平面波超敏感血流显像联合实时剪切波弹性成像对乳腺良恶性结节的鉴别诊断价值

Value of angio planewave ultrasensitive imaging combined with real-time shear wave elastography in the differential diagnosis of benign and malignant breast nodules

目的 探讨平面波超敏感血流显像(AP)联合实时剪切波弹性成像(SWE)对乳腺良恶性结节的鉴别诊断价值。方法 选取101个经病理证实的BI-RADS分类3~5类乳腺结节,其中良性53个,恶性48个。应用AP根据血流特征进行半定量血流分级与微血管构筑分型,SWE获得结节杨氏模量最大值和平均值(Emax、Emean),以及SWE分型情况,比较良恶性结节上述检查结果的差异。将单因素分析差异有统计学意义的指标纳入二元Logistic回归,分析乳腺恶性结节的独立危险因素。以病理结果为金标准,绘制受试者工作特征(ROC)曲线分析并比较AP、SWE单独及联合应用鉴别诊断乳腺良恶性结节的效能,计算曲线下面积(AUC)。结果 乳腺良恶性结节AP半定量血流分级、AP微血管构筑分型、Emax、Emean及SWE分型比较,差异均有统计学意义(均P<0.001)。Logistic回归分析显示,AP微血管构筑分型和Emax均为乳腺恶性结节的独立危险因素(OR=2.359、1.022,均P<0.05);ROC曲线分析显示,AP半定量血流分级、AP微血管构筑分型鉴别诊断乳腺良恶性结节的AUC分别为0.823、0.898,二者比较差异有统计学意义(Z=2.18,P<0.05)。Emax、Emean、SWE分型鉴别诊断乳腺良恶性结节的AUC分别为0.918、0.829、0.898,Emax与Emean的AUC比较,差异有统计学意义(Z=3.11,P<0.05)。建立联合应用的回归方程为:Logit(P)=-4.950+0.858×AP微血管构筑分型+0.021×Emax,联合应用鉴别诊断乳腺良恶性结节的AUC为0.945,高于AP微血管构筑分型和Emax单独应用,差异均有统计学意义(Z=2.41、1.97,均P<0.05);联合应用的诊断敏感性、特异性、准确率分别为83.33%、92.45%、88.12%。结论 AP联合SWE能显著提高乳腺良恶性结节的鉴别诊断效能,具有较好的临床应用价值。

Objective To investigate the value of angio planewave ultrasensitive imaging(AP)combined with realtime shear wave elastography(SWE)in the differential diagnosis of benign and malignant breast nodules.Methods Totally 101breast nodules of BI-RADS classification 3 to 5 confirmed by pathology were selected,of which 53 were benign and 48 were malignant. AP was applied to semi-quantitative flow grading and microvascular configuration staging according to flow characteristics,and SWE was used to obtain the maximum and average values of Young’s modulus of nodules(Emax,Emean),as well as SWE staging,the differences of the above findings between benign and malignant nodules were compared. The indicators with statistically significant differences in univariate analysis were included in binary Logistic regression to obtain the independent influencing factors of breast malignant nodules. Taking pathological findings as the gold standard,the receiver operating characteristic(ROC)curves were drawn to analyze and compare the efficacy of AP and SWE alone and in combination in the differential diagnosis of benign and malignant breast nodules.Results The differences in AP semi-quantitative flow grading, AP microvascular configuration typing, Emax, Emean and SWE typing between benign and malignant breast nodules were statistically significant(all P<0.001).ROC curve analysis showed that the AUC of AP semi-quantitative blood flow grading and AP microvascular configuration typing in the differential diagnosis of benign and malignant breast nodules were 0.823 and0.898,respectively,the difference was statistically significant(Z=2.18,P<0.05).The AUCs of Emax,Emean,and SWE staging in the differential diagnosis of benign and malignant breast nodules were 0.918,0.829 and 0.898,respectively,the difference between the AUCs of Emax and Emean was statistically significant(Z=3.11,P<0.05).Logistic regression analysis showed that AP microvascular configuration typing and Emax were independent risk factors for malignant breast nodules(OR=2.359,1.022,both P<0.05),the regression equation for the combined diagnosis was established:Logit(P)=-4.950+0.858×AP microvascular configuration typing+0.021×Emax,and the AUC of the combined application in the differential diagnosis of benign and malignant breast nodules was 0.945,which was higher than that of AP microvascular configuration typing and Emax alone,and the differences were statistically significant(Z=2.41,1.97,both P<0.05).The sensitivity,specificity and accuracy of combined application were 83.33%,92.45% and 88.12%,respectively.Conclusion AP combined with SWE can significantly improve the diagnostic efficacy of malignant breast nodules,which has good clinical application value.