弹性成像在鉴别乳腺良恶性肿块中的价值及误漏诊因素分析(1)
【摘要】 目的：探討弹性成像在鉴别乳腺良恶性肿块中的价值及误漏诊因素。方法：选取2015年
2月-2018年9月间南方医科大学附属普宁华侨医院收治的92例乳腺肿块患者，对所有患者经病理学证实的共98个乳腺肿块进行回顾性分析，其中良性肿块共58个，恶性肿块共40个。所有患者均予以超声弹性成像应变率比值、5分评分法和B超检查，以病理学结果作为“金标准”，应用受试者工作曲线(receiver operating characteristic curves，ROC)观察比较弹性成像应变率比值、5分评分法和B超在鉴别良恶性乳腺肿块中的效能。结果：弹性成像应变率比值共检出良性肿块51个，恶性肿块47个;5分评分法共检出良性肿块54个，恶性肿块44个;B超共检出良性肿块47个，恶性肿块51个;ROC曲线显示，弹性成像应变率比值诊断鉴别良恶性乳腺肿块的曲线下面积(Area under curve，AUC)最高(AUC=0.919，P=0.000)，其次为弹性成像5分评分法和B超(AUC=0.889，0.736;P=0.000，0.000)，其中应变率比值的AUC高于B超(Z=2.399，P=0.016 5);弹性成像应变率比值和5分评分法鉴别良恶性乳腺肿块的准确度均高于B超(字2=11.025，7.202;P=0.001，0.007);两者灵敏度均高于B超(字2=6.135，4.114;P=0.013，0.043);应变率比值特异度高于B超(字2=5.841，P=0.016);应变率比值阳性预测值高于B超(字2=5.017，P=0.025);两者阴性预测值均高于B超(字2=6.652，4.443;P=0.010，0.035);92例患者共检出乳腺肿块98个，应用弹性成像应变率比值鉴别良恶性出现误漏诊9例(9.18%)。多因素Logistic回归分析表明，肿块直径与总体误漏诊率无显著相关性(P=0.913)，肿块深度与总体误漏诊率有相关性，其中深度≤4 mm是乳腺肿块良恶性鉴别误漏诊的独立危险因素(OR=0.073，P=0.022)。结论：弹性成像应变率比值用于鉴别乳腺良恶性肿块中的恶性检出率较高，具有更好的诊断效能，值得临床推广应用，其中当肿块深度≤4 mm是弹性成像应变率比值鉴别乳腺肿块良恶性误漏诊的独立危险因素，临床应用时应注意。
【关键词】 乳腺肿块; 弹性成像; 应变率比值; 5分评分法; 诊断效能; 误漏诊
【Abstract】 Objective：To investigate the value of elastography in differentiating benign and malignant breast masses and the factors of misdiagnosis.Method：From February 2015 to September 2018，92 patients with breast tumors in Puning Overseas Chinese Hospital Affiliated to Southern Medical University were selected.A total of 98 breast tumors confirmed by pathology were retrospectively analyzed，including 58 benign tumors and 40 malignant tumors.All patients were examined by ultrasound elastography strain rate ratio，5 points scoring and B-mode ultrasonography.Pathological results were used as the gold standard and receiver operating characteristic curves(ROC)were used to compare the effectiveness of elastography，B ultrasound and mammography in differentiating benign and malignant breast masses.Result：51 benign and 47 malignant breast masses were detected by elastography strain rate，54 benign and 44 malignant breast masses were detected by 5 points scoring，47 benign and 51 malignant breast masses were detected by ultrasound，and the ROC curve showed that the area under the curve(Area under curve，AUC)of strain rate in differentiating benign and malignant breast masses was the highest(AUC=0.919，P=0.000)and followed by 5 points scoring and B-mode ultrasound(AUC=0.889，0.736;P=0.000，0.000).The AUC of strain ratio was higher than that of ultrasound(Z=2.399，P=0.016 5).
The accuracy of elastography strain ratio and 5-point scoring in differentiating benign and malignant breast masses were higher than that of B-mode ultrasound(字2=11.025，7.202;P=0.001，0.007).The sensitivity of both methods were higher than that of B-mode ultrasound(字2=6.135，4.114;P=0.013，0.043).The specificity of strain ratio was higher than that of B-mode ultrasound(字2=5.841，P=0.016).The positive predictive value of strain ratio was higher than that of B-mode ultrasound(字2=5.017，P=0.025);The negative predictive value of both methods were higher than that of B-mode ultrasound(字2=6.652，4.443;P=0.010，0.035).9cases(9.18%)were misdiagnosed as benign or malignant.Multivariate logistic regression analysis showed that there was no significant correlation between the tumor diameter and the overall misdiagnosis rate(P=0.913)，and the tumor depth was related to the overall misdiagnosis rate.The depth ≤4 mm was an independent risk factor for the differential misdiagnosis between benign and malignant breast masses(OR=0.073，P=0.022)., http://www.100md.com(黄翠云?陈兰香?陈武镇?曾婷婷)
2月-2018年9月间南方医科大学附属普宁华侨医院收治的92例乳腺肿块患者，对所有患者经病理学证实的共98个乳腺肿块进行回顾性分析，其中良性肿块共58个，恶性肿块共40个。所有患者均予以超声弹性成像应变率比值、5分评分法和B超检查，以病理学结果作为“金标准”，应用受试者工作曲线(receiver operating characteristic curves，ROC)观察比较弹性成像应变率比值、5分评分法和B超在鉴别良恶性乳腺肿块中的效能。结果：弹性成像应变率比值共检出良性肿块51个，恶性肿块47个;5分评分法共检出良性肿块54个，恶性肿块44个;B超共检出良性肿块47个，恶性肿块51个;ROC曲线显示，弹性成像应变率比值诊断鉴别良恶性乳腺肿块的曲线下面积(Area under curve，AUC)最高(AUC=0.919，P=0.000)，其次为弹性成像5分评分法和B超(AUC=0.889，0.736;P=0.000，0.000)，其中应变率比值的AUC高于B超(Z=2.399，P=0.016 5);弹性成像应变率比值和5分评分法鉴别良恶性乳腺肿块的准确度均高于B超(字2=11.025，7.202;P=0.001，0.007);两者灵敏度均高于B超(字2=6.135，4.114;P=0.013，0.043);应变率比值特异度高于B超(字2=5.841，P=0.016);应变率比值阳性预测值高于B超(字2=5.017，P=0.025);两者阴性预测值均高于B超(字2=6.652，4.443;P=0.010，0.035);92例患者共检出乳腺肿块98个，应用弹性成像应变率比值鉴别良恶性出现误漏诊9例(9.18%)。多因素Logistic回归分析表明，肿块直径与总体误漏诊率无显著相关性(P=0.913)，肿块深度与总体误漏诊率有相关性，其中深度≤4 mm是乳腺肿块良恶性鉴别误漏诊的独立危险因素(OR=0.073，P=0.022)。结论：弹性成像应变率比值用于鉴别乳腺良恶性肿块中的恶性检出率较高，具有更好的诊断效能，值得临床推广应用，其中当肿块深度≤4 mm是弹性成像应变率比值鉴别乳腺肿块良恶性误漏诊的独立危险因素，临床应用时应注意。
【关键词】 乳腺肿块; 弹性成像; 应变率比值; 5分评分法; 诊断效能; 误漏诊
【Abstract】 Objective：To investigate the value of elastography in differentiating benign and malignant breast masses and the factors of misdiagnosis.Method：From February 2015 to September 2018，92 patients with breast tumors in Puning Overseas Chinese Hospital Affiliated to Southern Medical University were selected.A total of 98 breast tumors confirmed by pathology were retrospectively analyzed，including 58 benign tumors and 40 malignant tumors.All patients were examined by ultrasound elastography strain rate ratio，5 points scoring and B-mode ultrasonography.Pathological results were used as the gold standard and receiver operating characteristic curves(ROC)were used to compare the effectiveness of elastography，B ultrasound and mammography in differentiating benign and malignant breast masses.Result：51 benign and 47 malignant breast masses were detected by elastography strain rate，54 benign and 44 malignant breast masses were detected by 5 points scoring，47 benign and 51 malignant breast masses were detected by ultrasound，and the ROC curve showed that the area under the curve(Area under curve，AUC)of strain rate in differentiating benign and malignant breast masses was the highest(AUC=0.919，P=0.000)and followed by 5 points scoring and B-mode ultrasound(AUC=0.889，0.736;P=0.000，0.000).The AUC of strain ratio was higher than that of ultrasound(Z=2.399，P=0.016 5).
The accuracy of elastography strain ratio and 5-point scoring in differentiating benign and malignant breast masses were higher than that of B-mode ultrasound(字2=11.025，7.202;P=0.001，0.007).The sensitivity of both methods were higher than that of B-mode ultrasound(字2=6.135，4.114;P=0.013，0.043).The specificity of strain ratio was higher than that of B-mode ultrasound(字2=5.841，P=0.016).The positive predictive value of strain ratio was higher than that of B-mode ultrasound(字2=5.017，P=0.025);The negative predictive value of both methods were higher than that of B-mode ultrasound(字2=6.652，4.443;P=0.010，0.035).9cases(9.18%)were misdiagnosed as benign or malignant.Multivariate logistic regression analysis showed that there was no significant correlation between the tumor diameter and the overall misdiagnosis rate(P=0.913)，and the tumor depth was related to the overall misdiagnosis rate.The depth ≤4 mm was an independent risk factor for the differential misdiagnosis between benign and malignant breast masses(OR=0.073，P=0.022)., http://www.100md.com(黄翠云?陈兰香?陈武镇?曾婷婷)