上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (4): 514-.doi: 10.3969/j.issn.1674-8115.2020.04.016

• 论著·临床研究 • 上一篇    下一篇

超声造影定量分析技术在乳腺导管内病变良恶性鉴别中的应用价值

王媚瑜1, 2*，张一峰2, 3*，陈 捷1，郑 丽1   

  1. 1. 上海市宝山区中西医结合医院超声科，上海201999；2. 同济大学附属第十人民医院超声医学科，上海200072；3. 同济大学医学院超声医学研究所，同济大学癌症中心，上海超声诊疗工程技术研究中心，上海200072
  • 出版日期:2020-04-28 发布日期:2020-05-22
  • 通讯作者: 郑 丽，电子信箱：zli9798@163.com。
  • 作者简介:王媚瑜（1982—），女，主治医师，学士；电子信箱：20247337@qq.com。张一峰（1980—），女，副主任医师，硕士；电子信箱：27763289@qq.com。*为共同第一作者。

Value of contrast-enhanced ultrasound quantitative analysis in differential diagnosis of benign and malignant breast intraductal lesions

WANG Mei-yu, ZHANG Yi-feng, CHEN Jie, ZHENG Li   

  1. 1. Department of Ultrasound, Baoshan Integrated Traditional Chinese and Western Medicine Hospital, Shanghai 201999, China; 2. Department of Medical Ultrasound, Shanghai Tenth Peoples Hospital, Tongji University School of Medicine, Shanghai 200072, China; 3. Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai 200072, China
  • Online:2020-04-28 Published:2020-05-22

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摘要： 目的·评价超声造影定量分析在乳腺导管内病变良恶性鉴别诊断中的应用价值。方法·回顾性分析2016年1月—2018年12月同济大学附属第十人民医院经乳腺外科手术切除并病理学确诊的63例患者的71个乳腺导管内病变的常规超声特征及超声造影时间-强度曲线，获得病灶区超声造影血流灌注参数。采用独立样本t检验分析良恶性病灶超声造影定量参数之间的差异。并利用受试者操作特征曲线（receiver operating characteristic curve，ROC曲线）评价常规超声、超声造影定量分析及两者联合应用鉴别诊断乳腺导管内病变良恶性的价值。结果·病理结果证实良性病灶42个，恶性病灶29个。在超声造影定量参数中，良恶性病灶组间达峰时间（t2.072，P0.042）、峰值强度（t-2.629，P0.011）、上升支斜率（t3.015，P0.004）和曲线下面积（t3.308，P0.001）的差异有统计学意义。常规超声、超声造影定量分析及两者联合应用诊断乳腺导管内病变良恶性的敏感度、特异度、准确度、阳性预测值、阴性预测值及ROC 曲线下面积分别为：常规超声，31.03%、90.48%、66.20%、69.20%、65.50%、0.608；超声造影定量分析，75.86%、71.43%、73.24%、64.70%、81.10%、0.776；两者联合应用，86.21%、97.62%、92.96%、96.15%、91.11%、0.943。结论·常规超声对于乳腺导管内病变诊断价值有限，而超声造影定量分析对于鉴别乳腺导管内病变良恶性有重要意义。常规超声与超声造影定量分析联合应用可以明显提高诊断价值。

关键词: 乳腺导管内病变, 超声造影, 时间-强度曲线

Abstract:

Objective · To evaluate the value of contrast-enhanced ultrasound quantitative analysis in the differential diagnosis of benign and malignant breast intraductal lesions. Methods · A retrospective analysis was made on the characteristics of conventional ultrasound and the time-intensity curve (TIC) of contrast-enhanced ultrasound (CEUS) of 71 breast intraductal lesions in 63 patients, which were surgically resected and pathologically confirmed in Shanghai Tenth People′s Hospital January 2016 to December 2018. The parameters of CEUS perfusion in the lesion area were obtained. Independent sample t test was used to analyze the differences of quantitative parameters between benign and malignant lesions. The receiver operating characteristic (ROC) curve was used to evaluate the value of conventional ultrasound, quantitative analysis of CEUS and their combination for the differential diagnosis of benign and malignant intraductal lesions of breast. Results · There were 42 benign lesions and 29 malignant lesions. Among the quantitative parameters of CEUS, time to peak (t2.072, P0.042), peak intensity (t-2.629, P0.011), rise slope rate (t3.015, P0.004) and the area under the curve (AUC) (t3.308, P0.001) were statistically significant. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and area under the ROC curve of conventional ultrasound were 31.03%, 90.48%, 66.20%, 69.20%, 65.50% and 0.608. Those of quantitative analysis of CEUS were 75.86%, 71.43%, 73.24%, 64.70%, 81.10% and 0.776. And those of their combination were 86.21%, 97.62%, 92.96%, 96.15%, 91.11% and 0.943. Conclusion · Conventional ultrasound is of limited value in the diagnosis of breast intraductal lesions, and quantitative analysis of CEUS is of great significance in differentiating benign malignant breast intraductal lesions. The combination of conventional ultrasound and quantitative analysis of CEUS can significantly improve the diagnostic value.

Key words: breast intraductal lesions, contrast-enhanced ultrasound, time-intensity curve (TIC)