| 摘要: |
| 目的 探索声辐射力弹性成像（ARFI）鉴别乳腺导管内原位癌（DCIS）伴浸润成分的应用价值。方法 选择2016.5-2019.6就诊于我院，经病理检查结果为DCIS的患者为研究对象。分为单纯DCIS组79人，DCIS-I组33人。所有患者于术前行钼靶、超声及ARFI检查，记录并比较两组患者年龄，肿块是否可触及，免疫组化及病理分级结果，钼靶单纯微钙化、微钙化伴肿物、结构扭曲、局限不对称增生及乳腺致密性，超声直径、后方声影、血流、BI-RADS及SWV情况。利用Logistic回归建立多指标联合诊断DCIS伴浸润成分的数学模型，并建立ROC曲线分析各指标单独及联合模型鉴别DCIS伴浸润成分的价值。结果 SWV、直径、病理等级及微钙化伴肿物对鉴别DCIS伴浸润性成分有显著影响（均P＜0.05）。SWV、直径、病理等级的AUC分别为0.823,0.728,0.710。微钙化伴肿物对鉴别DCIS伴浸润性成分的诊断灵敏度、特异度及准确度分别为24.2%，86.1%和67.9%。联合诊断拟合方程为logit(P) =-11.205+2.535*SWV+1.995*直径+1.466*微钙化伴肿物+1.910*病理等级。其AUC为0.923，最佳诊断点为0.284，敏感性87.9%，特异性86.1%。结论 ARFI、超声和病理分级联合鉴别DCIS伴浸润性成分的准确性高于各指标单独诊断。 |
| 关键词: 乳腺导管原位癌 浸润性成分 声辐射力弹性成像 超声 |
| DOI： |
| 投稿时间：2020-08-13修订日期：2020-09-27 |
| 基金项目:上海市卫生和计划生育委员会科研课题基金(编号：20164Y0276) |
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| Value of acoustic radiation force elastography in the identification of ductal carcinoma in situ with infiltrating components |
| Sun Xiaolan,Dai Yuping,Zhang Jun,Chen Zhen |
| (Department of Ultrasound,Shidong Hospital,Yangpu District, Shanghai;Department of Pathology,Shidong Hospital,Yangpu District,Shanghai) |
| Abstract: |
| Objective To explore the value of acoustic radiation force impulse (ARFI) elastography in the identification of ductal carcinoma in situ (DCIS) with infiltrating components. Methods A total of 112 patients were diagnosed with DCIS were selected from May 2016 to June 2019, divided into pure DCIS group and DCIS with infiltrating components (DCIS-I) group according to the postoperative pathological results. The result of general clinicopathologica, mammography, ultrasound and ARFI elastography were compared between two groups. Logistic regression was used to establish a mathematical model for multi-index combined diagnosis of DCIS with infiltrating components, and the diagnostic value of the each index and their combinational model was analyzed by ROC curve. Results SWV, diameter of ultrasound, pathological grade and microcalcification with tumor had significant effects on the result of diagnostic (all P<0.05). The AUC of SWV, diameter of ultrasound , pathological grade were 0.823, 0.728 and 0.710 respectively. The diagnostic sensitivity, specificity and accuracy of microcalcification with tumor were 24.2% , 86.1% and 67.9 respectively. The combined fitting equation was logit(P) =-11.205+2.535*SWV+1.995*diameter+1.466*microcalcification with tumor+1.910*pathological grade. Its AUC was 0.923, and the best diagnostic point was 0.284. The sensitivity was 87.9%, and the specificity was 96.1%. Conclusion The accuracy of the combination of SWV, diameter of ultrasound, pathological grade and microcalcification with tumor in differentiating DCIS with infiltrating components is better than better than each alone. |
| Key words: DCIS, infiltrating components, ARFI, ultrasound |
