超声造影定量参数联合人类表皮生长因子受体-2、原癌基因对肿块型乳腺癌的诊断价值

Diagnostic value of contrast-enhanced ultrasound quantitative parameters combined with human epidermal growth factor receptor-2 and proto-oncogene for lump-type breast cancer

目的探讨超声造影定量参数联合人类表皮生长因子受体-2(HER-2)、原癌基因(CerbB-2)对肿块型乳腺癌的诊断价值。方法选取我院经术后病理确诊的肿块型乳腺癌患者61例(恶性组)和乳腺良性肿瘤患者73例(良性组),应用超声造影检测两组峰值强度(PI)、上升支斜率(WIS)、达峰时间(TTP)、曲线下面积(AUC1)和梯度(Grad);采用免疫组织化学检测两组HER-2、CerbB-2的表达情况。比较两组上述参数的差异。分析超声造影定量参数与HER-2、CerbB-2表达的相关性。绘制受试者工作特征(ROC)曲线分析超声造影定量参数、HER-2、CerbB-2单独及联合诊断肿块型乳腺癌的效能,并对其曲线下面积进行比较。结果恶性组与良性组PI、TTP、AUC1和Grad比较差异均有统计学意义(均P<0.05),而WIS比较差异无统计学意义。恶性组HER-2、CerbB-2阳性表达率均较良性组高,差异均有统计学意义(均P<0.05)。PI、TTP、AUC1、Grad均与HER-2呈正相关(r=0.407,0.396,0.361,0.339,均P<0.05),TTP与CerbB-2呈正相关(r=0.464,P=0.000),其余超声造影定量参数均与HER-2、CerbB-2表达无相关性。超声造影定量参数联合HER-2、CerbB-2诊断肿块型乳腺癌的曲线下面积及95%可信区间、敏感性、特异性、准确率分别为0.894(0.807~0.989)、0.885、0.918、0.903,均优于超声造影定量参数或HER-2、CerbB-2单独应用的诊断效能,差异均有统计学意义(均P<0.05)。结论超声造影定量参数有助于鉴别诊断乳腺良恶性病变,且与乳腺癌组织中HER-2、CerbB-2的表达相关,联合应用可提高肿块型乳腺癌患者术前和非侵袭性诊断的准确性,为临床治疗提供参考依据。

Objective To investigate the diagnostic value of quantitative parameters of contrast-enhanced ultrasound(CEUS)combined with human epidermal growth factor receptor 2(HER-2)and proto-oncogene(CerbB-2)for lump-type breast cancer.Methods A total of 61 patients with lump-type breast cancer(malignant group)and 73 patients with benign breast tumor(benign group)confirmed by postoperative pathology in our hospital were selected,and the peak intensity(PI),ascending branch slope(WIS),peak time(TTP),area under the curve(AUC1)and gradient(Grad)of the two groups were measured by CEUS.The expression of HER-2 and CerbB-2 in both groups were detected by immunohistochemical staining.The correlation between quantitative parameters of CEUS and the expression of HER-2 and CerbB-2 were analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of quantitative parameters of CEUS,HER-2 and CerbB-2 alone and in combination in the diagnosis of lump-type breast cancer,and the areas under the curve were compared.Results There were statistically significant differences in PI,TTP,AUC1 and Grad between the malignant group and the benign group(all P<0.05),while there was no statistically significant difference in WIS.The positive expression rates of HER-2 and CerbB-2 in malignant group were significantly higher than those in benign group,and the differences were statistically significant(both P<0.05).PI,TTP,AUC1 and Grad were positively correlated with HER-2(r=0.407,0.396,0.361,0.339,all P<0.05).TTP was positively correlated with CerbB-2(r=0.464,P=0.000),and other CEUS quantitative parameters had no correlation with the expression of HER-2 and CerbB-2.The area under curve,95%confidence interval,sensitivity,specificity and accuracy of CEUS quantitative parameters combined with HER-2 and CerbB-2 in the diagnosis of lump-type breast cancer were 0.894(0.807~0.989),0.885,0.918 and 0.903,respectively,which were better than those of quantitative parameters of CEUS alone or HER-2 and CerbB-2 alone,and the differences were statistically significant(all P<0.05).Conclusion The quantitative parameters of CEUS are helpful in differentiating benign and malignant breast lesions,and are correlated to the expressions of HER-2 and CerbB-2.The combined diagnosis of quantitative parameters of CEUS and HER-2 and CerbB-2 can improve the accuracy of preoperative and non-invasive diagnosis of patients with lump-type breast cancer,and provide reference for clinical treatment.