超声造影在评价乳腺良性结节、原位癌及浸润性癌中的应用价值

Application value of contrast-enhanced ultrasound in evaluating benign breast nodules,carcinoma in situ and invasive carcinoma

目的:探讨超声造影在乳腺良、恶性结节中的应用价值。方法:选取医院行乳腺结节超声造影的340例(344枚结节)患者,所有患者均行超声引导下穿刺活检或手术切除,根据病理结果将其分为良性组(227例、229枚结节)和恶性组(113例、115枚结节),恶性组中原位癌23枚结节,浸润性癌92枚结节,分析恶性结节的独立危险因素及超声造影对恶性结节的诊断价值,以及组间超声造影参数的差异。结果:多因素Logistic回归分析结果显示,乳腺结节的增强范围、增强程度、增强均质性、形态、滋养动脉以及蟹足均为恶性结节的独立危险因素(OR=2.088,OR=2.127,OR=1.937,OR=3.387,OR=2.280,OR=2.757;P<0.05),且诊断价值较高。良性组与恶性组中原位癌比较,结节增强后形态、边界、蟹足及滋养动脉差异有统计学意义(χ^(2)=7.566,χ^(2)=5.794,χ^(2)=12.175,χ^(2)=19.442;P<0.05),原位癌与浸润性癌比较,仅增强范围差异具有统计学意义(χ^(2)=6.185,P<0.017)。结论:超声造影不仅有助于乳腺良恶性结节的鉴别,亦可用于原位癌与良性结节的鉴别诊断。

Objective:To explore the application value of contrast-enhanced ultrasound(CEUS) in evaluating benign and malignant nodules of breast.Methods:340 patients with 344 breast nodules who underwent CEUS in hospital were selected.All patients underwent ultrasound-guided needle biopsy or surgical resection.According to the pathological results,they were divided into benign group(227 patients,229 nodules) and malignant group(113 patients,115 nodules).In malignant group,23 nodules were carcinoma in situ and 92 nodules were invasive carcinoma.The independent risk factors of malignant nodules and the diagnostic value of CEUS for malignant nodules were analyzed,and the differences of CEUS parameters among various groups were further analyzed.Results:The results of multivariate logistic regression analysis showed that the enhanced scope,enhanced intensity,enhanced homogeneity,irregular shape,nutrient artery and “crab foot” sign were independent risk factors of malignant nodules(OR=2.088,OR=2.127,OR=1.937,OR=3.387,OR=2.280,OR=2.757,P<0.05),and the diagnostic values of them were higher.The differences of shape,boundary,“crab feet” sign and nutrient artery of carcinoma in situ after nodules were enhanced between benign and malignant group were significant(χ^(2)=7.566,χ^(2)=5.794,χ^(2)=12.175,χ^(2)=19.442,P<0.05).The difference of enhanced scope between carcinoma in situ and invasive carcinoma was significant(χ^(2)=6.185,P<0.017).Conclusion:CEUS is not only helpful in distinguishing benign and malignant nodules of breast,but also can be used to distinguish carcinoma in situ and benign nodules.