超声弹性成像不同参数在乳腺良恶性肿瘤鉴别诊断中的应用价值

摘要

Objective To compare the diagnostic value of area ratio,strain ratio measure method and Itoh5 scoring system for differentiation breast benign and malignant solid lesions.Methods One hundred and eighty-eight patients with 201 lesions(146 benign,55 malignant)were included in the study.The lesion were scored with Itoh5 scoring system,By the strain ratio measure method equipped with the ultrasonic machine,strain ratio and area ratio of the lesion were calculated,strain ratio with 3.08 as the cutoff point,To compare the diagnostic value of area ratio,strain ratio measure method and Itoh5 scoring system for differentiation breast benign and malignant solid lesions.According to pathologic diagnosis,the diagnostic performance of the 3 methods was evaluated with receiver operating characteristic curve(ROC).Results The area under curve(AUC)of area ratio was 0.959,that of strain ratio measure method was 0.965,.and that of Itoh5 scoring system 0.906.Sensitivity was 76％ for area ratio 83％ for SR and 89％for Itoh5 scoring system.Specificity was 81％ for area ratio 91％ for SR and 94％ for Itoh5 scoring system.Accuracy was 79％ for area ratio 91％ for SR and 91％ for Itoh5 scoring system.The diagnostic performance of SR was almost in the same with area ratio (P＞0.05),strain ratio measure method and area ratio had higher accuracy than Itoh5 scoring system.Conclusions The diagnostic value of area ratio and strain ratio measure method with 3.08 as the cutoff point in ultrasonic elastography for differentiation breast benign and malignant lesions with ultrasonic elastography had higher accuracy than Itoh5 scoring system.The diagnostic performance of area ratio was almost in the same with strain ratio measure method.%目的 探讨超声弹性成像Itoh五分法、比值法和面积比法对乳腺良恶性病灶的鉴别诊断价值.方法 对经手术病理证实的188例患者共201个病灶(良性146个,恶性55个)进行超声弹性成像检查,以Itoh五分法对病灶进行评分；测量病灶与周围组织的弹性应变率比值(SR),以3.08为界点判断病灶良恶性,并测量病灶在灰阶图及弹性图中的长径和面积,计算面积比,以病理诊断为金标准,构建受试者应用曲线,比较3种方法对乳腺肿物的诊断价值.结果 Itoh五分法、比值法、面积比法对乳腺良恶性肿瘤进行鉴别诊断,其敏感性分别为76％、83％、89％,特异性分别为81％、91％、94％,准确性分别为79％、91％、91％,分别构建3种诊断标准的ROC曲线,面积比法为0.959,比值法为0.965,Itoh五分法为0.906.超声弹性应变率比值法与面积比法对乳腺肿物的诊断价值相似(P＞0.05),而面积比法、比值法均优于Itoh五分法(P＜0.05).结论 超声弹性应变率比值法和面积法在乳腺良恶性肿瘤的鉴别诊断中具有较高的价值,其诊断的敏感性、特异性、准确性均高于Itoh五分法,而超声弹性面积比法与应变率比值法对乳腺肿物的诊断价值相似.