特殊类型乳腺癌的超声造影特征及其诊断价值研究

Characteristics and diagnostic value of contrast-enhanced ultrasound in special types of breast cancer

摘要:

目的 分析特殊类型乳腺癌的超声造影特征及其诊断价值。方法 选取2018 年1 月—2020 年1 月 廊坊市中医医院接诊的396 例乳腺癌患者作为研究对象，术前均进行常规超声和超声造影检查，分析特殊类 型乳腺癌的超声造影特征及定量参数，采用ROC 曲线下面积（AUC）分析超声造影对特殊类型乳腺癌的诊 断效能。结果 在396 例乳腺癌患者中，非特殊类型乳腺癌362 例，特殊类型乳腺癌34 例。不同类型乳腺 癌的超声造影形态、边界、穿入或扭曲血管结构、造影剂分布、病灶内充盈缺损区及肿块大小比较，差异有 统计学意义（P <0.05）。黏液癌造影剂到达时间、达峰值时间较浸润性小叶癌、髓样癌、导管内乳头状癌长 （P <0.05），髓样癌、导管内乳头状癌的峰值强度较浸润性小叶癌、黏液癌大（P <0.05）。超声造影诊断浸润 性小叶癌、髓样癌的准确率较常规超声高（P <0.05）。超声造影诊断特殊类型乳腺癌的AUC 较常规超声大 （P <0.05）。结论 特殊类型乳腺癌具有一定的超声造影特征，偏向于良性特征，诊断准确性优于常规超声， 值得临床进一步推广应用。

Abstract:

Objective To analyze the characteristics of contrast-enhanced ultrasound and its diagnostic value in special types of breast cancer. Methods A total of 396 breast cancer patients who were admitted to our hospital from January 2018 to January 2020 were selected as the research subjects. The conventional ultrasound and contrast-enhanced ultrasound were performed before surgery to analyze the characteristics of special types of breast cancer. Postoperative pathological outcomes were used as the standard diagnosis and the area under the receiver operating characteristic (ROC) curve (AUC) was used to analyze the diagnostic performance of contrast-enhanced ultrasound in special types of breast cancer. Results Among the 396 breast cancer patients, 362 were non-special types of breast cancer and 34 were special types of breast cancer. There were differences in the morphology, margin, angioarchitecture, the distribution of the contrast media, filling defect area and tumor size among distinct types of breast cancer under the contrast-enhanced ultrasound (P < 0.05). The arrival time (AT) and time to peak (TTP) of the contrast media in mucinous carcinoma were significantly longer than those in invasive lobular carcinoma, medullary carcinoma, intraductal papillary carcinoma (P < 0.05). The peak intensity (PI) of the contrast media in medullary carcinoma and intraductal papillary carcinoma was significantly larger than that in invasive lobular carcinoma and mucinous carcinoma (P < 0.05). Besides, the accuracy of contrast-enhanced ultrasound in the diagnosis of special types of breast cancer was higher than that of conventional ultrasound (P < 0.05). After ROC curve analysis, the AUC of ultrasound contrast diagnosis of special types of breast cancer was 0.842, which was significantly greater than 0.675 of conventional ultrasound (P < 0.05). Conclusions The special types of breast cancer show certain features which tend to be more characteristic of benign lesions in contrast-enhanced ultrasound. In addition, the diagnostic accuracy of contrast-enhanced ultrasound is better than that of conventional ultrasound, which deserves further clinical application.