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目的探讨不同超声弹性定量参数鉴别诊断乳腺肿块(BM)的价值。方法选择2013年8月至2014年6月收治的111例(共150个病灶)BM患者,均行超声弹性成像检查(UE),且经穿刺或手术活检明确病理性质,并构建受试者工作特征曲线(ROC),比较弹性评分、面积比(A2/A1)、应变率比值(SR)对于BM良恶性的鉴别诊断价值。结果 (1)临床资料:150个病灶中,良性病灶90个,恶性病灶60个。(2)弹性评分:对于BM良恶性诊断,弹性评分的敏感性、特异性、准确性分别为95.0%、81.1%、86.7%。构建ROC曲线后显示,其曲线下面积(AUC)、诊断临界值分别为0.925、3.5。(3)A2/A1:较之良性肿块,恶性肿瘤的A2/A1明显大,差异有统计学意义(P<0.05)。构建ROC曲线后显示,其AUC、诊断临界值分别为0.896、1.2,敏感性、特异性、准确性分别为91.7%、80.0%、84.7%。(4)应变率比值(SR):较之良性肿块,恶性肿瘤的SR均明显大,差异有统计学意义(P<0.05)。构建ROC曲线后显示,SR的AUC、诊断临界值分别为0.803、2.4,敏感性、特异性、准确性分别为63.3%、84.4%、76.0%。(5)各弹性参数比较:对于BM的鉴别诊断,以弹性评分的价值最高,其次为A2/A1,而SR的鉴别诊断价值较前两者要低。结论对于BM良恶性鉴别诊断,各弹性定量参数均有一定诊断价值,其中弹性评分、A2/A1的鉴别诊断价值较高。
Objective To investigate the value of different quantitative ultrasound parameters in the differential diagnosis of breast masses (BM). Methods A total of 111 patients (150 lesions) with BM were admitted to our hospital from August 2013 to June 2014. All patients underwent echocardiography (UE). The pathological features were confirmed by puncture or biopsy, and the work of the subjects was constructed (ROC), comparative elastic score, area ratio (A2 / A1), and strain rate ratio (SR) in the differential diagnosis of benign and malignant BM. Results (1) clinical data: 150 lesions, 90 benign lesions, 60 malignant lesions. (2) Elasticity score: The sensitivity, specificity and accuracy of elasticity score were 95.0%, 81.1% and 86.7% respectively for the diagnosis of benign and malignant BM. Constructing ROC curve showed that the area under the curve (AUC), the diagnostic threshold were 0.925,3.5. (3) A2 / A1: Compared with benign tumor, the A2 / A1 of malignant tumor was significantly larger, the difference was statistically significant (P <0.05). After constructing ROC curve, the AUC and diagnostic threshold were 0.896 and 1.2, respectively. The sensitivity, specificity and accuracy were 91.7%, 80.0% and 84.7% respectively. (4) Strain rate ratio (SR): Compared with benign tumor, the SR of malignant tumor was significantly larger, the difference was statistically significant (P <0.05). After constructing ROC curve, the critical value of AUC of SR was 0.803,2.4, respectively. The sensitivity, specificity and accuracy were 63.3%, 84.4% and 76.0% respectively. (5) Comparison of elastic parameters: For the differential diagnosis of BM, the value of elasticity score is the highest, followed by A2 / A1, while the differential diagnosis value of SR is lower than the former two. Conclusion For the differential diagnosis of benign and malignant BM, all elastic quantitative parameters have certain diagnostic value, of which elastic score, A2 / A1 differential diagnosis is higher.