乳腺非肿块性病变的超声特征探讨及多模态超声诊断

Ultrasonic characteristics and multi-mode ultrasound diagnosis of non-mass breast lesions

目的 分析非肿块性乳腺病变(NML)在B型超声(US)、彩色多普勒超声、应变弹性成像(SE)和对比增强超声(CEUS)中的特征,建立多模态超声方法鉴别恶性NML病变,并比较多模式超声方法诊断恶性NML的诊断效能。方法 回顾性分析2020年12月—2023年7月本院行乳腺多模超声(B超+CDFI+SE+CEUS)检查患者的临床资料,以病理学结果作为金标准,分为良性组和恶性组。比较两组患者的年龄、临床症状及月经史、US、彩色多普勒、SE、CEUS各种模式下多个参数的差异,并使用二元逻辑回归法确定诊断恶性NML独立的危险因素,进一步建立恶性NML预测模型并检查模型的ROC曲线下面积(AUC)、敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV)并比较不同超声模式下的NML诊断效能。结果 共纳入68例患者(共71个乳腺病变)。患者平均年龄(46.32±9.96)岁。病变的最大直径0.47~5.62 cm,平均值为(2.25±1.30)cm。恶性组40个(56.3%),良性组31个(43.7%)。两组的年龄、微钙化、血管分布、达峰时间、峰值强度、蟹爪状形态和硬度均具有统计学差异(P<0.05)。其中微钙化、高峰值强度、质硬是恶性NML的独立危险因素,包含上述危险因素建立的预测模型诊断恶性NML的敏感度、特异度、PPV、NPV、准确度分别为92.5%、83.9%、90.2%、89.7%、92.9%,较其他超声模式的准确度明显提高。结论 多模式超声方法简单、诊断性能高,有助于预测NML的潜在恶性。

Objective To analyze the characteristics of non-mass breast lesions(NML) in B-mode ultrasound(US),color Doppler ultrasound(CDFI),strain elastography(SE) and contrast-enhanced ultrasound(CEUS),and to establish a multimodal ultrasound method for diagnosis of malignant NML,and to compare the diagnostic efficacy of multimodal ultrasound methods in the diagnosis of malignant NML.Methods The clinical data of patients who underwent breast multimodal ultrasound(ultrasound+CDFI+SE +CEUS) in our hospital from December 2020 to July 2023 were retrospectively analyzed.Pathological results were the gold standard.The patients were divided into the benign group and the malignant group.The age,clinical symptoms,menstrual history,multi parameters of US,color Doppler,SE and CEUS were compared between the two groups.Binary logistic regression was used to determine the independent risk factors for the diagnosis of malignant NML.The area under the ROC curve(AUC),sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV) of the model were examined,and the diagnostic efficacy of NML of different ultrasound modes was compared.Results A total of 68 patients with 71 breast lesions were enrolled.The mean age of the patients was 46.32±9.96 years.The mean maximum diameter of the lesions was 2.25cm±1.30cm(0.47 cm-5.62 cm).There were 40(56.3%) malignant lesions and 31(43.7%) benign lesions.There were statistically significant differences in age,microcalcification,vascular distribution,time to peak(TTP),peak intensity(PI),claw shape and stiffness between the two groups(P<0.05).Among them,microcalcification,peak intensity and hard texture were independent risk factors for malignant NML.The sensitivity,specificity,PPV,NPV and accuracy of the prediction model including the above risk factors for malignant NML were 92.5%,83.9%,90.2%,89.7% and 92.9%,respectively,which was significantly higher than that of other ultrasound modes.Conclusions Multimodal ultrasound is simple and has high diagnostic performance,which is helpful to predict the potential malignancy of NML.