声触诊组织成像量化技术对三阴性与非三阴性乳腺癌的鉴别诊断价值

Virtual Touch Tissue Imaging Quantification in Differential Diagnosis of Triple-negative and Non-triple-negative Breast Cancer

目的探讨声触诊组织成像量化(virtual touch tissue imaging quantification,VTIQ)技术对三阴性与非三阴性乳腺癌的鉴别诊断价值。方法回顾性分析2017年1月~2019年1月于笔者医院接受诊治的乳腺癌患者共270例,术前均行VTIQ检查,并获取术后病理结果。依据免疫组化结果中ER、PR、Her-2的表达情况及Ki-67水平,将患者分为luminal-A组(122例),luminal-B组(83例),Her-2组(39例)及三阴性组(26例)。记录术前行VTIQ检查的乳腺癌肿块内的剪切波速度(shear wave velocity,SWV)最大值、最小值和平均值(单位为m/s),比较三阴性组与非三阴性组乳腺癌肿块内的SWV值。根据受试者工作曲线(receiver operating characteristic curve,ROC)来确定三阴性组乳腺癌中准确率最高的一组SWV值,并获得最佳诊断截断值。评估VTIQ技术在判断三阴性乳腺癌(triple negative breast cancer,TNBC)中的诊断效能,包括诊断准确性、敏感度、特异性、阳性预测值和阴性预测值。结果VTIQ结果显示,三阴性组乳腺癌肿块内的SWV最大值、最小值及平均值均高于非三阴性组乳腺癌(6.61±1.03m/s vs 6.09±0.76m/s、5.01±0.96m/s vs 4.11±1.12m/s、5.69±1.07m/s vs 4.87±1.16m/s),差异均有统计学意义(t=3.171、3.944、3.451,P均<0.01)。三阴性组乳腺癌肿块内的SWV(最大值、最小值及平均值)的ROC曲线下面积(area under curve,AUC)分别为0.922、0.934、0.938。以SWV平均值的诊断效能最高,最佳截点值为5.279m/s。VTIQ(SWV平均值)对于三阴性乳腺癌的诊断效能,准确度95.93%,敏感度96.15%,特异性95.90%,阳性预测值71.43%,阴性预测值99.57%。结论VTIQ技术在预测TNBC中具有一定的诊断价值,其中以SWV平均值的诊断效能最高,将SWV平均值≥5.279m/s作为预测TNBC的重要参考指标之一。

Objective To explore the differential diagnosis of VTIQ in triple-negative and non-triple-negative breast cancer.Methods A retrospective analysis was made of 270 breast cancer patients treated in our hospital from January 2017 to January 2019.Before operation,VTIQ was performed and postoperative pathological results were obtained.According to the expression of ER,PR,Her-2 and Ki-67 level,the patients were divided into luminal-A group(122 cases),luminal-B group(83 cases),Her-2 group(39 cases)and triple negative group(26 cases).We recorded the maximum,minimum and average value(in m/s)of shear wave velocity(SWV)in breast cancer mass examined by VTIQ before operation.Comparison of SWV values in breast cancer masses between triple-negative and non-triple-negative groups was made.According to the receiver operating characteristic(ROC)curve,the SWV values with the highest diagnostic efficacy in triple negative breast cancer were determined,and the best cut-off was obtained.We evaluated the diagnostic efficacy of ABVS and VTIQ in triple negative breast cancer,including diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value.Results The results of VTIQ showed that the maximum,minimum and average SWV values in breast cancer mass of triple negative groups were higher than those of non-triple negative groups(6.61±1.03m/s vs 6.09±0.76m/s,5.01±0.96m/s vs 4.11±1.12m/s,5.69±1.07m/s vs 4.87±1.16m/s).The difference was significant(t=3.171,3.944,3.451,P<0.01).In the triple negative groups,the area under curve(AUC)of SWV(maximum,minimum and average)was 0.922,0.934,0.938,respectively.Among them,the diagnostic efficiency of SWV average was the highest,and the best cut-off point was 5.279m/s.The diagnostic efficacy of VTIQ(the average value of SWV)for triple negative breast cancer was as follows:diagnostic accuracy 95.93%,sensitivity 96.15%,specificity 95.90%,PPV 71.43%and NPV 99.57%.Conclusion VTIQ technology has certain diagnostic value in predicting TNBC.Among them,the diagnostic accuracy of SWV average value is the highest,and the average value of SWV≥5.279m/s can be used as one of the important reference indexes for predicting TNBC.