高频超声结合甲胎蛋白对小儿睾丸肿瘤精确定性诊断的价值

Value of high-frequency ultrasound combined with alpha-fetoprotein in accurate qualitative diagnosis of pediatric testicular tumors

目的探讨高频超声结合血清甲胎蛋白(AFP)对小儿睾丸肿瘤精确定性诊断的价值。方法回顾性分析经手术及病理证实的47例睾丸肿瘤的超声特征(物理性质、有无钙化、Alder血流分级)及AFP水平,进一步将肿瘤按照两种方式分组:恶性肿瘤组和良性肿瘤组、卵黄囊瘤组和非卵黄囊瘤组,采用受试者工作特征曲线(ROC)分析超声特征及AFP对睾丸肿瘤的精确定性诊断效能。结果卵黄囊瘤18例,超声表现为实性或几乎实性肿块,可伴有数个小无回声区,不伴钙化,Alder血流分级为3级。非卵黄囊瘤29例,超声表现为囊性、实性或混合性包块,大多伴有钙化,部分呈蜂窝状回声,Alder血流分级为0~3级血流。ROC曲线分析显示,超声特征诊断小儿睾丸恶性肿瘤的曲线下面积、灵敏度、特异度分别为,实性或几乎实性:0.894、83.3%、95.5%;无钙化:0.904、94.4%、86.4%;Alder血流3级:0.941、88.9%、95.5%;AFP最佳界值(18.8 ng/ml)诊断的曲线下面积、灵敏度、特异度分别为0.972、100%、95.5%,超声特征联合AFP诊断的曲线下面积、灵敏度、特异度分别为0.992、100%、90.9%。进一步分析显示,实性或几乎实性、无钙化两个指标联合诊断卵黄囊瘤的灵敏度、特异度均为100.0%。结论小儿睾丸卵黄囊瘤具有特异性的超声表现,高频超声能够做出相对精确诊断,结合血清AFP可以进一步对小儿睾丸其他恶性肿瘤做出相对精确的定性诊断。

Objective To explore the value of high frequency ultrasound combined with serum alpha-fetoprotein(AFP)in the accurate qualitative diagnosis of pediatric testicular tumors.Methods The ultrasound characteristics(physical properties,calcification,alder blood flow classification)and AFP levels of 47 testicular tumors confirmed by operation and pathology were analyzed retrospectively.The tumors were further divided into two ways:malignant tumor group and benign tumor group,yolk sac tumor group and non yolk sac tumor group.The characteristics of ultrasound and the accurate qualitative diagnosis efficiency of AFP in testicular tumors were analyzed by receiver operating characteristic curve(ROC).Results 18 cases of yolk sac tumor showed solid or almost solid mass,which may be accompanied by several small anechoic areas without calcification.The Alder blood flow grade were grade 3.29 cases of nonyolk sac tumor showed cystic,solid or mixed mass,most of them have calcification and some of them showed honeycomb echo.Alder blood flow grade were 0-3 grade.ROC curve analysis showed that the area under the curve,sensitivity and specificity of the ultrasound characteristics and AFP in the diagnosis of pediatric testicular malignancies were:solid or almost solid mass(0.894,83.3%,95.5%),and no calcification(0.904,94.4%,86.4%),Alder blood flow level 3(0.941,88.9%,95.5%),AFP by best cut-off value 18.8 ng/ml(0.972,100%,95.5%),ultrasound features combined with AFP(0.992,100%,90.9%).All the testicular malignancies,such as yolk sac tumor,immature teratoma,teratoma combined with yolk sac tumor,can be identified by ultrasound features combined with AFP.Further analysis showed that the sensitivity and specificity of the diagnosis of yolk sac tumor with combined solid or almost solid and no calcification were both 100.0%,which can accurately distinguish all cases of yolk sac tumor.Conclusions Pediatric testicular yolk sac tumor has specific ultrasound performance,high-frequency ultrasound can make a relatively accurate diagnosis,combined with serum AFP can further make a relatively accurate qualitative diagnosis of other malignant tumors of the testis in children.