剪切波弹性成像对乳腺导管原位癌的诊断价值及漏诊的潜在因素-东南大学学报医学版

剪切波弹性成像对乳腺导管原位癌的诊断价值及漏诊的潜在因素

单位：1. 南京医科大学第一附属医院超声医学科, 江苏南京 210029;
2. 东南大学附属中大医院江北院区超声科, 江苏南京 210044;
3. 东南大学附属中大医院超声科, 江苏南京 210009;
4. 南京医科大学第一附属医院放射科, 江苏南京 210029

关键词：乳腺导管原位癌剪切波弹性成像超声检查诊断

分类号：R737.9;R445.1

出版年·卷·期（页码）：2021·40·第二期（183-188）

摘要：

目的：探讨剪切波弹性成像对乳腺导管原位癌（DCIS）的诊断价值，分析DCIS漏诊的原因及弹性参数假阴性预测结果的影响因素。方法：回顾性分析2019年1月至10月就诊的148例（共161个病灶）乳腺病变患者的影像学资料，其中DCIS 21个（DCIS组），DCIS伴微浸润19个（DCIS-MI组），乳头状癌21个（PC组），浸润性导管癌50个（IDC组）和良性病变50个（良性组）。所有病例先行常规超声检查记录病灶的特征，然后行剪切波弹性成像并获得最大弹性模量值（Emax）、最小弹性模量值（Emean）、弹性标准差（Esd）和弹性比值（Eratio）。分析5组病变超声特征的差异、弹性参数在良恶性病变中的诊断价值以及4组恶性病变假阴性率，探讨DCIS组弹性参数假阴性预测结果的影响因素。结果：5组病灶大小和边缘比较差异均有统计学意义（均P<0.001），4组恶性病变病灶大小明显大于良性组，且DCIS组、DCIS-MI组和IDC组病灶大小呈渐增趋势。5组乳腺病灶Emax、Emean、Esd及Eratio比较差异均有统计学意义（均P<0.001），Emax、Emean、Esd及Eratio鉴别诊断乳腺良恶性病变的ROC曲线下面积分别为0.869、0.878、0.837和0.822，当分别取77.48 kPa、29.68 kPa、9.95 kPa和2.78 kPa时，诊断效能最佳。DCIS组假阴性率最高。DCIS组Emax、Esd假阴性预测结果与病灶大小有关（P=0.022、0.004），Esd假阴性预测结果与病灶方位有关（P=0.012）。结论：DCIS组弹性参数介于良性组及3组恶性病变（DCIS-MI组、PC组和IDC组）之间，可能是造成剪切波弹性成像对DCIS漏诊的原因。Emax、Esd假阴性预测结果与DCIS病灶大小及方位可能存在一定的关联。

Objective: To explore the diagnostic value of shear wave elastography in ductal carcinoma in situ (DCIS) of the breast, and analyze the causes of misdiagnosis of DCIS and the influencing factors of false negative prediction results of elastic parameters. Methods: From January to October 2019, a total of 148 cases (161 lesions) of patients with breast lesions image data, including 21 ductal carcinoma in situ lesions (DCIS group),19 ductal carcinoma in situ with micro infiltration lesions (DCIS-MI group),21 papillary carcinoma lesions (PC group),50 invasive ductal carcinoma lesions (IDC group) and 50 benign lesions (Benign group) were retrospectively studied. In all cases, the features of the lesions were recorded by ultrasonography, then shear wave elastography was performed and the maximum elasticity (Emax), the minimum elasticity (Emean), the elasticity standard deviation (Esd) and the elasticity ratio (Eratio) were obtained. The differences of sonographic features in five groups, the diagnostic value of elastic parameters in benign and malignant lesions, and the number of false negative cases of malignant lesions in four groups were analyzed. The influencing factors of false negative prediction of elastic parameters in DCIS were discussed. Results: There were statistically significant differences in the size and margin of the lesions among the five groups (all P<0.001).The lesion sizes of the four malignant groups were significantly larger than that of the benign group, and the size of the DCIS group, DCIS-MI group and IDC group showed an increasing trend. There were statistical differences in Emax, Emean, Esd and Eratio among five groups of breast lesions (all P<0.001).The areas under ROC curve of Emax, Emean, Esd and Eratio for the differential diagnosis of benign and malignant breast lesions were 0.869, 0.878, 0.837 and 0.822, respectively. When 77.48 kPa, 29.68 kPa, 9.95 kPa and 2.78 kPa were selected, the diagnostic efficiency was the best. The false negative rate of the DCIS group was the highest. In the DCIS group, the false negative prediction results of Emax and Esd were related to lesion size (P=0.022, 0.004), and the false negative prediction results of Esd were related to lesion orientation(P=0.012). Conclusion: The elastic parameters of DCIS group are between the benign group and three groups of malignant lesions (DCIS-MI group, PC group and IDC group), which maybe the reason of shear wave elastography misdiagnosis. Maybe it has a certain correlation between false negative prediction results of Emax or Esd and the size or orientation of DCIS lesions.

参考文献：

[1] LÆNKHOLM A,JENSEN M,KROMAN N,et al.Breast cancer in situ.From pre-malignant lesion of uncertain significance to well-defined non-invasive malignant lesion.The Danish Breast Cancer Cooperative Group Register 1977-2007 revisited[J].Acta Oncol,2008,47(4):765-771.
[2] 林僖,林庆光,李程,等.超声检查对乳腺导管内癌的早期诊断价值[J/OL].中华医学超声杂志(电子版),2016,13(4):297-301.
[3] EVANS A,WHELEHAN P,THOMSON K,et al.Differentiating benign from malignant solid breast masses:value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification[J].Brit J Cancer,2012,107(2):224-229.
[4] 曾庆劲,曾婕,郑荣琴,等.剪切波弹性成像在乳腺实性病变良恶性鉴别诊断中的价值[J].中华超声影像学杂志,2014,23(2):129-132.
[5] 唐丽娜,王瑶琴,陈轶洁,等.超声剪切波弹性定量参数在优化乳腺结节BI-RADS分类中的价值[J].中国超声医学杂志,2016,32(8):687-690.
[6] 史宪全,李俊来,李秋洋,等.超声剪切波弹性模量参数在评估乳腺良恶性病灶中的应用价值比较[J].中国医学科学院学报,2015,37(3):294-298.
[7] VINNICOMBE S J,WHELEHAN P,THOMSON K,et al.What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?[J].Eur Radiol,2014,24(4):921-926.
[8] 王敏,崔可飞,司彩凤.定量剪切波弹性成像对乳腺癌假阴性诊断的分析[J].中国超声医学杂志,2014,30(11):974-976.
[9] EVANS A,WHELEHAN P,THOMSON K,et al.Invasive breast cancer:relationship between shear-wave elastographic findings and histologic prognostic factors[J].Radiology,2012,263(3):673-677.
[10] FRANK G A,DANILOVA N V,ANDREEVA LULU,et al.WHO classification of tumors of the breast,2012[J].Arkh Patol,2013,75(2):53-63.
[11] SHIN Y J,KIM S M,YUN B L,et al.Predictors of invasive breast cancer in patients with ductal carcinoma in situ in ultrasound-guided core needle biopsy[J].J Ultras Med,2019,38(2):481-488.
[12] BAE J S,CHANG J M,LEE S H,et al.Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ[J].Eur Radiol,2017,27(1):7-15.
[13] HUNG W K,YING M,CHAN M,et al.The impact of sentinel lymph node biopsy in patients with a core biopsy diagnosis of ductal carcinoma in situ[J].Breast Cancer,2010,17(4):276-280.
[14] WILKIE C,WHITE L,DUPONT E,et al.An update of sentinel lymph node mapping in patients with ductal carcinoma in situ[J].AM J Surg,2005,190(4):563-566.
[15] GANAU S,ANDREU F J,ESCRIBANO F,et al.Shear-wave elastography and immunohistochemical profiles in invasive breast cancer:Evaluation of maximum and mean elasticity values[J].Eur J Radiol,2015,84(4):617-622.
[16] SIM Y T,VINNICOMBE S,WHELEHAN P,et al.Value of shear-wave elastography in the diagnosis of symptomatic invasive lobular breast cancer[J].Clin Radiol,2015,70(6):604-609.
[17] 王颖彦,费高强,沈会明,等.乳腺导管原位癌和浸润性导管癌超声多模态表现与免疫指标的相关性研究[J].东南大学学报(医学版),2019,38(5):898-901.
[18] DURHAN G,ÖZTEKIN P S,VNVERDI H,et al.Do histopathological features and microcalcification affect the elasticity of breast cancer?[J].J Ultras Med,2017,36(6):1101-1108.
[19] MUELLER M M,FUSENIG N E.Friends or foes-bipolar effects of the tumour stroma in cancer[J].Nat Rev Cancer,2004,4(11):839-849.
[20] 孙琳,杨顺实,田青青,等.乳腺导管内癌及其微浸润与乳腺浸润性导管癌旳超声及病理特征[J].中国超声医学杂志,2015,31(5):394-397.
[21] BRENNAN M E,TURNER R M,CIATTO S,et al.Ductal carcinoma in situ at core-needle biopsy:meta-analysis of underestimation and predictors of invasive breast cancer[J].Radiol,2011,260(1):119-128.
[22] EVANS A,PURDIE C A,JORDAN L,et al.Stiffness at shear-wave elastography and patient presentation predicts upgrade at surgery following an ultrasound-guided core biopsy diagnosis of ductal carcinoma in situ[J].Clin Radiol,2016,71(11):1156-1159.
[23] YOON J H,JUNG H K,LEE J T,et al.Shear-wave elastography in the diagnosis of solid breast masses:what leads to false-negative or false-positive results?[J].Eur Radiol,2013,23(9):2432-2440.
[24] 赵淳,许华宁,沈碧潇,等.超声图像及造影特征对乳腺导管内癌的早期诊断价值[J].东南大学学报(医学版),2020,39(3):293-297.

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