超声弹性成像与超声造影对乳腺癌的诊断效能及其与免疫组织化学指标的相关性

Diagnostic efficacy of ultrasonic elastography and contrast-enhanced ultrasound in breast cancer and their correlation with immunohistochemical markers

目的:探索超声弹性成像与超声造影对乳腺癌的诊断效能及其与免疫组织化学指标的相关性。方法:回顾性分析2019年2月至2021年3月期间收集的接受超声弹性成像与超声造影检查的134例疑似单发病灶乳腺癌患者,均进行超声造影、超声弹性成像检查。以组织病理活检为“金标准”,分析各项诊断方式的诊断效能,同时进行人类表皮生长因子受体-2(humanepidermal growth factor receptor-2,HER-2)、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、Ki-67检测,分析超声参数[达峰时间(timetopeak,TTP)、最大弹性(max imum enhancement,Ema x)值]与免疫组织化学指标的相关性。结果:超声造影诊断准确率为78.36%,超声弹性成像诊断准确率为72.39%,两项联合诊断准确率为94.03%。经受试者工作特征(receiver operating characteristic,ROC)曲线分析,超声弹性成像、超声造影、两项联合预测乳腺癌的曲线下面积(area under the curve,AUC)分别为0.652、0.743、0.928。同时HER-2阳性表达者的Emax值[(144.47±22.13)kPa]和TTP水平[(17.58±2.11)s]均高于阴性表达者;Ki-67高表达患者的Ema x值[(145.11±19.76)kPa]和TTP水平[(17.82±2.55)s]均高于低表达者(均P<0.05)。经Spearman法分析,TTP与Ki-67呈正相关。结论:超声造影联合超声弹性成像诊断乳腺癌的效能较高,且超声参数TTP可能与Ki-67存在关联。

Objective:To explore the diagnostic efficacy of breast cancer by ultrasound elastography and contrast-enhanced ultrasound and its correlation with immunohistochemical indexes.Methods:Retrospective analysis of 134 patients of suspected single focus breast cancer who underwent ultrasound elastography and contrast-enhanced ultrasound were collected from February 2019 to March 2021.Contrast-enhanced ultrasound and ultrasound elastography were performed.The diagnostic efficacy of various diagnostic methods was analyzed with histopathological biopsy as the agold standardo.At the same time,human epidermal growth factor receptor-2(HER-2),estrogen receptor(ER),progesterone receptor(PR),and Ki-67 were detected,the correlations between ultrasonic parameters[time to peak(TTP),maximum enhancement(Emax)value]and immunohistochemical indexes were analyzed.Results:The diagnostic accuracy of contrast-enhanced ultrasound was 78.36%,the diagnostic accuracy of ultrasound elastography for breast cancer was 72.39%,and the combined diagnostic accuracy of the two was 94.03%.According to the receiver operating characteristic(ROC)curve analysis,the areas under the curve(AUCs)of ultrasound elastography,contrast-enhanced ultrasound,and the two combined to predict breast cancer were 0.652,0.743,and 0.928,respectively.At the same time,the Emax value[(144.47±22.13)kPa]and TTP levels[(17.58±2.11)s]of HER-2 positive expression were higher than those of negative expression;the levels of Emax value[(145.11±19.76)kPa]and TTP[(17.82±2.55)s]in patients with high Ki-67 expression were higher than those in patients with low Ki-67 expression(all P<0.05).By Spearman analysis,TTP was positively correlated with Ki-67.Conclusion:Contrast-enhanced ultrasound combined with elastography is more effective in the diagnosis of breast cancer,and the ultrasonic parameter TTP may be associated with Ki-67.