Evaluation of ultrasound multiple parameters (two-dimensional, color Doppler flow imaging, shear wave elastography, contrast-enhanced imaging) in breast cancer versus pathological control
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摘要:
目的 分析乳腺癌超声多参数(二维高频超声、彩色多普勒血流显像、剪切波弹性成像、造影)评估与病理对照。 方法 选择2018年4月~2020年9月我院诊治的乳腺占位性病变患者61例(72个病灶)，均行二维高频超声、彩色多普勒血流显像、剪切波弹性成像、造影和病理检查，以术后病理检查结果为金标准。计算各种检查方法诊断乳腺癌的敏感度、准确度。 结果 术后病理诊断结果示：61例(72个病灶)中有43例恶性(51个病灶)，18例良性(21个病灶)；二维高频超声诊断乳腺癌敏感度47.06%，特异性66.67%，准确度52.78%；彩色多普勒血流显像敏感度60.78%，特异性71.43%，准确度63.89%；剪切波弹性成像敏感度82.35%，特异性80.95%，准确度81.94%；超声造影敏感度86.27%，特异性85.71%，准确度86.11%；联合诊断敏感度94.12%，特异性90.48%，准确度93.06%。联合诊断乳腺癌准确率高于单独二维、彩色多普勒血流显像、剪切波弹性成像、造影检查(P < 0.05)。 结论 乳腺癌超声多参数(二维、彩色多普勒血流显像、剪切波弹性成像、造影)联合检查，可明显提高乳腺癌诊断的准确率。 Abstract:Objective To compare the multimodal ultrasonographic parameters (two-dimensional high frequency ultrasound, color Doppler flow imaging (CDFI), shear wave elasticity imaging, contrast-enhanced ultrasound) and clinicopathological appearances of breast cancer. Methods Sixty-one patients (72 lesions) with breast space occupying lesions from April 2018 to September 2020 in our hospital were enrolled. Two-dimensional high frequency ultrasound, color Doppler flow imaging, shear wave elasticity imaging, contrast-enhanced ultrasound and pathological examinations were performed on all patients. Using pathological results as gold standard, the sensitivity and accuracy of each examination in the diagnosis of breast cancer were analyzed. Results Pathological results showed that among 61 patients (72 lesions), 43 were malignant (51 lesions) and 18 were benign (21 lesions). In the diagnosis of breast cancer, the sensitivity, specificity and accuracy were 47.06%, 66.67% and 52.78% through two-dimensional high frequency ultrasound, those of color Doppler flow imaging were 60.78%, 71.43% and 63.89%, and those of shear wave elasticity imaging were 82.35%, 80.95% and 81.94%, and those of contrast-enhanced ultrasound were 86.27%, 85.71% and 86.11%. The sensitivity, specificity and accuracy of combined examinations in the diagnosis of breast cancer were 94.12%, 90.48% and 93.06%, respectively. The accuracy of combined examination in the diagnosis of breast cancer was higher than that of single examination (P < 0.05). Conclusion Combined examinations can significantly improve accuracy of diagnosis of breast cancer, which is highly consist with pathological results. -
图 1 某女性患者，浸润性导管癌Ⅲ级(HE, ×200)
Figure 1. A female patient, grade III invasive ductal carcinoma (HE, ×200)
图 2 同病理结果病例的二维高频超声、剪切波弹性成像、CDFI及造影图像
A: 二维高频超声图像显示: 实性低回声包块, 边界清晰, 边缘成角及小分叶改变, 内部回声不均匀, 见微钙化, 后方回声轻度衰减, 纵横比<1; B: 剪切波弹性成像图像显示: 内部彩色部分缺失, 周边以黄色、橘红色为主, 成“硬环征”声像, SWE-Emax 132.6 kPa，SWE-Emean 38.6 kPa，SWE-Emin 0.1 kPa; C: CDFI图像显示：肿块内可见5个及以上点状血管及3个较长血管丰富血流信号，按Adler半定量法分III级; D: 造影图像示：肿块造影后体积明显较二维高频超声测量增大，中部未见增强，边缘增强明显高于周围组织，肿块整体造影增强成不均匀型.
Figure 2. Two-dimensional high frequency ultrasound imaging, shear wave elasticity imaging, CDFI imaging and contrast- enhanced ultrasound imaging of patient with same pathologic result
图 3 二维、CDFI、剪切波成像、造影单独超声技术及联合超声多参数诊断的ROC曲线
Figure 3. ROC curves of single and combined examinations of two-dimensional high frequency ultrasound, CDFI, shear wave elasticity imaging, and contrast-enhanced ultrasound.
表 1 二维、CDFI、剪切波成像、造影及联合结果
Table 1. Combined examinations of two-dimensional high frequency ultrasound, CDFI, shear wave elasticity imaging and contrastenhanced ultrasound (n)
项目 诊断 病理 合计 恶性 良性 二维 恶性 24 7 31 良性 27 14 41 CDFI 恶性 31 6 37 良性 20 15 35 剪切波成像 恶性 42 4 46 良性 9 17 26 造影 恶性 44 3 47 良性 7 18 25 联合 恶性 48 2 50 良性 3 19 22 合计 51 21 72 
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