弹性成像对乳腺微小病变诊断的误诊因素。结果剪切波弹性成像对乳腺微小病变诊断效能高于B超检测方法(均P<0.05);多因素logistic回归分析结果显示,病变<8 mm(OR=11.284,P=0.006)、原位癌(OR=8.402,P=0.044)为导致假阴性检查结果的独立危险因素;距离皮肤距离>9 mm(OR=8.116,P=0.006)、距离浅部胸壁距离<2 mm(OR=11.831,P=0.002)、乳房厚度>24 mm(OR=10.032,P=0.006)为导致假阳性检查结果的独立危险因素。结论剪切波弹性成像技术能定性、定量的分析乳腺微小病变的良恶性,具有较高的诊断效能,但仍存在一些导致误诊的因素,其中乳腺病变<8 mm、原位癌为导致剪切波弹性成像假阴性检查结果的独立危险因素;距离皮肤距离>9 mm、距离浅部胸壁距离<2 mm、乳房厚度>24 mm为导致剪切波弹性成像假阳性检查结果的独立危险因素。

Objective To analyze the differential diagnosis and misdiagnosis of benign and malignant breast cancer by shear wave elastography. Methods A total of 146 patients with microscopic lesions of the breast who were treated in our hospital from January 2017 to January 2019 were enrolled, including 48 malignant tumors and 98 benign tumors. All patients underwent shear wave elastography and ultrasonography. The diagnostic efficacy of two methods for benign and malignant breast lesions was compared. Univariate and multivariate logistic regression models were used to analyze the misdiagnostic factors affecting small breast lesions by shear wave elastography. Results The diagnostic efficiency of shear wave elastography for breast small lesions was higher than that of B-ultrasound(all P<0.05). Univariate and multivariate logistic regression analysis showed that lesions<8 mm(OR=11.284, P=0.006) and carcinoma in situ(OR=8.402, P=0.044) were independent risk factors leading to false negative test results;distance from the skin>9 mm(OR=8.116, P=0.006), distance from the shallow chest wall<2 mm(OR=11.831, P=0.002), breast thickness>24 mm(OR=10.032, P=0.006) were independent risk factors leading to false positive test results. Conclusion Shear wave elastography can qualitatively and quantitatively analyze the benign and malignant lesions of breast microscopic lesions, and has high diagnostic efficiency, but there are still some factors leading to misdiagnosis.