超声血流参数联合CT鉴别诊断乳腺良恶性结节的临床价值

Value of ultrasound blood flow parameters combined with CT in differential diagnosis of benign and malignant breast nodules

目的探讨超声血流参数联合CT鉴别诊断乳腺良恶性结节的临床价值。方法选取2021年1月-2023年1月安徽省阜阳市颖泉区第五人民医院收治的79例乳腺结节患者,均经病理诊断证实,恶性结节42例,良性结节37例。所有患者均行超声和CT检查。比较良性结节组与恶性结节组患者超声血流参数[收缩期峰值血流速度(PSV)、阻力指数(RI)和搏动指数(PI)];比较良性结节组与恶性结节组CT形态学特征及CT参数[表面通透性(PS)、血流量(BF)和血容量(BV)];比较恶性结节不同病理特征超声血流参数和CT参数变化。采用ROC曲线分析超声血流参数联合CT参数对乳腺恶性结合诊断价值。结果恶性结节组患者PSV、RI和PI高于良性结节组,差异均有统计学意义(P<0.05)。恶性结节组患者非均匀强化率、边缘毛刺率和形态分叶率高于良性结节组,差异均有统计学意义(P<0.05)。恶性结节组患者PS、BF和BV高于良性结节组,差异均有统计学意义(P<0.05)。恶性结节Ⅲ~Ⅳ期患者的PSV、RI和PI高于Ⅰ~Ⅱ期患者,低分化患者PSV、RI和PI高于中高分化患者,淋巴结转移患者PSV、RI和PI高于无淋巴结转移患者,差异均有统计学意义(P<0.05)。恶性结节患者中,Ⅲ~Ⅳ患者的PS、BF和BV高于Ⅰ~Ⅱ期患者,低分化患者PS、BF和BV高于中高分化患者,淋巴结转移患者PS、BF和BV高于无淋巴结转移患者,差异均有统计学意义(P<0.05)。经ROC曲线分析,超声血流参数联合CT参数诊断恶性结节灵敏度和特异度高于超声血流参数、CT参数单项(P<0.05)。结论超声血流参数联合CT鉴别诊断乳腺良恶性结节价值良好,可提高诊断恶性结节灵敏度和特异度,值得临床借鉴。

Objective To explore the clinical value of ultrasonic blood flow parameters combined with CT in the differential diagnosis of benign and malignant breast nodules.Methods A total of 79 patients with breast nodules admitted to the Fuyang Fifth People's Hospital from January 2021 to January 2023 were selected.All patients were confirmed by pathological diagnosis,including 42 cases of malignant nodules and 37 cases of benign nodules.All patients underwent ultrasound and CT examinations.The ultrasonic blood flow parameters(peak systolic velocity[PSV],resistance index[RI],and pulsatility index[PI])of patients in the benign nodule group were compared with those in the malignant nodule group.The CT morphological features and CT parameters(permeability surface[PS],blood flow[BF],and blood volume[BV])of patients in the benign nodule group were compared with those in the malignant nodule group.The changes in ultrasonic blood flow parameters and CT parameters in malignant nodules with different pathological features were compared.ROC curve analysis was used to evaluate the diagnostic value of ultrasonic blood flow parameters combined with CT parameters in the diagnosis of malignant breast nodules.Results The PSV,RI,and PI of patients in the malignant nodule group were significantly higher than those in the benign nodule group(P<0.05).The non-uniform enhancement,spiculation,and lobulation rates of patients in the malignant nodule group were significantly higher than those in the benign nodule group(P<0.05).The PS,BF,and BV of patients in the malignant nodule group were significantly higher than those in the benign nodule group(P<0.05).The PSV,RI,and PI of patients in stageⅢ-Ⅳmalignant nodules were higher than those in stage I-Ⅱmalignant nodules;the PSV,RI,and PI of poorly differentiated patients were higher than those of moderately to highly differentiated patients;and the PSV,RI,and PI of patients with lymph node metastasis were higher than those without lymph node metastasis,all with statistical significance(P<0.05).In malignant nodules,the PS,BF,and BV of patients in stageⅢ-Ⅳwere higher than those in stage I-Ⅱ;the PS,BF,and BV of poorly differentiated patients were higher than those of moderately to highly differentiated patients;and the PS,BF,and BV of patients with lymph node metastasis were higher than those without lymph node metastasis,all with statistical significance(P<0.05).ROC curve analysis showed that the sensitivity and specificity of ultrasonic blood flow parameters combined with CT parameters in the diagnosis of malignant nodules were significantly higher than those of ultrasonic blood flow parameters or CT parameters alone(P<0.05).Conclusion Ultrasonic blood flow parameters combined with CT have good value in the differential diagnosis of benign and malignant breast nodules and can strengthen the sensitivity and specificity of diagnosing malignant nodules,suggesting clinical reference value.