乳腺BI-RADS3-5类良恶性结节超声造影增强形态模式及时间-强度曲线类型差异性分析

Difference analysis of CEUS enhanced morphology pattern and TIC type between benign and malignant nodules of BI-RADS3-5 type of breast

目的:分析乳腺BI-RADS3-5类良恶性结节超声造影(CEUS)增强形态模式及时间-强度曲线(TIC)类型差异。方法:选取医院乳腺外科收治的131例女性乳腺BI-RADS3-5类病变患者,根据病理结果将其分为良性组(61例)和恶性组(70例)。所有患者均为单发结节,术前行常规超声及超声造影检查,记录并比较两组患者观察区域的造影增强特点、TIC类型及相关参数,分析乳腺BI-RADS3-5类良恶性结节CEUS增强形态模式及TIC类型差异。结果:恶性结节超声造影增强特征多为高增强、血管行走紊乱、增强边界不清晰、增强面积>50%、造影剂分布不均匀以及病灶范围增大;良性结节多为等低增强、血管行走规则、增强边界清晰、增强面积<50%、造影剂分布均匀以及病灶范围未见明显变化。两组乳腺结节TIC类型差异无统计学意义;恶性组乳腺结节峰值强度、相对峰值强度、相对曲线下面积、相对达峰时间以及相对上升斜率水平明显高于良性组,相对开始增强时间明显低于良性组(t=4.731,t=6.757,t=2.950,t=2.997,t=3.137,t=3.652;P<0.05)。logistic回归分析得知,增强边界、病灶范围增大及相对峰值强度对乳腺恶性结节的诊断具有显著意义。受试者工作特征(ROC)曲线下面积(AUC)分析得出,造影TIC评估乳腺恶性结节的AUC为0.785;增强模式评估乳腺恶性结节的AUC为0.719。结论:CEUS增强边界、病灶范围增大及相对峰值强度有助于乳腺良恶性结节病灶诊断,造影TIC与增强模式在鉴别乳腺BI-RADS3-5类良恶性结节具有一定价值。

Objective:To analyze the difference of enhanced morphological mode of contrast-enhanced ultrasonography(CEUS)and time intensity curve(TIC)type between benign and malignant nodules of BI-RADS3-5 type of breast.Methods:The clinical data of 131 female patients with BI-RADS3-5 lesions in breast surgery were selected and they were divided into benign group(61 cases)and malignant group(70 cases)according to the pathological results.All patients were solitary nodules and they underwent routine ultrasound and CEUS examination before operation.The contrast-enhanced characteristics,TIC types and related parameters of the observation region of the two groups were recorded and compared.And the differences of CEUS enhanced morphological patterns and TIC types between benign and malignant nodules of BI-RADS3-5 type of breast were analyzed.Results:The most of the CEUS enhanced characteristics of malignant nodules were high enhancement,disordered vascular walking,unclear enhanced boundary,enhanced area>50%,uneven distribution of contrast media and enlarged focus scope.And the most of benign nodules were iso-low enhancement,regular vascular walking,clear enhanced boundary,enhanced area<50%,uniform distribution of contrast media and focus scope.There was no significant difference in TIC types of breast nodules between the two groups(P>0.05).The peak intensity,relative peak intensity,relative area under the curve(AUC),relative time to peak and the level of relative rising slope of breast nodules in malignant group were significantly higher than those in benign group,and the relative beginning enhancement time of malignant group was significantly lower than that of benign group(t=4.731,t=6.757,t=2.950,t=2.997,t=3.137,t=3.652,P<0.05).The results of Logistic regression analysis showed that the enhanced boundary,the enlargement of lesion range and the relative peak intensity had significant significances in diagnosing malignant nodules of breast.The analyses of receiver operating characteristic(ROC)curve showed that the AUC of contrast TIC was 0.785 in assessing malignant nodules of breast.The AUC of enhancement mode was 0.719 in assessing malignant nodules of breast.Conclusion:CEUS enhanced boundary,the enlargement of lesion range and relative peak intensity contribute to diagnose the lesions of benign and malignant nodules of breast.Contrast TIC and enhanced mode are of a certain value in differentiating benign and malignant nodules of BI-RADS3-5 type of breast.