CEUS多参数联合血清外泌体CD82、孕激素受体膜组分1检测对乳腺癌早期筛查的临床价值

Clinical value of CEUS combined with serum exosome CD82 and progesterone receptor membrane component 1 detection in early screening of breast cancer

目的:探讨CEUS多参数联合血清外泌体CD82、孕激素受体膜组分1检测对乳腺癌早期筛查的临床价值。方法:对2019年10月~2020年12月入本院的92例乳腺癌早期患者作为研究对象,均进行DWI检查并计算表观扩散系数(ADC),同时检测血清CA153、CA125和CEA水平,并根据穿刺或手术病理检查结果将患者分为乳腺癌组和良性疾病组,比较两组DWI图像特征、ADC值和血清CA153、CA125和CEA水平,分析DWI和肿瘤标志物单独及联合应用对乳腺癌的诊断价值。二者单独诊断及联合诊断的灵敏度、特异度、准确性、阳性预测值和阴性预测值。结果:两组患者在年龄、体重指数、初潮年龄及CHOL比较无统计差异,而空腹血糖(FTG)和糖基类抗原153(CA153)的比较差异有统计学意义(P<0.05);良性组峰值强度、区域血流量及肿瘤直径显著性小于乳腺癌组(P<0.05),平均通过时间显著性大于乳腺癌组(P<0.05);良性组中PGRMC1浓度为(41.58±16.28)ng/L,乳腺癌组中PGRMC1浓度为(39.24±10.57)ng/L,组间PGRMC1浓度有明显差异(P<0.05);相比良性组,乳腺癌组的CD82表达量更高(P<0.05)。乳腺良恶性肿物间的增强强度与肿物内血管形态间比较,有统计学差异(P<0.05),肿瘤的造增强方式及有无灌注缺损比较,无统计学差异(P>0.05);PEAK诊断乳腺癌的敏感度为45.37%、特异性为75.02%、准确度为54.42%、阳性预测值为80.02%及阴性预测值为38.54%。CEUS与CD82、PGRMC1联合诊断甲状腺癌的特异度和准确度分别高于单独应用CEUS(P<0.05)。结论:CEUS多参数联合CD82与PGRMC1联合能够更准确对乳腺癌的诊断效能,对于乳腺癌高早期血清学筛查及临床治疗方案的选择至关重要。

92 patients with early breast cancer admitted to Xingtai third hospital from October 2019 to December 2020 were enrolled in this study. DWI was performed and apparent diffusion coefficient(ADC)was calculated. Serum CA153,CA125 and CEA levels were also measured. The patients were divided into breast cancer group and benign breast disease group according to the results of puncture or surgical pathological examination. DWI image characteristics,ADC values and serum CA153,CA125 and CEA levels were compared between the two groups. The diagnostic value of DWI and tumor markers alone and in combination for breast cancer was analyzed,including their sensitivity,specificity,accuracy,positive predictive value and negative predictive value. The results showed that there was no statistical difference in age,body mass index,age at menarche and CHOL between the two groups,but there was statistical difference in fasting blood glucose(FTG)and carbohydrate antigen 153(CA153)(P < 0. 05);the peak intensity,regional blood flow and tumor diameter in the benign group were significantly smaller than those in the breast cancer group(P < 0. 05),and the mean transit time was significantly longer than that in the breast cancer group(P < 0. 05). The PGRMC1 concentration in benign group was(41. 58 ± 16. 28)ng/L,and that in breast cancer group was(39. 24 ± 10. 57)ng/L. There was a significant difference in the PGRMCl concentration between the groups(P < 0. 05). Compared with the benign group,the CD82 expression in breast cancer group was higher(P < 0. 05). There was a statistically significant difference between the enhancement intensity between benign and malignant breast tumors and the vascular morphology in the tumors(P < 0. 05),and there was no statistically significant difference between the enhancement pattern of tumors and the presence or absence of perfusion defect(P > 0. 05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of PEAK in the diagnosis of breast cancer were 45. 37%,75. 02%,54. 42%,80. 02% and 38. 54%,respectively. The specificity and accuracy of CEUS combined with CD82 and PGRMC1 in the diagnosis of thyroid cancer were higher than those of CEUS alone(P < 0. 05). CEUS multi-parameter combined with CD82 and PGRMCl can diagnose breast cancer more accurately.