多模态超声在涎腺局灶性病变良恶性鉴别诊断中的价值

目的探讨多模态超声鉴别诊断涎腺局灶性病变性质的价值。 方法回顾性分析2018年1月至2020年12月在解放军总医院第一医学中心收治的128例涎腺局灶性病变患者的临床资料以及超声影像资料。以手术或穿刺病理结果为金标准，将其分为良性组和恶性组。128例均行常规超声（US）、实时超声弹性成像（RTE）及超声造影（CEUS）检查，记录并分析3种模态的超声图像特征。采用χ²检验比较2组间病灶的超声图像特征，绘制受试者工作特征（ROC）曲线，计算US、US+RTE、US+CEUS、US+RTE+CEUS诊断涎腺局灶性病变的诊断效能以及ROC曲线下面积。 结果128例中，病理诊断良性病灶85例，恶性病灶43例。良性组病灶中91.8%（78/85）边界清晰、58.8%（50/85）形态规则，分别高于恶性病灶的58.1%（25/43）、18.6%（8/43），差异均有统计学意义（P均＜0.001）；恶性组病灶中46.5%（20/43）RTE分级为Ⅲ级、72.1%（31/43）CEUS模式表现为Ⅱc型，良性组病灶中仅16.5%（14/85）RTE分级为Ⅲ级、11.8%（10/85）CEUS模式表现为Ⅱc型，2组比较差异均有统计学意义（P均＜0.05）。US+RTE任意一项结果阳性即诊断恶性对涎腺病变良恶性诊断的敏感度、特异度为0.767、0.800，ROC曲线下面积和约登指数为0.784、0.567。US+CEUS任意一项结果阳性即诊断恶性的敏感度、特异度分别为0.791、0.882，ROC曲线下面积和约登指数为0.837、0.673。US+RTE+CEUS中任意2项或以上结果阳性即诊断为恶性，其敏感度、特异度、准确性、阳性预测值和阴性预测值分别为0.767、0.941、0.883、0.868、0.889，ROC曲线下面积和约登指数为0.854、0.708。 结论多模态超声联合应用有助于提高超声对涎腺局灶性病变良恶性的鉴别诊断价值。

Value of multi-modal ultrasound in differential diagnosis of benign and malignant focal lesions of the salivary gland

ObjectiveTo assess the value of multi-modal ultrasound in the differential diagnosis of focal lesions of the salivary gland. MethodsA retrospective analysis was conducted on the clinical and ultrasonic imaging data of 128 patients with focal lesions of salivary gland who were cured at the First Medical Center of PLA General Hospital from January 2018 to December 2020. Those patients were divided into either a benign group or a malignant group based on the pathology results as golden standard. All the patients underwent conventional ultrasound (US), real-time ultrasound elastography (RTE), and contrast enhanced ultrasound sonography (CEUS), and the features of all ultrasound images were recorded and analyzed. The χ² test was used to compare the multimodal ultrasound image characteristics of the lesions between the two groups, and the receiver operating characteristic (ROC) curve was plotted. The diagnostic efficacy of US, US+RTE, US+CEUS, and US+RTE+CEUS in the diagnosis of focal salivary gland lesions was assessed by the area under the ROC curve (AUC). ResultsAmong the 128 patients included, 85 were confirmed to have benign lesions through pathological diagnosis, and 43 had malignant lesions. The incidence of sharpness of the border and regularity of the shape on US was significantly higher in the benign group than in the malignant group (P＜0.001). In the malignant group, 46.5% (20/43) of cases were classified as grade Ⅲ by RTE and 72.1% (31/43) were classified as type IIc by CEUS; the corresponding percentages in the benign group were only 16.5% (14/85) and 11.8% (10/85), respectively. When positivity obtained by either US or RTE was used to diagnose malignancy, the sensitivity, specificity, AUC, and Youden's index were 0.767, 0.800, 0.784, and 0.567, respectively. When positivity obtained by either US or CEUS was used to diagnose malignancy, the sensitivity, specificity, AUC, and Youden's index were 0.791, 0.882, 0.837, and 0.673, respectively. When positivity obtained by any one of US, RTE, and CEUS was used to diagnose malignancy, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value were 0.767, 0.941, 0.883, 0.868, and 0.889, respectively, and the AUC and Youden's index were 0.854 and 0.708, respectively. ConclusionCombined application of multi-modal ultrasound can improve the differential diagnosis of benign and malignant focal lesions of the salivary gland.