超声BI-RADS分级联合血清CA153、CEA、ALP检测在乳腺癌早期诊断及腋窝淋巴结转移预测中的应用

Application of Ultrasound BI-RADS Grading Combined with Serum CA153,CEA and ALP Detection in the Early Diagnosis of Breast Cancer and Prediction of Axillary Lymph Node Metastasis

目的:探究超声BI-RADS分级联合血清糖类抗原153(CA153)、癌胚抗原(CEA)、碱性磷酸酶(ALP)检测在乳腺癌早期诊断及腋窝淋巴结转移预测中的应用价值。方法:以2020年5月—2022年5月景德镇市第二人民医院97例乳腺癌患者(恶性组)及72例乳腺良性肿瘤患者(良性组)为研究对象进行回顾性研究,比较良性组及恶性组的超声征象、超声BI-RADS分级及血清指标,分析超声BI-RADS分级联合血清指标对乳腺癌的诊断价值;根据患者腋窝淋巴结转移情况将恶性组患者分为转移组及未转移组,分析超声BI-RADS分级联合血清指标与乳腺癌腋窝淋巴结转移的关系及诊断价值,并比较不同临床特征患者的血清CA153、CEA、ALP水平。结果:恶性组中肿瘤边缘不光整、形态不规则、纵横比≥1、内部微钙化、内部血流RI≥0.7、后方回声衰减、周围组织改变的比例分别为83.51%、88.66%、57.73%、59.79%、60.82%、18.56%和27.84%,高于良性组的23.61%、25.00%、9.72%、8.33%、6.94%、4.17%、1.39%(P<0.05);良性组中超声BI-RADS分级1级2例,2级17例,3级22例,4A级18例,4B级8例,4C级5例,5级0例;恶性组中1级0例,2级0例,3级5例,4A级9例,4B级31例,4C级25例,5级27例。超声BI-RADS分级对乳腺癌的诊断准确率为84.02%(142/169)。恶性组血清CA153、CEA、ALP水平均高于良性组[(11.39±2.24)U/m L、(5.13±1.17)ng/m L、(88.46±17.13)U/L vs(7.61±1.69)U/mL、(2.11±0.42)ng/mL、(54.05±10.98)U/L,P<0.05];联合检测诊断乳腺癌的AUC大于超声BI-RADS分级与血清指标单独检测(P<0.05);转移组中超声BI-RADS分级1级0例,2级0例,3级1例,4A级2例,4B级7例,4C级13例,5级16例;未转移组超声BI-RADS分级1级0例,2级0例,3级4例,4A级7例,4B级24例,4C级12例,5级11例。转移组的超声BI-RADS分级显著高于未转移组(P<0.05);转移组血清CA153、CEA、ALP水平均高于未转移组[(13.51±2.39)U/mL、(5.93±1.16)ng/m L、(94.16±12.54)U/L vs(9.96±1.82)U/mL、(4.59±0.89)ng/mL、(84.63±10.07)U/L,P<0.05];联合检测诊断乳腺癌腋窝淋巴结转移的AUC大于超声BI-RADS分级与血清指标单独检测(P<0.05);超声BI-RADS分级升高、CA153≥11.98 U/mL、CEA≥5.13 ng/mL是乳腺癌腋窝淋巴结转移的影响因素(P<0.05);肿瘤直径>2 cm的乳腺癌患者血清CA153、CEA水平均高于肿瘤直径≤2 cm患者,TNM分期Ⅲ、Ⅳ期患者的血清CA153、CEA水平均高于Ⅰ、Ⅱ期患者,低分化患者的血清CA153、CEA水平均高于中、高分化患者(P<0.05)。结论:超声BI-RADS分级联合血清CA153、CEA、ALP检测对乳腺癌具有诊断价值,对腋窝淋巴结转移具有预测价值,且患者血清CA153、CEA水平或与肿瘤直径、TNM分期等肿瘤病理特征有关。

Objective:To explore the application value of ultrasound BI-RADS grading combined with serum carbohydrate antigen 153(CA153),carcinoma embryonic antigen(CEA)and alkaline phosphatase(ALP)detection in the early diagnosis of breast cancer and the prediction of axillary lymph node metastasis.Method:A total of 97 patients with breast cancer(malignant group)and 72 patients with benign breast tumors(benign group) in the Second People's Hospital of Jingdezhen from May 2020 to May 2022 were selected as the research subjects for retrospective study. The ultrasound signs, ultrasound BI-RADS grading and serum indicators were compared between benign group and malignant group, and the diagnostic value of ultrasound BI-RADS grading combined with serum indicators on breast cancer was analyzed. According to the axillary lymph node metastasis of the patients, the patients in malignant group were divided into metastasis group and non-metastasis group. The relationship of ultrasound BI-RADS grading combined with serum indicators with axillary lymph node metastasis of breast cancer and its diagnostic value were analyzed, and serum levels of CA153, CEA and ALP were compared among patients with different clinical characteristics. Result: The proportions of patients with unsmooth tumor edge, irregular shape, aspect ratio ≥1, internal microcalcification, internal blood flow RI ≥0.7, posterior echo attenuation, and surrounding tissue changes were 83.51%, 88.66%, 57.73%, 59.79%, 60.82%, 18.56% and 27.84% in malignant group, which were higher than 23.61%, 25.00%, 9.72%, 8.33%, 6.94%, 4.17% and 1.39% in benign group (P<0.05). In benign group, there were 2 cases of BI-RADS grade 1, 17 cases of grade 2, 22 cases of grade 3, 18 cases of grade 4A, 8 cases of grade 4B, 5 cases of grade 4C and 0 case of grade 5. In malignant group, there were 0 case of grade 1, 0 case of grade 2, 5 cases of grade 3, 9 cases of grade 4A, 31 cases of grade 4B, 25 cases of grade 4C and 27 cases of grade 5. The diagnostic accuracy rate of ultrasound BI-RADS grading for breast cancer was 84.02% (142/169). The levels of CA153, CEA and ALP in malignant group were higher than those in benign group [(11.39±2.24) U/mL vs (7.61±1.69) U/mL, (5.13±1.17) ng/mL vs (2.11±0.42) ng/mL, (88.46±17.13) U/L vs (54.05±10.98) U/L, P<0.05]. The AUC of combined detection in the diagnosis of breast cancer was greater than that of ultrasound BI-RADS grading or serum indicators alone (P<0.05). In metastasis group, there were 0 case of BI-RADS grade 1, 0 case of grade 2, 1 case of grade 3, 2 cases of grade 4A, 7 cases of grade 4B, 13 cases of grade 4C and 16 cases of grade 5. In non-metastasis group, there were 0 case of BI-RADS grade 1, 0 case of grade 2, 4 cases of grade 3, 7 cases of grade 4A, 24 cases of grade 4B, 12 cases of grade 4C and 11 cases of grade 5. The ultrasound BI-RADS grading in metastasis group was significantly higher than that in non-metastasis group (P<0.05). Serum levels of CA153, CEA and ALP were higher in metastasis group than those in non-metastasis group [(13.51±2.39) U/mL vs (9.96±1.82) U/mL, (5.93±1.16) ng/mL vs (4.59±0.89) ng/mL, (94.16±12.54) U/L vs (84.63±10.07) U/L, P<0.05]. The AUC of combined detection in the diagnosis of axillary lymph node metastasis of breast cancer was greater than that of ultrasound BI-RADS grading or serum indicators alone (P<0.05). Elevated ultrasound BI-RADS grade, CA153 ≥11.98 U/mL, and CEA ≥5.13 ng/mL were the influencing factors of axillary lymph node metastasis of breast cancer (P<0.05). The levels of serum CA153 and CEA in patients with breast cancer of tumor diameter >2 cm were higher than those in patients with tumor diameter ≤2 cm, and the levels in patients with TNM stage Ⅲ and Ⅳ were higher than those in patients with TNM stage Ⅰ and Ⅱ, and the levels in patients with poor differentiation were higher than those in patients with middle or high differentiation (P<0.05). Conclusion: Ultrasound BI-RADS grading combined with serum CA153, CEA and ALP detection has diagnostic value on breast cancer, and has predictive value on axillary lymph node metastasis, and serum CA153 and CEA levels of patients may be related to tumor diameter, TNM stage and other tumor pathological characteristics.