乳腺导管内良恶性肿瘤超声图像特征的对比分析

Comparative analysis of ultrasound image features of benign and malignant breast intraductal tumors

目的对比分析乳腺导管内良恶性肿瘤的超声图像特征。方法选取我院经手术病理证实的乳腺导管内肿瘤患者68例,根据病理结果分为乳腺导管内乳头状瘤组(45例)和乳腺导管内癌组(23例),均行超声检查,比较两组临床特征和常规超声表现,并进行多因素Logistic回归分析乳腺导管内癌的独立相关因素;绘制受试者工作特征(ROC)曲线分析超声对乳腺导管内肿瘤良恶性的鉴别诊断价值。结果两组在病变长径、前后径、位置、内部回声、微小钙化、后方回声、边界方面比较,差异均有统计学意义(均P<0.05);两组在年龄、乳头溢血,以及病变内部血流、形态、边缘、侧边声影、导管扩张方面比较,差异均无统计学意义。多因素Logistic回归分析结果显示:病变长径(OR=1.083,95%可信区间1.022~1.149,P=0.008)、病变位置(OR=0.214,95%可信区间0.071~0.649,P=0.006)是诊断乳腺导管内癌的独立相关因素。以病变长径14.65 mm作为鉴别乳腺导管内良恶性肿瘤的截断值,其敏感性和特异性分别为60.9%、71.1%,曲线下面积为0.694(95%可信区间0.558~0.829,P=0.009);以病变位置是否位于以乳头为中心直径2 cm外绘制诊断乳腺导管内癌的二变量ROC曲线,其敏感性和特异性分别为73.9%、62.2%,曲线下面积为0.681(95%可信区间0.547~0.815,P=0.015)。结论超声对乳腺导管内良恶性肿瘤的鉴别诊断有一定价值,其中病变长径和位置是诊断乳腺导管内癌的独立相关因素,结合乳腺导管内癌病变内部多伴微小钙化、后方回声多异常、边界多不清等超声特征,可提高诊断准确率。

Objective To comparatively analysis the ultrasound image features of benign and malignant breast intraductal tumors.Methods Sixty-eight patients with breast intraductal tumors confirmed by surgery and pathology in our hospital were selected.According to the pathological results,the patients were divided into intraductal papilloma group(45 casas)and intraductal carcinoma group(23 cases).Ultrasonography was performed,the clinical features and conventional ultrasound features were compared.The independent related factors of breast intraductal carcinoma were analyzed by multivariate logistic regression.The receiver operating characteristic(ROC)curve was drawn to analyze the differential diagnosis value of benign and malignant breast intraductal tumors.ResultsThere were statistically significant differences between the two groups in the length of lesion,anteroposterior diameter,location,internal echo,internal microcalcification,posterior echo and boundary(all P<0.05).There were no statistically significant differences between the two groups in the age,nipple hemorrhage,internal blood flow,morphology,margins,side sound shadows,and ductal dilatation.Multivariate Logistic regression analysis showed that the length of the lesion(OR=1.083,95%CI 1.022~1.149,P=0.008)and the lesion location(OR=0.214,95%CI 0.071~0.649,P=0.006)were independent related factors for the diagnosis of intraductal carcinoma of the breast.Taking the length of the lesion of 14.65 mm as the cut-off value for the differentiation of benign and malignant breast intraductal tumor,the sensitivity and specificity were 60.9%and 71.1%,respectively,and the area under ROC curve was 0.694(95%CI 0.558~0.829,P=0.009).The two-variable ROC curve for identifying intraductal carcinoma was drawn based on whether the tumor lesion was located at 2 cm away from the nipple,the sensitivity and specificity were 73.9%and 62.2%,respectively,and the area under the ROC curve was0.681(95%CI 0.547~0.815,P=0.015).ConclusionUltrasound has a certain value in differential diagnosis of benign and malignant breast intraductal tumor the length and the location of the lesion are independent correlated factors in the diagnosis of breast intraductal carcinoma.The accuracy of intraductal carcinoma can be improved by diagnosing with the characteristics of ultrasound,such as micro-calcification,posterior echo abnormal and unclear boundary.