乳腺良恶肿瘤患者超声弹性成像定量参数与临床分期、病理分子分型的相关性分析

Correlation Analysis of Quantitative Parameters of Ultrasound Elastic Imaging with Clinical stage and Pathological Molecular Classification of Benign and Malignant Breast Tumors

目的:探讨乳腺良恶肿瘤患者超声弹性成像定量参数与临床分期、病理分子分型的相关性。方法:选择2020年1月至2022年12月来我院诊治的乳腺肿块患者85例,均行超声弹性成像检查,分析85例乳腺肿块患者的病理检查结果,对比良恶性肿瘤患者的弹性成像参数,对弹性应变率、直径变化率、面积比及三者联合绘制ROC曲线,分析不同乳腺肿瘤患者临床分期的弹性成像参数,分析乳腺肿瘤患者病理分子分型的弹性成像参数。结果:85例乳腺肿块患者中,良性肿块35例,恶性肿块50例。恶性组的弹性应变率、肿块直径、直径变化率、肿块面积、面积比明显较良性组低(P<0.05)。面积比ROC曲线AUC为0.580,以1.73为临界值,乳腺恶性肿瘤的诊断灵敏度为73.5%,特异度为38.5%;直径变化率ROC曲线AUC为0.630,以0.28为临界值,诊断灵敏度为75.5%,特异度为47.5%;弹性应变率ROC曲线AUC为0.790,以15.2cm^(2)为临界值,诊断灵敏度为64.5%,特异度为83.5%,以三者联合绘制ROC曲线AUC为0.920,诊断灵敏度为82.5%,特异度为92.5%。乳腺恶性肿瘤患者TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比对比有统计学意义(P<0.05);其中IV期者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比明显较Ⅲ、Ⅱ、Ⅰ期者高,Ⅱ期者明显较Ⅱ、Ⅰ期者高,II期者明显较I期高。乳腺恶性肿瘤患者Luminal A型者、Liminal B型者、Her2过表达型者、基底样型者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比对比有统计学意义(P<0.05);其中LiminalB型者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比明显较LuminalA型者、Her2过表达型者、基底样型者高,Her2过表达型者明显较Luminal A型者、基底样型者高(P均<0.05),Luminal A型者与基底样型者对比无统计学意义(P>0.05)。结论:超声弹性成像可用于乳腺良恶肿瘤的诊断,超声弹性成像定量参数可用于恶性乳腺肿瘤临床分期、Liminal B型、Her2过表达型的判断。

Objective:To investigate the correlation between quantitative parameters of ultrasound elastic imaging and clinical stage and pathological molecular classification of benign and malignant breast tumors.Methods:85 patients with breast mass admitted to our hospital from January 2020 to December 2022 were selected to undergo ultrasound elastic imaging examination.The pathological examination results of 85 patients with breast mass were analyzed,elastic imaging parameters of benign and malignant tumors were compared,and ROC curves were drawn for elastic strain rate,diameter change rate,area ratio and the three combined.The elastic imaging parameters of different clinical stages of breast cancer patients and the elastic imaging parameters of pathological molecular classification of breast cancer patients were analyzed.Results:Among 85 patients with breast mass,35 cases were benign and 50 cases were malignant.The elastic strain rate,mass diameter,diameter change rate,mass area and area ratio in the malignant group were significantly lower than those in the benign group(P<0.05).The area ratio ROC curve AUC was 0.580,with 1.73 as the critical value,the diagnostic sensitivity and specificity of breast malignant tumor were 73.5%and 38.5%.The ROC curve of diameter change rate was 0.630 with 0.28 as the critical value.The diagnostic sensitivity was 75.5%and the specificity was 47.5%.The ROC curve of elastic strain rate was 0.790,with 15.2 cm^(2) as the critical value,the diagnostic sensitivity was 64.5%,and the specificity was 83.5%.The ROC curve was drawn with the three factors combined,and the AUC was 0.920,the diagnostic sensitivity was 82.5%,and the specificity was 92.5%.There were significant differences in the elastic strain rate,mass diameter,diameter change rate,mass area and area ratio in patients with breast malignant tumor at TNM stageⅠ ,Ⅱ,Ⅲ and Ⅳ(P<0.05).Among them,the elastic strain rate,mass diameter,diameter change rate,mass area and area ratio of stage Ⅳ were significantly higher than those of stage Ⅲ,Ⅱ and Ⅰ,stage Ⅱ was significantly higher than those of stage Ⅱ and Ⅰ,and stage Ⅱ was significantly higher than those of stage Ⅰ.The differences of elastic strain rate,mass diameter,rate of diameter change,mass area and area ratio in Luminal A,Liminal B,Her2 overexpression and basal-like patients with breast malignant tumor were statistically significant(P<0.05).The elastic strain rate,mass diameter,rate of diameter change,mass area and area ratio of the Liminal B type are significantly higher than those of Luminal A,Her2 overexpression and basal-like type,and the overexpression of Her2 is significantly higher than those of Luminal A and basal-like type(all P<0.05).There was no statistical significance between Luminal A type and basal-like type(P>0.05).Conclusion:Ultrasound elastic imaging can be used for the diagnosis of benign and malignant breast tumors,and the quantitative parameters of ultrasound elastic imaging can be used to judge the clinical stage of malignant breast tumors,the Liminal type B,the Her2 overexpression type.