超声鉴别诊断恶性外周神经鞘瘤与神经纤维瘤

Ultrasonic differential diagnosis of malignant peripheral nerve sheath tumor and neurofibroma

目的评价超声鉴别诊断恶性外周神经鞘瘤(MPNST)与神经纤维瘤的价值。方法纳入经病理学证实的45例MPNST(MPNST组)与98例神经纤维瘤患者(神经纤维瘤组),比较组间一般资料及灰阶超声表现差异;构建二元Logistic回归分析模型用于鉴别MPNST与神经纤维瘤。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价回归模型及各超声表现鉴别二者的效能,采用Delong检验评价诊断效能的差异。结果MPNST组患者年龄显著大于神经纤维瘤组(P<0.05);组间病灶位置、最大径、最小径、形态、边界、囊性成分、靶征及血流分级差异均有统计学意义(P均<0.05)。Logistic回归分析显示病灶位置、形态、边界及血流分级是鉴别MPNST与神经纤维瘤的独立因素(P均<0.05);回归模型鉴别二者的AUC为0.895,准确率、敏感度及特异度分别为83.92%、86.67%及82.65%,鉴别效能显著高于单一超声表现(P均<0.05)。结论超声可为鉴别诊断MPNST与神经纤维瘤提供依据。

Objective To observe the value of ultrasonography in differential diagnosis of malignant peripheral nerve sheath tumor(MPNST)and neurofibroma.Methods A total of 45 patients with MPNST(MPNST group)and 98 patients with neurofibroma(neurofibroma group)were enrolled,both were pathologically confirmed.The general data and grayscale ultrasonic manifestations were compared between groups.Binary Logistic regression analysis model was used to distinguish MPNST from neurofibroma.The receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the effectiveness of the regression model and ultrasonic findings.Delong test was used to evaluate the differences of diagnostic efficiencies.Results The age of patients in MPNST group were significantly higher than that in neurofibroma group(P<0.05).There were statistically significant differences of lesions location,the maximum diameter,the minimum diameter,shape,margin,cystic component,target sign and blood flow grading between groups(all P<0.05).Logistic regression analysis showed that the lesion location,shape,margin and blood flow grading were independent factors for distinguishing MPNST from neurofibroma(all P<0.05).The AUC of the regression model for distinguishing MPNST from neurofibroma was 0.895,and the accuracy,sensitivity and specificity were 83.92%,86.67%and 82.65%,respectively,and the identification efficiency was significantly higher than that of ultrasonic findings alone(all P<0.05).Conclusion Ultrasound could provide evidences for differential diagnosis of MPNST and neurofibroma.