超声造影在浅表软组织肿瘤穿刺活检中的应用价值

Application value of contrast‑enhanced ultrasonography in superficial soft tissue tumor puncture biopsy

目的:比较超声造影(CEUS)与普通二维超声引导在浅表软组织肿瘤穿刺活检中的临床应用价值。方法:回顾性分析超声引导下行穿刺活检的软组织肿瘤患者69例并根据引导方式不同分为二维超声组32例和超声造影组37例。以术后病理结果为金标准,计算并比较两组的准确率以及两组鉴别软组织肿瘤良恶性的诊断敏感性、特异性、阳性预测值、阴性预测值,绘制普通二维超声及超声造影引导下穿刺活检诊断软组织肿瘤的受试者工作特征(ROC)曲线,并计算其曲线下面积(AUC)。结果:两组患者在性别、年龄、病灶位置、病灶长径的差异均无统计学意义。普通二维超声组和超声造影组穿刺准确率分别为69.57%和92.85%,差异有统计学意义(P<0.05),普通二维超声组平均穿刺次数为5.0次/人,超声造影组平均穿刺次数为4.6次/人,差异无统计学意义(P>0.05)。两组方法鉴别良恶性肿瘤的敏感度、特异度、阳性预测值和阴性预测值分别为100%、81.25%、70%和100%与100%、93.75%、92.3%和100%,差异均无统计学意义(P>0.05)。普通二维超声组AUC为0.825,超声造影组AUC为0.941,差异有统计学差异(P<0.05)。结论:对于具有巨大尺寸并且表现为不均质性的软组织肿瘤,超声造影可有效规划穿刺路径,精准安全引导穿刺并在最具代表性的区域采样活检,较常规超声能取得更高的诊断准确率,为临床提供更有效的信息,是一种微创高效、实时可视的手段。

Objective:To compare the clinical application value of contrast‑enhanced ultrasound(CEUS)and conventional two‑dimensional ultrasound guidance in soft tissue tumor puncture biopsy.Methods:Retrospective analysis of sixty‑nine patients with soft tissue tumors who were divided into 32 cases in the two‑dimensional ultrasound group and 37 cases in the CEUS group according to the different guid‑ance methods.Using the postoperative pathological results as the gold standard,the diagnostic accura‑cy,sensitivity,specificity,positive predictive value,and negative predictive value of the two groups in identifying benign and malignant soft tissue tumors were calculated and compared.The reciver op‑erating characteristic(ROC)curves for the diagnosis of soft tissue tumors with conventional ultrasound and CEUS‑guided puncture biopsy were plotted,and the area under the curve(AUC)was calculated.Results:There was no statistically significant difference between the two groups in terms of gender,age,lesion location,and lesion diameter.The puncture accuracy rates were 69.57%and 92.85%in the two‑dimensional ultrasound group and CEUS group,respectively,with statistically significant dif‑ference(P<0.05).The mean of puncture times were 5.0 per person in conventional ultrasound group and 4.6 per person in the CEUS group,without statistically significant difference(P>0.05).The sensitivity,specificity,positive predictive value,and negative predictive value for identifying benign and malignant tumors in both groups were 100%,81.25%,70%,and 100%,respectively,versus 100%,93.75%,92.3%,and 100%,respectively,without statistically significant difference(P>0.05).The AUC was 0.825 in the conventional ultrasound group and 0.941 in the CEUS group with statistically significant difference(P<0.05).Conclusion:For soft tissue tumors with large size and heterogeneity,CEUS could be adopted to effectively plan the puncture path,accurately and safely guide the puncture,and perform sample biopsy in the most representative area,which can achieve higher diagnostic accuracy and provide more effective clinical information than conventional ultra‑sound.The CEUS is a minimally invasive and efficient means of real‑time visualization.