超声联合X线钼靶用于乳腺癌的诊断价值及与分子亚型的相关性研究

Diagnostic Value of Ultrasonography and X-ray Molybdenum Target in Breast Cancer and Its Correlation with Molecular Subtypes

目的:探讨超声及X线钼靶的多模态影像技术用于乳腺癌的临床诊断效能,并分析其与乳腺癌分子亚型的相关性。方法:选择2017年1月—2020年6月在我院手术治疗的158例乳腺癌患者,术后病理确诊213个病灶,其中恶性病灶163个,良性病灶50个。所有患者术前均行二维超声、彩色多普勒超声和X线钼靶检查,比较二维超声(Ⅰ组)、彩色多普勒超声(Ⅱ组)、X线钼靶(Ⅲ组)、二维超声+彩色多普勒超声(超声组,Ⅳ组)以及二维超声+彩色多普勒超声+X线钼靶(多模态影像组,Ⅴ组)诊断乳腺癌的准确度、灵敏度、特异度以及阳性预测值(PPV)、阴性预测值(NPV),分析影像学特征与分子亚型(Luminal A型、Luminal B型、HER-2过度表达型和三阴型-TN)的相关性。结果:Ⅴ组诊断乳腺癌的准确度、灵敏度均明显高于Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组(P<0.05),Ⅴ组诊断乳腺癌的NPV明显高于Ⅰ组、Ⅱ组、Ⅲ组(P<0.05)。乳腺癌不同分子亚型的边缘、钙化、后方回声、Alder分级等超声特征存在明显统计学差异(P<0.05);X线钼靶的癌灶肿块、癌灶形态、边缘等比较,各分子亚型间差异有统计学意义(P<0.05)。结论:超声联合X线钼靶的多模态影像用于乳腺癌的诊断效能最高,乳腺癌的超声特征、X线钼靶特征与分子亚型间存在相关性。

Objective:To investigate the clinical diagnostic efficacy of multimodal imaging techniques of ultrasound and X-ray molybdenum target in breast cancer,and analyze the correlation between it and molecular subtypes of breast cancer.Methods:158 patients with breast cancer,selected from January 2017 to June 2020,were treated by operation in our hospital.213 lesions were confirmed by postoperative pathology,including 163 malignant lesions and 50 benign lesions.All patients were diagnosed by two-dimensional ultrasound,color Doppler ultrasound and X-ray molybdenum target examination before operation.The accuracy,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of two dimensional ultrasound(groupⅠ),color Doppler ultrasound(groupⅡ),X-ray molybdenum target(groupⅢ),two-dimensional ultrasound+color Doppler ultrasound(ultrasound group,groupⅣ)and two-dimensional ultrasound+color Doppler ultrasound+X-ray molybdenum target(multimodal imaging group,groupⅤ)were compared.The correlation between imaging features and molecular subtypes(Luminal A,Luminal B,HER-2 overexpression and triple negative-TN)were analyzed.Results:The accuracy and sensitivity in groupⅤwere significantly higher than those in groupⅠ,groupⅡ,groupⅢand groupⅣ(P<0.05),and NPV in groupⅤwas significantly higher than that in groupⅠ,groupⅡand groupⅢ(P<0.05).There were significant differences in the ultrasonic characteristics of breast cancer,such as edge,calcification,posterior echo and alder classification among different molecular types(P<0.05);there were statistically significant differences in X-ray mammography characteristics of tumor mass,tumor shape and margin of mammography among different molecular types of breast cancer(P<0.05).Conclusion:Ultrasound combined with X-ray mammography was the most effective in the diagnosis of breast cancer,and there was a correlation between ultrasound features,X-ray mammography features and molecular subtypes of breast cancer.