浸润带超声造影梯度特征预测浸润性导管癌Nottingham分级及病理真实浸润的价值

Predictive value of infiltrating zone contrast-enhanced ultrasound gradient features in Nottingham grading and pathologically true infiltration of invasive ductal carcinoma

目的探讨浸润带超声造影梯度特征在预测浸润性导管癌(IDC)Nottingham分级及病理真实浸润中的价值。方法回顾性分析2019年7月至2022年6月江苏大学附属医院手术病理证实的女性乳腺癌患者78例(95个肿块), 根据Nottingham组织学分级系统将所有肿块分为Ⅰ级(22个)、Ⅱ级(28个)、Ⅲ级(45个)。比较三组肿块浸润带最大径及浸润带内外缘梯度特征参数差异, 将差异性参数纳入多元有序Logistic回归分析及ROC曲线分析, 进一步挖掘差异性梯度特征与肿块病理真实浸润的关系。结果方差分析显示三组肿块在浸润带比值(ΔL1-2/L1)、达峰时间梯度值(ΔTTP)、上升支斜率梯度值(ΔRS)、峰值强度梯度值(ΔPI)及曲线下面积梯度值(ΔAUC)差异有统计学意义(均P<0.05)。多元有序Logistic回归分析显示ΔTTP、ΔPI及ΔAUC是IDC组织学分级的独立影响因子(均P<0.05), 三者联合预测IDC组织学Ⅰ级、Ⅱ级和Ⅲ级的曲线下面积分别为0.692、0.705和0.765。另外, 肿块病理真实浸润最大径与ΔTTP(r=0.621, P<0.05)呈正相关, 与ΔPI(r=-0.605, P<0.05)及ΔAUC(r=-0.719, P<0.05)呈负相关。结论浸润带超声造影梯度特征可有效预测IDC组织学等级, 并且与肿块病理真实浸润程度密切相关。

Objective To investigate the predictive value of infiltrating zone contrast-enhanced ultrasound(CEUS)gradient features in Nottingham grading and pathologically true infiltration of invasive ductal carcinoma(IDC).Methods A retrospective analysis was performed on 78 female breast cancer patients(95 masses)confirmed by surgical and pathology in the Affiliated Hospital of Jiangsu University from July 2019 to June 2022,which were divided into Grade-Ⅰ(22 masses),Grade-Ⅱ(28 masses),and Grade-Ⅲ(45 masses)according to the Nottingham histological grading system.The differences in the maximum diameter of the infiltration zone and the characteristic parameters of the gradient of the inner and outer edges of the infiltration zone among the three groups of masses were compared,and the differential gradient features among them were analyzed by multivariate ordered Logistic regression and ROC curves.The relationship between the differential gradient characteristics of the infiltration zone and the pathologically true infiltration of the mass was further explored.Results The univariate analysis showed statistically significant differences among the three groups for peak-arrival time gradient(ΔTTP),ascending branch slope gradient(ΔRS),peak intensity gradient(ΔPI)and area gradient under the curve(ΔAUC)(all P<0.05).Multiple ordered logistic regression analysis showed thatΔTTP,ΔPI andΔAUC had independent influences on the histologic grading of IDC(all P<0.05),and the area under the curve for the combination of the three in predicting IDC histology gradesⅠ,ⅡandⅢwas 0.692,0.705 and 0.765,respectively.In addition,the maximum diameter of pathologically true infiltration of the mass was positively correlated withΔTTP(r=0.621,P<0.05)and negatively correlated withΔPI(r=-0.605,P<0.05)andΔAUC(r=-0.719,P<0.05).Conclusions Infiltration zone CEUS gradient features are effective in predicting the histologic grade of IDC and strongly correlate with the degree of pathologically true infiltration of the mass.