剪切波弹性成像定量参数对乳腺肿块良恶性鉴别及与生物学指标的相关性分析

Efficacy of quantitative parameters of shear wave elastography in differential diagnosis of breast masses and their correlations with biological parameters

摘要:

目的 分析剪切波弹性成像（SWE）定量参数对乳腺肿块良恶性的鉴别价值及与生物学指标的相关性。方法 2018年9月—2021年10月于甘肃中医药大学附属医院超声科检查的100例乳腺肿块患者均接受SWE检查，根据手术或穿刺的病理结果分为恶性组和良性组。对比两组SWE定量参数，采用受试者工作特征（ROC）曲线分析SWE定量参数预测乳腺肿块良恶性的价值；采用免疫组织化学法检查，对比不同临床病理特征乳腺癌病灶的SWE定量参数值，经Kendall相关性分析乳腺癌病灶的SWE定量参数与生物学指标的相关性。结果 恶性组AE-max、Shell1 E_max、Shell2 E_max、Shell3 E_max较良性组大（P <0.05）。ROC曲线结果显示，AE-max、Shell1 E_max、Shell2 E_max、Shell3 E_max及4者联合检测预测乳腺癌发生的AUC分别为0.830、0.906、0.844、0.833和0.978。乳腺癌病灶各生物学指标阳性、阴性表达的AE-max、Shell1 E_max、Shell2 E_max、Shell3 E_max比较，差异有统计学意义（P <0.05）。乳腺癌病灶的AE-max、Shell1 E_max、Shell2 E_max、Shell3 E_max与PR呈正相关（r =0.612、0.632、0.613和0.597，均P <0.05），与ER呈正相关（r =0.426、0.463、0.385和0.361，均P <0.05），与HER-2呈正相关（r =0.569、0.711、0.603和0.587，均P <0.05），与Ki-67呈正相关（r =0.603、0.658、0.553和0.611，均P <0.05）。恶性乳腺肿块PR、ER、HER-2及Ki-67阳性率高于良性乳腺肿块（P <0.05），有淋巴结转移HER-2阳性率高于无淋巴结转移（P <0.05）。结论 SWE定量参数可有效鉴别乳腺肿块良恶性，且与乳腺癌生物学指标密切相关。

关键词:乳腺癌;剪切波弹性成像;定量参数;鉴别;生物学指标

Abstract:

Objective To analyze the efficacy of quantitative parameters of shear wave elastography (SWE) in differentiating benign from malignant breast masses and their correlations with biological parameters.Methods A total of 100 patients with suspected breast cancer examined in the Department of Ultrasound of Affiliated Hospital of Gansu University of Chinese Medicine from September 2018 to October 2021 were selected. All of them underwent SWE, and they were divided into malignant group and benign group based on the pathological results obtained by the surgery or puncture examination. The quantitative parameters of SWE were compared between the two groups, and the value of SWE quantitative parameters in predicting the malignancy of breast masses was analyzed by receiver operating characteristic (ROC) curve. All the masses were investigated with immunohistochemical assays, and SWE quantitative parameters were compared among breast masses with different biological characteristics. In addition, the correlation between SWE quantitative parameters and biological parameters of breast masses were analyzed via Kendall rank correlation test.Results AE-max, Shell1 E_max, Shell2 E_max and Shell3 E_max in the malignant group were higher than those in the benign group (P < 0.05). The ROC curve analysis exhibited that the area under the ROC curve (AUC) of AE-max, Shell1 E_max, Shell2 E_max, Shell3 E_max and the combination of these 4 parameters in predicting breast cancer was 0.830, 0.906, 0.844, 0.833 and 0.978, respectively. The differences of AE-max, Shell1 E_max, Shell2 Emax and Shell3 E_max among breast masses with different expressions of biological parameters were statistically significant (P < 0.05). The AE-max, Shell1 E_max, Shell2 E_max, and Shell3 E_max of breast masses were all positively associated with the expressions of PR (r =0.612, 0.632, 0.613 and 0.597, all P < 0.05), ER (r = 0.426, 0.463, 0.385 and 0.361, all P < 0.05), HER-2 (r = 0.569, 0.711, 0.603 and 0.587, all P < 0.05) and Ki-67 (r = 0.603, 0.658, 0.553 and 0.611, all P < 0.05). The positive rates of PR, ER, HER-2 and Ki-67 of the malignant breast masses were significantly higher than those of the benign breast masses (P < 0.05), and the presence of lymph node metastasis indicated a higher positive rate of HER-2 (P < 0.05).Conclusions SWE quantitative parameters can effectively differentiate between the benign and malignant breast masses, and are closely related to the biological parameters of breast cancer.

Key words:breast cancer;shear wave elastography;quantitative parameters;identification;biological parameters