超声弹性成像与常规超声联合定量检测 早期乳腺癌的诊断价值

Diagnostic value of quantitative detection of early breast cancer by ultrasound elastography and conventional ultrasound

摘要:

目的 探讨超声弹性成像与常规超声联合诊断早期乳腺癌的价值。方法 选取2016 年1 月— 2016 年12 月于唐山市开滦总医院行乳腺超声检查的95 例患者（104 个病灶）。病灶均接受常规超声、剪 切波超声弹性成像，并与穿刺活检或手术标本病理诊断结果对比。评价各诊断方案单独及联合应用的价值。 结果 104 个病灶中，良性病变38 个（36.54%）；恶性病变66 个（63.46%）。良性病变组病灶形态规则、病 灶边界清晰、内部无回声、纵横比<1、血流分级0 级及阻力指数<0.7 比均高于恶性病变组（P <0.05），后方 回声衰减低于恶性病变组（P <0.05）。恶性病变组最大弹性模量、平均弹性模量高于良性病变组（P <0.05）。 二维超声、二维剪切波超声弹性成像、三维超声、三维剪切波超声弹性成像对诊断恶性病变的敏感性分别为 0.773、0.970、0.803 和0.909，特异性分别为0.737、0.895、0.921 和0.737，准确率分别为0.760、0.942、0.846 和0.846。联合诊断敏感性高于单独检测，但特异性低于单独检测。结论 二维超声、三维超声能够为早期乳 腺癌诊断提供较多有利证据，但诊断效能相对较差。二维剪切波超声弹性成像对诊断早期乳腺癌的效能较好， 联合方案能提升诊断敏感性。

Abstract:

Objective To explore the value of ultrasound elastography combined with conventional ultrasound in the diagnosis of early breast cancer. Methods Totally 95 cases with 104 breast solid nodules diagnosed by breast ultrasound examination were involved. All cases were examined by common ultrasound and shear wave elastography (SWE). The pathology was taken as gold standard to analyze the value of two-dimensional ultrasonography, elastography and three-dimensional ultrasound in the diagnosis of early stage breast cancer. Results Among the 104 lesions, 38 were benign lesions, accounting for 36.54%, and 66 were malignant lesions, accounting for 63.46%. The proportion of benign lesions with regular lesion shape, clear lesion boundary, no internal echo, aspect ratio < 1, blood flow grading < 0.7 and resistance index < 0.7 were significantly more than those of malignant lesions by Chisquare test, and the proportion of posterior echo attenuation was significantly less than that of malignant lesions. The difference was significant (P < 0.05). The above indexes in benign lesion group were higher than those in malignant lesion group, and the posterior echo and attenuation were less than those in malignant lesion group (P < 0.05). The sensitivity of two-dimensional ultrasound, two-dimensional SWE, three-dimensional ultrasound and three-dimensional SWE in diagnosis of malignant lesions were 0.773, 0.970, 0.803 and 0.909, the specificity was 0.737, 0.895, 0.921, 0.737, and the accuracy rate were 0.760, 0.942, 0.846, 0.846. The sensitivity of combined diagnosis is higher than that of single detection, but the specificity is lower than that of single detection. Conclusion Two-dimensional ultrasound and three-dimensional ultrasound can provide many evidences for the early diagnosis of breast cancer, but the diagnosis efficiency are both relatively poor. Two-dimensional SWE has better performance in the diagnosis of early stage breast cancer. Parallel detection can improve the diagnostic sensitivity.