超声造影对乳腺实性导管内乳头状瘤诊断效能的初步研究

Preliminary study on the diagnostic efficacy of contrast-enhanced ultrasound in breast solid ductal papilloma

目的通过与乳腺纤维腺瘤(FA)的对比分析,探讨超声造影对乳腺实性导管内乳头状瘤(sIDP)的诊断价值。方法回顾性分析2016年10月至2021年1月在苏州大学附属第一医院经病理证实的62例sIDP与94例FA患者的超声造影资料,根据病理结果将其分为sIDP组和FA组。观察两组病灶增强速度、增强程度、增强均匀度及增强后边缘是否光整、增强范围是否增大、病灶内边缘是否有环状无增强区及无增强区的内缘是否光整等特征。利用SonoLiver软件分别对两组病灶超声造影的动态过程进行离线分析,获得病灶的增强顺序示意图。以病理结果为金标准,应用单因素分析,将两组间差异有统计学意义的参数纳入多因素Logistic回归分析,建立鉴别诊断模型。采用ROC曲线分析各参数及诊断模型诊断sIDP的效能。结果与FA组相比,sIDP组超声造影多表现为快进、高增强,增强顺序多表现为离心型,超声造影后病灶边缘多伴有无增强区且无增强区内缘不光整,两组间差异有统计学意义(均P<0.05)。二分类Logistic回归提示年龄、增强程度和增强顺序为诊断sIDP的独立危险因素。ROC曲线显示年龄、增强程度及增强顺序三参数联合诊断sIDP的ROC曲线下面积为0.874(95%CI=0.812~0.922)、准确率为76.9%,敏感度为67.7%,特异度为83.0%,阳性预测值为72.4%,阴性预测值为79.6%。结论sIDP与FA患者在年龄、增强程度、增强顺序方面存在显著差异,三参数联合可提高sIDP的诊断效能。

Objective To evaluate the value of contrast-enhanced ultrasound(CEUS)in the diagnosis of solid intraductal papilloma(sIDP)of breast by comparing with fibronenoma of breast(FA).Methods The CEUS data of 62 cases of sIDP patients and 94 cases of FA patients that confirmed by pathology in the First Affiliated Hospital of Soochow University from October 2016 to January 2021 were retrospectively analyzed.The patients were divided into sIDP group and FA group according to the pathological results.The enhancement speed,enhancement degree,enhancement uniformity,whether the edge after enhancement was polished,whether the enhancement range was enlarged,whether there was a ring unenhanced area in the inner edge of the lesion and whether the inner edge of the unenhanced area was polished were observed in the two groups.SonoLiver software was used to perform offline analysis of the dynamic process of CEUS in the two groups respectively,the enhancement sequence diagram of the lesions was obtained.The pathological result was taken as the gold standard,univariate analysis was applied,and the parameters with statistical significance between the two groups were included in multivariate Logistic regression analysis to establish a differential diagnosis model.The diagnostic efficiency of sIDP was analyzed by ROC curve and diagnostic model.Results Compared with the FA group,CEUS in the sIDP group mostly showed fast forward,high enhancement,and the enhancement sequence was mostly centrifugal.After CEUS,the lesion edges in the sIDP group were mostly accompanied by unenhanced areas and the inner edges of the unenhanced areas were not intact,and the differences between the two groups were statistically significant(all P<0.05).Binary Logistic regression showed that age,enhancement degree and enhancement order were independent risk factors for sIDP diagnosis.The ROC curve showed that the area under the ROC curve of age,enhancement degree and enhancement sequence combined for the diagnosis of sIDP was 0.874(95%CI=0.812-0.922),the accuracy was 76.9%,the sensitivity was 67.7%,the specificity was 83.0%,the positive predictive value was 72.4%,and the negative predictive value was 79.6%.Conclusions There are significant differences in age,enhancement degree and enhancement sequence between sIDP and FA patients.The three-parameter combination can improve the diagnostic efficiency of sIDP.