基于Logistic回归模型探讨超声造影和弹性成像联合血清miR-141、miR-27a水平鉴别乳腺肿块良恶性的价值

The value of contrast-enhanced ultrasound(CEUS)and elastography combined with serum miR-141 and miR-27a levels in differentiating benign and malignant breast masses based on Logistic regression model

目的探讨通过超声造影和弹性成像联合血清miR-141、miR-27a水平构建的Logistic回归模型在乳腺肿块良恶性鉴别诊断中的价值。方法选择2020年8月至2022年9月于山西省人民医院就诊的98例乳腺肿块患者作为研究对象。对所有患者进行超声造影和弹性成像检查,记录肿块弹性值(ultrasonic elastic value of mass,EvM)、周围脂肪弹性值(ultrasonic elastic value of tissue,EvT)、超声造影峰值强度(peak intensity,PI)、达峰时间(time to peak,TP)、平均度越时间(mean transit time,MTT)、肿块增强强度、增强均匀度、增强后病灶大小、显影时间、增强后有无放射性增强、有无穿支血流。应用定量实时聚合酶联反应法测定血清miR-141、miR-27a的表达水平。结果98例患者病灶中,63例为良性肿块,35例为恶性肿块。恶性组的超声造影高增强、显影时间早于周围组织、出现穿支血管和周围放射状增强的比例显著高于良性组(χ^(2)=19.36,6.71、19.06、10.28,P<0.001、0.010、<0.001、0.001)。恶性组的PI为17.20±3.04,显著高于良性组的15.02±1.95(t=3.83,P<0.001);恶性组TP为27.33±4.37,显著低于良性组的29.97±4.09(t=2.98,P=0.004)。恶性组的弹性成像参数EvM和EvT分别为(78.29±12.11)kPa和(13.13±2.56)kPa,均显著高于良性组的(50.07±9.61)kPa和(10.61±2.07)kPa,差异有统计学意义(t=11.33、2.62,P=<0.001、0.011)。恶性组的血清miR-141和miR-27a水平分别为(0.83±0.18)和(0.69±0.13),显著高于良性组的(0.61±0.13)和(0.50±0.07),差异有统计学意义(t=6.28、8.23,P均<0.001)。多因素Logistics回归分析结果显示增强强度、穿支血管、放射状增强、PI、EvM和血清miR-27a水平是乳腺恶性肿块的独立危险因素。Logistics回归模型诊断乳腺肿块良恶性的ROC曲线AUC为0.953(0.911~0.996),灵敏度和特异度分别为91.4%和88.9%。结论超声造影和弹性成像联合血清miR-141、miR-27a水平构建的Logistic回归模型在乳腺肿块良恶性鉴别诊断中具有较好的临床应用价值。

Objective To investigate the value of Logistic regression model constructed by contrast-enhanced ultrasound and elastography combined with serum levels of miR-141 and miR-27a in the differential diagnosis of benign and malignant breast masses.Methods A total of 98 patients with breast mass treated in Huainan Oriental Hospital Group General Hospital from Aug.2020 to Sep.2022 were selected as the research objects.Contrast-enhanced ultrasound and elastography were performed on all patients to record the elastic value of mass(EvM),ultrasonic elastic value of tissue(EvT),peak intensity(PI),time to peak(TP),mean transit time(MTT),tumor enhancement intensity,enhancement uniformity,lesion size after enhancement,development time,radiation enhancement after enhancement,and perforator blood flow.The expression levels of miR-141 and miR-27a in serum were determined by quantitative real-time polymerase chain reaction.Results Among the 98 cases,63 cases were benign and 35 cases were malignant.The proportion of contrast-enhanced ultrasound,earlier development time,perforator vessels and peripheral radial enhancement in the malignant group was significantly higher than that in the benign group(P<0.05).The PI of the malignant group was 17.20±3.04,which was significantly higher than that of the benign group(15.02±1.95,t=3.83,P<0.001).The TP of malignant group was 27.33±4.37,which was significantly lower than that of benign group(29.97±4.09,t=2.98,P=0.004).The elastic imaging parameters EvM and EvT in the malignant group were(78.29±12.11)kPa and(13.13±2.56)kPa,respectively,which were significantly higher than those in the benign group(50.07±9.61)kPa and(10.61±2.07)kPa,and the difference was statistically significant(t=11.33,2.62,2.62).P=<0.001,0.011).The levels of serum miR-141 and miR-27a in the malignant group were(0.83±0.18)and(0.69±0.13),respectively,which were significantly higher than those in the benign group(0.61±0.13)and(0.50±0.07),with statistical significance(t=6.28,8.23,P<0.001).Multivariate Logistics regression analysis showed that enhancement intensity,perforator vessels,radial enhancement,PI,EvM and serum miR-27a level were independent risk factors for breast cancer.The AUC of the Logistics regression model for diagnosing benign and malignant breast masses was 0.953(0.911 to 0.996),and the sensitivity and specificity were 91.4%and 88.9%,respectively.Conclusion The Logistic regression model constructed by contrast-enhanced ultrasound and elastography combined with serum levels of miR-141 and miR-27a has good clinical application value in the differential diagnosis of benign and malignant breast masses.