基于临床及超声特征列线图模型诊断淋巴瘤

Nomogram model based on clinical and ultrasonic characteristics for diagnosing lymphoma

目的观察基于临床及超声特征列线图模型诊断淋巴瘤的价值。方法回顾性分析176例因浅表淋巴结肿大而疑诊淋巴瘤患者,根据病理结果将其分为淋巴瘤组(n=90,侵袭亚组40例、非侵袭亚组50例)与非淋巴瘤组(n=86);比较组间与亚组间临床及超声资料,采用多因素logistic回归分析筛查淋巴瘤的独立危险因素并据以构建列线图;采用受试者工作特征曲线,比较常规超声、常规超声造影(C-CEUS)、高帧频超声造影(H-CEUS)及列线图评估淋巴瘤的效能。结果多因素logistic回归分析结果显示,年龄>59岁、淋巴结皮质条状/网状高回声及H-CEUS“离心烟花”样增强均为淋巴瘤的独立危险因素(P均<0.05)。以年龄59岁为最佳截断值,其诊断淋巴瘤的敏感度、特异度、准确率及曲线下面积(AUC)分别为67.78%、58.10%、63.06%及0.630;以皮质条状/网状高回声评估分别为73.33%、58.10%、65.91%及0.657;根据H-CEUS“离心烟花”样增强诊断时分别为77.78%、69.80%、73.86%及0.738。常规超声、C-CEUS、H-CEUS及列线图模型诊断淋巴瘤的AUC分别为0.657、0.540、0.738及0.844。结论基于临床及超声特征列线图模型诊断淋巴瘤效能良好;H-CEUS“离心烟花”样增强可视为淋巴瘤特异性表现。

Objective To observe the value of nomogram model based on clinical and ultrasonic characteristics for diagnosing lymphoma.Methods Data of 176 patients with suspected lymphoma due to enlarged superficial lymph nodes were retrospective analyzed.The patients were divided into lymphoma group(n=90,invasive subgroup[n=40]and noninvasive subgroup[n=50])or non-lymphoma group(n=86)based on pathological results.Clinical and ultrasonic data were compared between groups and subgroups.Multivariate logistic regression was used to screen the independent risk factors of lymphoma,and then a nomogram was constructed.Receiver operating characteristic curves were drawn to evaluate the efficacy of conventional ultrasound,conventional contrast-enhanced ultrasound(C-CEUS),high-frame-rate contrast-enhanced ultrasound(H-CEUS)and nomogram for diagnosing lymphoma.Results Multivariate logistic regression analysis revealed that age>59 years,cortical stripe/reticular hyperecho of lymph nodes and“centrifugal firework”enhancement pattern showed with H-CEUS were all independent risk factors of lymphoma(all P<0.05).Taken 59 years as the best cut-off value of patients’age,the sensitivity,specificity,accuracy and the area under the curve(AUC)for diagnosing lymphoma was 67.78%,58.10%,63.06%and 0.630,respectively.The sensitivity,specificity,accuracy and AUC of cortical stripe/reticular hyperecho of lymph nodes for diagnosing lymphoma was 73.33%,58.10%,65.91%and 0.657,respectively,while of“centrifugal firework”pattern enhancement in H-CEUS was 77.78%,69.80%,73.86%and 0.738,respectively.AUC of conventional ultrasound,C-CEUS,H-CEUS and nomogram for diagnosing lymphoma was 0.657,0.540,0.738 and 0.844,respectively.Conclusion Nomogram model based on clinical and ultrasonic characteristics had good diagnostic efficacy for lymphoma,and“centrifugal firework”pattern enhancement in H-CEUS could be regarded as the specific characteristic of lymphoma.