术前二维灰阶超声、三维容积超声及弹性成像对乳腺癌大小测量的准确性及其影响因素研究

Preoperative assessment of the accuracy of breast cancer size measured by two-dimensional ultrasound,three-dimensional volume ultrasound and ultrasound strain elastography and its influencing factors

目的术前评估二维超声(2D-US)、三维容积超声(3D-US)、应力式超声弹性成像(USE)对乳腺癌大小测量的精确性及其影响因素。方法将2016年4-11月南方医科大学南方医院经手术证实的101例乳腺癌患者纳入研究。术前运用2D-US、3D-US及USE对病灶最大径进行测量。比较各超声技术测值与术后病理测值的一致性;分析各临床病理因素及影像特征对各超声技术测值准确性的影响。结果各超声技术测值与术后病理测值一致性的组内相关系数由高到低依次为3D-US(0.90)>2D-US(0.81)>SUE(0.78),差异有统计学意义(均P<0.01)。在3D-US中,年龄>40岁组较≤40岁组测值准确率高;在2D-US中,浸润性导管癌(IDC)不伴导管内原位癌(DCIS)组较IDC伴DCIS组测值准确率高,无微钙化组较微钙化组高,病变长径≤2 cm组较>2 cm组高;IDC组较浸润性小叶癌(ILC)组高;在USE中,IDC不伴DCIS组较IDC伴DCIS组测值准确率高,无微钙化组较微钙化组高;差异有统计学意义(均P≤0.05)。结论对乳腺癌病灶大小精准测量,3D-US最优,受临床病理因素及影像特征影响最小,其次为2D-US与USE,可为临床确定乳腺癌病灶范围提供超声依据。

Objective To evaluate the accuracy of two-dimensional ultrasound(2D-US),three-dimensional volume ultrasound(3D-US)and ultrasound strain elastography(USE)in the measurement of preoperative tumor size of breast cancer and its influencing factors.Methods A total of 101 patients with breast cancer in Nanfang Hospital of Southern Medical University from April to November 2016 were recruited in this study.The maximum diameter of the lesion was examined by 2D-US 3D-US and USE before core needle biopsy or surgery biopsy.The Bland-Altman analysis and intraclass correlation coefficient(ICC)were used to analyze the consistency between the ultrasonic technique measurements and the pathological measurements of postoperative lesion.Chi-square test or Fisher exact test was used to analyze whether the accuracy of three imaging techniques was affected by different clinical pathologic factors and imaging characteristics.Results 3D-US showed better agreement with histology than 2D-US and USE,with a higher ICC(ICC 3D-US=0.90>ICC 2D-US=0.81>ICC SUE=0.78)and low variation.In 3D-US,the accuracy rate of the age>40 years old group was higher than≤40 years old group.In 2D-US,the measurement accuracy of invasive ductal carcinoma(IDC)without intraductal carcinoma in situ(DCIS)group was higher than DCIS with DCIS group,non-microcalcifications group was more accurate than microcalcifications group.The long diameter of lesion≤2 cm group was more accurate than>2 cm group,IDC group was more accurate than invasive lobular carcinoma(ILC)group.In USE,the measurement accuracy of IDC without DCIS group was higher than DCIS with DCIS group,non-microcalcifications group was more accurate than microcalcifications group.All the differences mentioned above were statistically significant(all P<0.05).Conclusions For accurate measurement of the size of breast cancer lesions,3D-US is the best,which is least affected by clinicopathological factors and imaging features,followed by 2D-US and USE.This has certain significance for clinically determining the extent of breast cancer lesions.