超声造影鉴别诊断乳腺良恶性病变的价值

Value of contrast-enhanced ultrasound in differential diagnosis of breast benign and malignant lesions

目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)在乳腺良恶性病变鉴别诊断中的价值。方法:回顾并分析66例经手术后病理学检查或粗针穿刺病理学检查证实的乳腺病变(恶性肿瘤41例,良性病变25例)的CEUS图像特征,所有患者术前均行常规超声及CEUS检查,观察并记录常规超声及CEUS声像图表现。结果:乳腺恶性肿瘤与良性病变相比,造影剂填充方向、CEUS后病灶范围是否扩大、周边是否有蟹足样穿支血管、病灶增强方式及病灶高增强持续时间差异均有统计学意义(P均<0.05)。恶性肿瘤CEUS灌注模式以向心性填充为主,多数病灶呈不均匀增强,增强范围大于常规超声时病灶大小,病灶周围常伴有蟹足样穿支血管。乳腺恶性肿瘤和良性病变均以高增强表现为主,但是恶性肿瘤高增强持续时间大于良性病变(P<0.05)。病灶不均匀增强以及病灶增强范围这两者对乳腺恶性肿瘤的诊断效能最佳,灵敏度、特异度、准确度及曲线下面积(area under curve,AUC)分别为78.0%、68.0%、74.2%及0.73。结论:CEUS时造影剂填充方向、病灶范围扩大、病灶周边蟹足样穿支血管、病灶增强方式及高增强持续时间这些声像图特征有助于乳腺良恶性病变的鉴别诊断,值得临床推广应用。

Objective: To evaluate the value of contrast-enhanced ultrasound(CEUS) in differential diagnosis of breast benign and malignant lesions. Methods: The CEUS features of pathologically proven breast lesions of 66 patients(41 malignant tumors and 25 benign lesions) were analyzed retrospectively. Conventional ultrasound and CEUS were performed in all cases preoperatively.The sonographic features of conventional ultrasound and CEUS were recorded and analyzed. Results: There were significant differences(P<0.05) in enhancement order, larger diameter of lesions after CEUS, claw-shaped vessels, enhancement pattern and the lasting hyperenhancement time between benign and malignant lesions. Most malignant tumors were characterized by centripetal enhancement, uneven enhancement, and the enhancement range was larger than conventional ultrasound, claw-shaped enhancement.Most malignant and benign breast lesions were hyperenhancement, but the duration of hyperenhancement in malignant tumors was longer than that in benign lesions(P<0.05). Uneven enhancement and the enhancement range had the best diagnostic performance for breast malignant tumors. The sensitivity, specificity, accuracy, and area under curve(AUC) were 78.0%, 68.0%, 74.2% and 0.73,respectively. Conclusion: These CEUS sonographic features, such as enhancement order, larger diameter of lesions after CEUS,claw-shaped vessels, enhancement pattern and the lasting hyperenhancement time are helpful for differential diagnosis of breast tumors which are worthy of clinical application.