三维能量多普勒定量技术对乳腺癌组织学分级的预测价值探讨

Predictive value of 3D power Doppler ultrasonography in histological grading of breast cancer

目的探讨三维能量多普勒超声(3D-PDUS)中血管定量参数对乳腺癌组织学分级的预测价值。方法回顾性选择2018年1月至2023年6月在杭州市中医院行手术治疗的乳腺癌患者77例(恶性肿块86个),所有肿块均经病理组织学检查证实,根据组织学分级分为Ⅰ级组、Ⅱ级组、Ⅲ级组。比较3组患者年龄、常规超声检查所见、3D-PDUS指标。常规超声检查所见包括淋巴结转移、肿块内部钙化、肿块Adler血流分级;3D-PDUS指标包括肿块体积、血管参数[血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)]。应用logistic回归分析乳腺癌组织学分级的危险因素。采用ROC曲线分析VI、FI、VFI对乳腺癌组织学分级的预测准确度。结果Ⅲ级组VI、FI、VFI高于Ⅱ级组,Ⅱ级组高于Ⅰ级组,差异均有统计学意义(均P<0.05)。其中FI为乳腺癌不同组织学分级的独立危险因素(P<0.001)。ROC曲线分析显示VI、FI、VFI对乳腺癌组织学分级的预测准确度均较高(AUC=0.888、0.891、0.894,均P<0.001)。结论3D-PDUS显示的VI、FI、VFI是瘤内血管化重要定量指标,可为乳腺癌患者组织学分级提供可靠的影像学预测信息。

Objective The aim of the study was to investigate the diagnostic and predictive value of vascular quantitative parameters in three-dimensional power Doppler ultrasonography(3D-PDUS)for histological grading of breast cancer.Methods In this retrospective observational study,77 breast cancer patients(with 86 malignant masses)underwent surgery in Hangzhou Hospital of Traditional Chinese Medicine January 2018 to June 2023 were included.All masses were confirmed by histopathological examination,and divided into grades I,II,and III groups accordingly.Age,conventional ultrasonoscopy and 3D-PDUS measures of patients were compared among the three groups using Kruskal-Wallis H test,Pearson's chi-squared test or Fisher exact test.Among which,conventional ultrasonoscopy included lymph node metastasis,internal calcification of mass and mass Adler grading;3D-PDUS measures included mass volume,and vascular parameters[vascularization index(VI),flow index(FI),vascularity flow index(VFI)].The risk factors for histological grading of breast cancer were analyzed by Oridinal logistics regression.ROC curve was used to compare the accuracy of VI,FI and VFI in predicting histological grade.Results Vascular parameter values of VI,FI,and VFI in grade III group were higher than those of grade II group,followed by the grade I group,with statistical significance(all P<0.05).Among the parameters,FI was an independent risk factor for different histological grades of breast cancer(P<0.001).ROC curve analysis showed that VI,FI and VFI all had high accuracy in predicting pathological grade(AUC=0.888,0.891,and 0.894,respectively,all P<0.001).Conclusion VI,FI and VFI are important quantitative index of intratumoral vascularization evaluated by 3D-PDUS,which could provide more reliable prediction diagnostic information for the histological grading of breast cancer.