-
三阴性乳腺癌(triple negative breast cancer,TNBC)是指雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人类表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)表达均为阴性的乳腺癌,在乳腺癌中占15%~20%[1]。目前,常规超声检查应用乳腺影像报告与数据系统(BI-RADS)对乳腺肿块进行分类,但有报道称其分类诊断具有明显局限[2-3]。近年来,实时剪切波弹性成像(SWE)技术开始应用于乳腺癌的诊断中,SWE是一种动态弹性成像的定量诊断技术,可以对乳腺病灶组织的硬度进行定量分析,以判断其良恶性[4]。本研究旨在结合SWE调整常规超声BI-RADS分类对TNBC进行诊断,探讨其诊断价值。
-
71例乳腺癌病人的图像中(见图 1~2),TNBC组边缘毛刺征、后方回声有衰减、有微钙化比例均低于非TNBC组(P < 0.05~P < 0.01),在腋窝淋巴结有转移方面,TNBC组高于非TNBC组(P < 0.05)。而2组在肿块纵横比、形状、血流分级、RI及弹性评分方面差异均无统计学意义(P>0.05)(见表 1)。
超声表现 TNBC组
(n=25)非TNBC组
(n=46)χ2 P 纵横比 ≥1
< 15(20.0)
20(80.0)6(13.0)
40(87.0)0.60 >0.05 形状 圆或椭圆
不规则8(32.0)
17(68.0)9(19.6)
37(80.4)1.38 >0.05 边缘毛刺征 有
无6(24.0)
19(76.0)27(58.7)
19(41.3)7.84 < 0.01 后方回声衰减 有
无5(20.0)
20(80.0)22(47.8)
24(52.2)5.32 < 0.05 微钙化 有
无12(48.0)
13(52.0)36(78.3)
10(21.7)8.56 < 0.01 内部血流 0~Ⅰ级
Ⅱ~Ⅲ级6(24.0)
19(76.0)10(21.7)
36(78.2)0.05 >0.05 血流RI < 0.7
≥0.79(36.0)
16(64.0)16(34.8)
30(65.2)0.01 >0.05 腋窝淋巴结 有转移
无转移16(64.0)
9(36.0)15(32.6)
31(67.4)6.49 < 0.05 SWE 病灶质软/中
病灶质硬4(16.0)
21(84.0)5(10.9)
41(89.1)0.38 >0.05 表 1 2组乳腺癌病人超声及SWE图像特征比较[n; 百分率(%)]
-
TNBC组Emean和Emax值均低于非TNBC组(P < 0.01),而2组Emin和SD值差异均无统计学意义(P>0.05)(见表 2)。
分组 n Emean值 Emax值 Emin值 SD值 TNBC组 25 76.25±43.26 93.56±48.35 63.25±45.55 12.32±7.99 非TNBC组 46 128.72±53.78 165.40±60.76 85.89±62.34 14.20±8.21 t — 4.19 5.09 0.48 0.81 P — < 0.01 < 0.01 >0.05 >0.05 表 2 2组乳腺癌病人SWE杨氏模量值比较(x±s; kPa)
-
TNBC组25例病人常规超声正确诊断21例,其灵敏度为84.0%,漏诊率为16.0%,结合SWE调整后正确诊断23例,其灵敏度为92.0%,漏诊率为8.0%;非TNBC组46例病人常规超声正确诊断41例,其灵敏度为89.1%,漏诊率为10.9%,结合SWE调整后正确诊断42例,其灵敏度为91.3%,漏诊率为8.7%(见表 3)。
BI-RADS 3类 4A类 4B类 4C类 5类 TNBC组 常规超声 4 6 6 8 1 SWE调整后 2 4 6 8 5 非TNBC组 常规超声 5 10 10 15 6 SWE调整后 4 11 10 13 8 表 3 常规超声结合SWE对BI-RADS分类的调整(n)
常规超声BI-RADS分类结合实时剪切波弹性成像对三阴性乳腺癌的诊断价值
Diagnostic value of conventional ultrasound BI-RADS classification combined with real-time shear wave elastography for triple negative breast cancer
-
摘要:
目的探讨常规超声乳腺影像报告与数据系统(breast imaging reporting and data system,BI-RADS)分类结合实时剪切波弹性成像诊断三阴性乳腺癌的诊断价值。 方法选取71例经病理证实为乳腺癌的住院病人,其中三阴性乳腺癌(TNBC组)25例,非三阴性乳腺癌(非TNBC组)46例,观察对比2组常规超声图像特征,同时进行实时剪切波弹性成像,测量弹性杨氏模量值,并进行BI-RADS分类的调整,比较联合诊断前后的诊断准确度。 结果常规超声中,与非三阴性乳腺癌相比,三阴性乳腺癌呈现出良性肿瘤特征,在边缘毛刺征率、后方回声衰减率及微钙化率方面较高,而淋巴结转移率较低(P < 0.05~P < 0.01)。TNBC组实时剪切波弹性成像弹性杨氏模量值Emean和Emax值明显低于非TNBC组(P < 0.01)。联合应用实时剪切波弹性成像进行BI-RADS分类调整之后,对于三阴性乳腺癌的诊断敏感度为92%,漏诊率为8%。 结论常规超声联合实时剪切波弹性成像诊断三阴性乳腺癌可以降低BI-RADS分类的漏诊率,在临床应用中有重要诊断价值。 -
关键词:
- 乳腺肿瘤 /
- 三阴性 /
- 剪切波弹性成像 /
- 乳腺影像报告与数据系统
Abstract:ObjectiveTo explore the clinical value of conventional ultrasound breast imaging reporting and data system(BI-RADS) classification combined with real-time shear wave elastography in the diagnosis of triple negative breast cancer. MethodsSeventy-one hospitalized patients with breast cancer confirmed by pathology were investigated, and 25 cases with triple negative breast cancer and 46 cases without triple negative breast cancer were divided into the TNBC group and non-TNBC group, respectively.The conventional ultrasonic image characteristics between two groups were observed and compared, the real-time shear wave elastography in two groups was performed to measure the elastic Young's modulus value, and the BI-RADS classification in two groups was adjusted to compare the diagnostic accuracy before and after combined diagnosis. ResultsIn conventional ultrasound, compared with non-triple negative breast cancer, the benign tumor features in triple negative breast cancer were found, the burr rate, echo attenuation rate and microcalcification rate at the edge of tumor were higher, and the rate of lymph node metastasis was lower(P < 0.05 to P < 0.01).The values of Emean and Emax in real-time shear wave elastography in TNBC group were lower than those in non-TNBC group(P < 0.01).After the combined application of real-time shear wave elastography for BI-RADS classification was adjusted, the diagnostic sensitivity and missed diagnosis rate for triple negative breast cancer were 92% and 8%, respectively. ConclusionThe conventional ultrasound combined with real-time shear wave elastography in the diagnosis of triple negative breast cancer can reduce the missed diagnosis rate of BI-RADS classification, and has important diagnostic value in clinical application. -
表 1 2组乳腺癌病人超声及SWE图像特征比较[n; 百分率(%)]
超声表现 TNBC组
(n=25)非TNBC组
(n=46)χ2 P 纵横比 ≥1
< 15(20.0)
20(80.0)6(13.0)
40(87.0)0.60 >0.05 形状 圆或椭圆
不规则8(32.0)
17(68.0)9(19.6)
37(80.4)1.38 >0.05 边缘毛刺征 有
无6(24.0)
19(76.0)27(58.7)
19(41.3)7.84 < 0.01 后方回声衰减 有
无5(20.0)
20(80.0)22(47.8)
24(52.2)5.32 < 0.05 微钙化 有
无12(48.0)
13(52.0)36(78.3)
10(21.7)8.56 < 0.01 内部血流 0~Ⅰ级
Ⅱ~Ⅲ级6(24.0)
19(76.0)10(21.7)
36(78.2)0.05 >0.05 血流RI < 0.7
≥0.79(36.0)
16(64.0)16(34.8)
30(65.2)0.01 >0.05 腋窝淋巴结 有转移
无转移16(64.0)
9(36.0)15(32.6)
31(67.4)6.49 < 0.05 SWE 病灶质软/中
病灶质硬4(16.0)
21(84.0)5(10.9)
41(89.1)0.38 >0.05 表 2 2组乳腺癌病人SWE杨氏模量值比较(x±s; kPa)
分组 n Emean值 Emax值 Emin值 SD值 TNBC组 25 76.25±43.26 93.56±48.35 63.25±45.55 12.32±7.99 非TNBC组 46 128.72±53.78 165.40±60.76 85.89±62.34 14.20±8.21 t — 4.19 5.09 0.48 0.81 P — < 0.01 < 0.01 >0.05 >0.05 表 3 常规超声结合SWE对BI-RADS分类的调整(n)
BI-RADS 3类 4A类 4B类 4C类 5类 TNBC组 常规超声 4 6 6 8 1 SWE调整后 2 4 6 8 5 非TNBC组 常规超声 5 10 10 15 6 SWE调整后 4 11 10 13 8 -
[1] 罗慧, 粟尤欢, 徐金锋, 等.三阴性乳腺癌的多模态影像表现[J].中国现代医学杂志, 2018, 28(31):74. doi: 10.3969/j.issn.1005-8982.2018.31.014 [2] 傅晓红, 沈燕, 刘淼, 等.声触诊组织成像和定量技术鉴别并优化BI-RADS 4类乳腺肿块的价值[J].中国临床医学, 2017, 24(2):214. [3] 尤其琴, 吴蓉.声脉冲辐射力弹性成像对BI-RADS 4类乳腺肿块的诊断价值[J].解放军预防医学杂志, 2016, 34(6):890. [4] 李真, 吕恒勇, 任泽阳, 等.腰背部肌筋膜疼痛综合征激痛点的剪切波弹性模量研究[J].国际生物医学工程杂志, 2016, 39(4):207. doi: 10.3760/cma.j.issn.1673-4181.2016.04.004 [5] MOON WK, CHANG SC, CHANG JM, et al.Classification of breast tumors using elastographic and B-mode features:comparison of automatic selection of representative slice and physician-selected slice of images[J].Ultrasound Med Biol, 2013, 39(7):1147. doi: 10.1016/j.ultrasmedbio.2013.01.017 [6] MERCADO CL.BI-RADS update[J].Radiol Clin North Am, 2014, 52(3):481. doi: 10.1016/j.rcl.2014.02.008 [7] 中华医学会超声医学分会.乳腺超声检查和诊断共识[J].中华放射学杂志, 2014, 48(9):718. doi: 10.3760/cma.j.issn.1005-1201.2014.09.004 [8] 王虹, 刘佩芳, 邵真真, 等.二维彩超联合SWE在乳腺疾病诊断中的应用价值[J].国际生物医学工程杂志, 2015, 38(2):107. doi: 10.3760/cma.j.issn.1673-4181.2015.02.011 [9] 洪敏, 李学亭, 侯云杰.超声BI-RADS联合超声弹性成像对乳腺肿块的诊断价值[J].温州医科大学学报, 2017, 27(10):766. doi: 10.3969/j.issn.2095-9400.2017.10.014 [10] TANGERUD Å, POTAPENKO I, SKJERVEN HK, et al.Radiologic evaluation of lumps in the male breast[J].Acta Radiologica, 2015, 57(7):481. [11] DENT R, TRUDEAU M, PRITCHARD KI, et al.Triple-negative breast cancer:clinical features and patterns of recurrence[J].Clin Cancer Res, 2018, 13(15Ptl):4429. [12] 中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志, 2017, 27(9):695. [13] 倪晨, 李婷, 吴振华, 等.三阴性乳腺癌化疗进展[J].中国癌症杂志, 2014, 24(4):316. doi: 10.3969/j.issn.1007-3969.2014.04.013 [14] 艾慧俊, 纪建松, 陈方红, 等.BI-RADS-US超声弹性成像对三阴性乳腺癌诊断价值探讨[J].医学影像学杂志, 2016, 26(6):1026. [15] 贾志莺, 张银华, 冷晓玲, 等.三阴性及非三阴性乳腺癌超声、临床病理特征的回顾性分析[J].中国临床医学影像杂志, 2017, 28(1):23. doi: 10.3969/j.issn.1008-1062.2017.01.007 [16] 丛瑞, 李晶.感兴趣区大小对剪切波弹性成像诊断乳腺肿块的影响[J].中国介入影像与治疗学, 2017, 14(9):534. [17] 李菲.三阴性乳腺癌常规超声及声触诊组织成像定量剪切波弹性成像特征[D].济南: 山东大学, 2018. [18] DŽOIZ DOMINKOVIZ M, IVANAC G, KELAVA T, et al.Elastographic features of triple negative breast cancers[J].Eur Radiol, 2016, 26(4):1090. doi: 10.1007/s00330-015-3925-7 [19] 张美恋.实时剪切波弹性成像诊断乳腺癌的价值及与病理学关系研究[D].福州: 福建医科大学, 2017. [20] CEBI OLGUN D, KORKMAZER B, KILIÇ F, et al.Use of shear wave elastog raphy to differentiate benign and malignant breast lesions[J].Diagn Interv Radiol, 2014, 20(3):239. doi: 10.5152/dir.2014.13306