超声造影对Ⅰ型与Ⅱ型乳头状肾细胞癌的鉴别诊断

Value of contrast-enhanced ultrasound in differential diagnosis of typeⅠand typeⅡpapillary renal cell carcinoma

目的探讨Ⅰ型与Ⅱ型乳头状肾细胞癌(PRCC)的超声造影表现及其鉴别诊断价值。方法回顾性分析2006年12月至2020年11月在东部战区总医院经病理证实的78例PRCC患者的常规超声检查及超声造影检查表现。78例患者中36例为Ⅰ型PRCC,42例为Ⅱ型PRCC,男性58例(74%),女性20例(26%),年龄(54±12)岁,范围30~76岁。采用单因素分析法比较两型PRCC患者影像学特征的差异,对差异有统计学意义的变量进一步行二元Logistic回归分析。应用受试者操作特征(ROC)曲线分析超声影像特征鉴别诊断Ⅰ型与Ⅱ型PRCC的价值。结果单因素分析结果显示,Ⅱ型PRCC病灶的术后病理最大径大于Ⅰ型PRCC病灶的[4.0(3.0,5.5)cm vs 3.1(2.1,4.0)cm],差异有统计学意义(U=555.500,P=0.043)。两型比较,根治性肾切除术(57.1%)更常用于Ⅱ型PRCC,部分肾切除术(22.2%)更常用于Ⅰ型PRCC,差异有统计学意义(P<0.016667)。常规超声检查时Ⅰ型与Ⅱ型PRCC各声像图特征差异无统计学意义(P>0.05),而超声造影检查时两型PRCC的病灶增强模式及增强边缘声像图特征差异有统计学意义(P<0.05)。进一步回归分析后,病灶的术后病理大小及病灶手术方式作为干扰因素被排除(P>0.05),而病灶的增强模式及增强边缘为诊断Ⅱ型PRCC的独立危险因素(OR=3.854、4.388,P均<0.05),ROC曲线分析显示二者联合诊断Ⅱ型PRCC的曲线下面积为0.724,敏感度为0.881,特异度为0.500。结论超声造影检查可为Ⅰ型与Ⅱ型PRCC的鉴别诊断提供有价值的信息。

Objective To assess the value of contrast-enhanced ultrasound examination in the differential diagnosis of typeⅠand typeⅡpapillary renal cell carcinoma(PRCC).Methods A total of 78 patients pathologically confirmed as having PRCC from December 2006 to November 2020 at the Eastern Theater General Hospital were enrolled.The conventional ultrasound and contrast-enhanced ultrasound(CEUS)findings were retrospectively analyzed.There were 58(74.0%)males and 20(26.0%)females,aged 30-78(54±12)years.Univariate analysis was used to compare the differences in imaging characteristics between the two types of PRCC patients,and binary logistic regression analysis was performed for variables with a statistically significant difference.Receiver operating characteristic(ROC)curve analysis was performed to assess the value of conventional ultrasound and CEUS imaging features in the differential diagnosis of typeⅠand typeⅡPRCC.Results Univariate analysis showed that the postoperative pathological maximum diameter of typeⅡPRCC lesions[4.0(3.0,5.5)cm]was significantly larger than that of typeⅠPRCC lesions[3.1(2.1,4.0)cm;U=555.500,P=0.043].Radical nephrectomy(57.1%)was more commonly used for typeⅡPRCC,and partial nephrectomy(22.2%)was more commonly used for typeⅠPRCC,the difference between them was statistically significant(P<0.016667).TypeⅠand typeⅡPRCC Ultrasound(Electronic Edition),September 2021,Vol.18,No.9 lesions had no statistically significant differences in conventional ultrasound imaging features(P>0.05).There were statistically significant differences in lesion enhancement pattern and ultrasonographic characteristics of the enhanced lesion edge between the two types of PRCC(P<0.05).After further regression analysis,the postoperative pathological size of the lesion and the surgical method were excluded as interfering factors(P>0.05),while the enhancement pattern and enhanced edge of the lesion were independent risk factors for the diagnosis of typeⅡPRCC(P<0.05,OR=3.854 and 4.388,respectively).ROC curve analysis showed that the area under the curve of the two indicators in combination to diagnose typeⅡPRCC was 0.724,with a sensitivity of 0.881 and specificity of 0.500.Conclusion CEUS examination can provide valuable information for the differential diagnosis of typeⅠand typeⅡPRCC.