常规超声联合超声造影在不同大小乳腺结节诊断中的应用价值

Value of conventional ultrasound combined with contrast-enhanced ultrasound in diagnosis of breast lesions of different sizes

背景超声(ultrasound,US)和超声造影(contrast-enhanced ultrasound,CEUS)是乳腺结节常用的诊断方法,US联合CEUS对不同大小的乳腺结节诊断效能不同,对<1.0 cm乳腺结节的诊断效能尚不清楚。目的分析US联合CEUS对不同大小乳腺结节的诊断效能。方法回顾性收集2021年1月—2022年12月在解放军总医院第一医学中心超声诊断科进行过乳腺US、CEUS检查并有明确良恶性病理结果的847例患者的临床资料和超声图像。按大小将结节分为3组:组1大小≤1.0 cm,组2大小1.0~2.0 cm,组3大小>2.0 cm。比较3组乳腺结节的CEUS特征以及US联合CEUS对乳腺结节的诊断效能。结果847例患者均为女性,年龄18~75岁,平均年龄45岁。所有病变的平均大小为1.9 cm,范围为0.3~13.9 cm。≤1.0 cm组194例(良性148例,恶性46例)、1.0~2.0 cm组358例(良性220例,恶性138例)、>2.0 cm组295例(良性135例,恶性160例)病变。恶性病变的CEUS特征表现为向心性增强、高增强、不均匀增强、边界不清晰、形态不规则、增强范围扩大和放射状增强。不同大小恶性乳腺病变的CEUS特征(增强均匀性、有无充盈缺损和消退时间)存在差异,US联合CEUS对3组乳腺结节的受试者工作特征曲线下面积分别为0.844、0.932、0.928,其中≤1 cm组的曲线下面积明显低于其他两组(P<0.05)。结论不同大小的乳腺病变超声造影特征不同。常规超声联合超声造影对不同大小的乳腺病变诊断效能存在差异,对>1.0 cm的病灶诊断效能较高。

Background Ultrasound(US)and contrast-enhanced ultrasound(CEUS)are commonly used for diagnosis of breast nodules.The diagnostic efficacy of ultrasound combined with ultrasonography varies with different sizes of breast nodules,but the diagnostic efficacy of ultrasonography for breast lesions<1.0 cm is unknown.Objective To analyze the diagnostic efficiency of conventional ultrasound combined with contrast-enhanced ultrasound in breast nodules of different sizes.Methods Clinical data and ultrasound images of 847 patients who underwent routine ultrasound and CEUS with definite pathological findings in the Ultrasonography Department of the First Medical Center of Chinese PLA General Hospital from January 2021 to December 2022 were analyzed retrospectively.The nodules were divided into three groups according to their sizes:group 1 with size≤1.0 cm,group 2 with size 1.0-2.0 cm,and group 3 with size>2.0 cm.The CEUS characteristics of breast nodules in the three groups and the diagnostic efficacy of US combined with CEUS for breast nodules were compared.Results All patients were female and their age ranged from 18 to 75 years with an average age of 45 years.The mean size of all lesions was 1.9 cm and ranged from 0.3 to 13.9 cm.There were 194 cases in the group 1(148 benign and 46 malignant),358 cases in the group 2(220 benign and 138 malignant),and 295 cases in the group 3(135 benign and 160 malignant).The characteristics of CEUS in malignant lesions were centripetal enhancement,hyperenhancement,heterogeneous enhancement,ill-defined margin,irregular shape,enlarged enhancement scope and radial enhancement.The CEUS characteristics(enhancement uniformity,presence of filling defects and time to regression)of breast malignant lesions of different sizes differed,and the areas under the curve of the working characteristics of US combined CEUS for subjects with breast nodules in the three groups were 0.844,0.932 and 0.928,respectively,with the area under the curve of the group of≤1 cm being significantly lower than that of the other two groups(P<0.005).Conclusion CEUS features of breast lesions of different sizes are different.The diagnostic efficacy of conventional US combined with CEUS for breast nodules of different sizes varies,and the diagnostic efficacy is higher for lesions>1.0 cm.