多模态超声特征预测Luminal亚型浸润性导管癌的临床应用

The clinical application of multimodal ultrasound features in predicting Luminal subtype invasive ductal carcinoma

目的探讨基于多模态超声特征预测Luminal亚型浸润性导管癌(IDC)的临床价值。方法选取内蒙古自治区人民医院2021年6月~2023年12月病理证实为Luminal型的IDC患者85例,其中Luminal A(LA)型38例,Luminal B(LB)型47例。比较两组病灶常规超声、弹性成像及超声造影特征的差异;将差异有统计学意义的特征进行单、多因素逻辑回归分析,并建立逻辑回归模型;绘制ROC曲线分析其预测LB型IDC的诊断效能。结果与LA组相比,LB组病灶最大直径、富血供型占比、病灶内部最大杨氏模量(E_(max))、瘤周平均杨氏模量(Emean shell-2.0)、最大杨氏模量(E_(max shell-2.0))、造影灌注缺损占比、峰值强度(PI)、AUC、平均渡越时间均较大;始增时间(AT)、瘤周高回声晕占比较小,差异均有统计学意义(P<0.05)。多因素回归分析显示:AT、瘤周高回声晕为预测LB型的独立保护因素,PI、灌注缺损、E_(max shell-2.0)为预测LB型的独立危险因素。构建预测LB型IDC的逻辑回归模型:Logit(P)=-9.868-2.004×瘤周高回声晕+2.896×灌注缺损-0.399×AT+0.379×PI+0.030×E_(max shell-2.0)。ROC曲线分析显示,逻辑回归模型诊断效能最高,曲线下面积为0.945,敏感度、特异度分别为89.4%、89.5%。结论不同Luminal亚型IDC的多模态超声特征具有一定的差异性,基于多模态超声特征所建立的逻辑回归模型在预测Luminal亚型中具有应用价值,能够为各亚型IDC的个体化诊疗提供重要参考依据。

Objective To investigate the clinical value of predicting Luminal subtype invasive ductal carcinoma(IDC)based on multimodal ultrasound features.Methods Eighty-five patients with Luminal IDC diagnosed by pathology from June 2021 to December 2023 in Inner Mongolia Autonomous Region People's Hospital were selected,including 38 cases in the Luminal A(LA)group and 47 cases in the Luminal B(LB)group.Differences in conventional ultrasound,elastography and contrastenhanced ultrasound characteristics of the lesions in the two groups were compared;characteristic parameters with statistically significant differences were subjected to single and multifactorial logistic regression analyses with the LB type,and a logistic regression model was established;and the diagnostic efficacy in predicting the LB type of IDC was analyzed by plotting the ROC curves.Results Compared with the LA group,the LB group had a larger maximum diameter of the lesion,percentage of blood-rich type,maximum Young's modulus inside the lesion(E_(max)),average peritumour Young's modulus(Emean shell-2.0),maximum Young's modulus(E_(max shell-2.0)),percentage of contrast perfusion defect,peak intensity(PI),area under the curve(AUC),and mean transit time;arrival time(AT)and percentage of peritumoural hyperechoic halo were smaller,and all the differences were statistically significant(P<0.05).Multifactorial regression analysis showed that AT and peritumoural hyperechoic halo were independent protective factors for the prediction of LB,and PI,perfusion defect and E_(max shell-2.0) were independent risk factors for the prediction of LB.A logistic regression model was constructed to predict LB-type IDC:Logit(P)=-9.868-2.004×peritumoural hyperechoic halo+2.896×perfusion defect-0.399×AT+0.379×PI+0.030×E_(max shell-2.0).ROC curve analysis showed that the logistic regression model had the highest diagnostic efficacy,with an area under the curve of 0.945 with a sensitivity and specificity of 89.4%and 89.5%,respectively.Conclusion The multimodal ultrasound characteristics of different IDC subtypes have certain differences,and the logistic regression model based on multimodal ultrasound characteristics has value in predicting Luminal subtypes,which can provide an important reference for individualised diagnosis and treatment of IDC of different subtypes.