超声特征和几何圆度鉴别诊断最大径<2 cm三阴性乳腺癌和纤维腺瘤的价值

Value of ultrasonic features and geometric roundness in the differentia diagnosis of triple negative breast cancer and fibroadenoma with the maximum diameter<2 cm

目的分析最大径<2 cm三阴性乳腺癌(TNBC)与乳腺纤维腺瘤(FA)的超声图像特征和几何圆度,提高临床鉴别诊断TNBC的准确性。方法回顾性分析我院经手术病理证实的74例最大径<2 cm的TNBC(TNBC组)和125例FA(FA组)患者的超声图像,比较两组年龄、病灶大小、形态、方位、边缘、回声模式、后方回声特征、钙化等特征,以及病灶几何圆度的差异。应用Logistic回归分析最大径<2 cm TNBC的独立影响因素,绘制受试者工作特征(ROC)曲线分析几何圆度对其的诊断效能。结果TNBC组平均年龄(47.3±10.7)岁,FA组(35.5±9.0)岁,差异有统计学意义(P<0.05)。与FA组比较,TNBC组病灶出现不规则形(49/74)、方位不平行(30/74)、边缘不光整(65/74)、后方回声增强(48/74)者更多,差异均有统计学意义(均P<0.05)。TNBC组BI-RADS 4类和5类病灶较FA组更多,差异均有统计学意义(均P<0.05)。TNBC组平均几何圆度81%±9%,大于FA组(66%±11%),差异有统计学意义(P<0.05)。Logistic回归分析显示,患者年龄>45岁(OR=7.81)、病灶形态不规则(OR=4.29)、方位不平行(OR=8.32)、后方回声增强(OR=7.54)、BI-RADS分类为4类(4A类:OR=1.06,4B类:OR=13.54,4C类:OR=31.92)和5类(OR=40.07),以及病灶几何圆度>80%(OR=71.62)是最大径<2 cm TNBC的独立影响因素。ROC曲线分析显示,诊断最大径<2 cm TNBC的几何圆度截断值为80%,曲线下面积为0.816,敏感性、特异性分别为77.2%、74.6%。结论与FA比较,最大径<2 cm的TNBC患者年纪多偏大,表现出更多可疑的超声特征和更大的几何圆度,有助于临床对二者进行鉴别诊断。

Objective To analyze the ultrasonic features and geometric roundness of triple negative breast cancer(TNBC)and breast fibroadenoma(FA)with the maximum diameter<2 cm,and to improve the clinical diagnostic accuracy of TNBC.Methods The ultrasound images were retrospectively analyzed in 74 patients with TNBC(TNBC group)and 125 patients with FA(FA group)who received surgical treatment and were pathologically confirmed with the maximum diameter<2 cm in our hospital.The age,size,shape,orientation,margin,echo pattern,posterior echo features,calcification and geometric roundness of the lesions were compared between the two groups.The independent impact factors of TNBC with maximum diameter<2 cm were analyzed by Logistic regression analysis,and receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficiency.Results The average age of TNBC group was(47.3±10.7)years old,and that of FA group was(35.5±9.0)years old,the difference was statistically significant(P<0.05).Compared with FA group,the probability of irregular shape(49/74),non parallel orientation(30/74),irregular edge(65/74)and posterior echo enhancement(48/74)was higher in TNBC group(all P<0.05).Most of the tumors in TNBC group were classified into BI-RADS 4 and 5,and the difference was statistically significant compared with FA group(both P<0.05).The average geometric roundness of TNBC group(81%±9%)was higher than that of FA group(66%±11%),and the difference was statistically significant(P<0.05).Logistic regression analysis showed that age>45 years old(OR=7.81),irregular shape(OR=4.29),non parallel orientation(OR=8.32),posterior echo enhancement(OR=7.54),BI-RADS classification of 4 categories(4A:OR=1.06,4B:OR=13.54,4C:OR=31.92)and 5 categories(OR=40.07),as well as the geometric roundness>80%(OR=71.62)were independent impact factors for TNBC with the maximum diameter<2 cm.ROC curve analysis showed that the cut-off value of geometric roundness in TNBC was 80%,area under the curve was 0.816,and the sensitivity and specificity were 77.2%and 74.6%,respectively.Conclusion Compared with FA,TNBC patients with the maximum diameter<2 cm are older,and showed more suspicious ultrasound features and larger geometric roundness,which is helpful for the differential diagnosis of TNBC with the maximum diameter<2 cm.