超声造影定量分析在乳腺浸润性导管癌预后评估中的应用

目的探讨超声造影定量分析参数在浸润性乳腺癌预后因素评估中的应用价值。方法对110例浸润性导管乳腺癌进行术前进行灰阶超声造影，并用定量分析QLAB软件分析，生成时间-强度曲线，对周围正常组织与肿瘤组织血流灌注参数进行比较，并分析浸润性乳腺癌超声造影灌注定量参数与预后因素关系。最后分别对各个超声造影定量灌注参数值做ROC曲线分析。结果与正常组织相比，肿瘤组织峰值强度（PI）明显升高，达峰时间（TTP）、平均渡越时间（MTT）明显短，差异有统计学意义（P < 0.05）；上升时间段（RT）相比差异无统计学意义（P>0.05）。与病理分级为高-中分化浸润性乳腺癌患者相比，低分化浸润性乳腺癌患者的RT、TTP明显延长，PI明显升高，差异有统计学意义（P < 0.05），而MTT相比差异无统计学意义（P>0.05）。肿瘤直径＞20 mm的浸润性乳腺癌患者的PI明显高于肿瘤直径≤20 mm患者（P < 0.05），而TTP、MTT、RT相比差异无统计学意义。与无淋巴结转移浸润性乳腺癌患者相比，有淋巴结转移患者的PI升高，RT延长，差异有统计学意义（P < 0.05），而TTP、MTT相比差异无统计学意义（P>0.05）；ER阴性、PR阴性的浸润性乳腺癌患者PI明显高于ER阳性、PR阳性患者，差异有统计学意义（P < 0.05），而TTP、MTT、RT相比差异无统计学意义（P>0.05）；有无Her-2与Ki-67的表达患者的PI、TTP、MTT、RT相比差异无统计学意义（P>0.05）。ROC曲线分析结果显示，PI在ER阴性表达、PR阴性表达鉴别诊断中具有中-低等的诊断效能，PI的截断点均为12.975 dB，标准误分别为0.073（95%CI: 0.562~0.849）、0.074（95%CI: 0.540~0.828），敏感度和特异性分别为77.40%、72.20%，65.20%、66.70%，曲线下面积分别为0.705、0.688。结论PI、TTP、RT能反映病灶内血流灌注情况，对浸润性乳腺癌患者预后评估有一定的帮助。 

Application of quantitative analysis of contrast-enhanced ultrasound in the evaluation of prognostic factors of breast invasive ductal carcinoma

ObjectiveTo explore the application value of ultrasound contrast quantitative analysis parameters in evaluating prognostic factors of invasive breast cancer.Methods110 cases of invasive ductal breast cancer were pre-operatively performed gray-scale ultrasound contrast. QLAB software was used to analyzed to generate time-intensity curve. The blood perfusion parameters of surrounding normal tissue and tumor tissue were compared. The relationship between quantitative parameters of ultrasound contrast perfusion of invasive breast cancer and prognostic factors were analyzed. Finally, ROC curve analysis was performed on the quantitative perfusion parameters of each ultrasound contrast.ResultsCompared with normal tissues, the peak intensity (PI) of tumor tissues was significantly increased, the peak time (TTP) and the mean transit time (MTT) were significantly shorter, the difference was statistically significant (P < 0.05). There is no statistically significant difference in the rise time (RT) (P>0.05). Compared with patients with high-to-medium differentiated invasive breast cancer, the RT and TTP of patients with poorly differentiated invasive breast cancer were significantly prolonged, and PI was significantly increased. The difference was statistically significant (P < 0.05). Compared with MTT, the difference was not statistically significant (P>0.05). The PI of invasive breast cancer patients with tumor diameter >20 mm was significantly higher than that of patients with tumor diameter ≤20 mm (P < 0.05), and there was no statistically significant difference between TTP, MTT and RT. Compared with patients with invasive breast cancer without lymph node metastasis, patients with lymph node metastasis had elevated PI and prolonged RT. The difference was statistically significant (P < 0.05), while the difference between TTP and MTT was not statistically significant (P>0.05). ER-negative and PR-negative invasive breast cancer patients were significantly higher PI than ER-positive and PR-positive patients, the difference was statistically significant (P < 0.05), but there was no statistically significant difference between TTP, MTT and RT (P>0.05). There is no statistically significant difference between PI-2, TTP, MTT, RT of patients with and without Her-2 expression (P>0.05). ROC curve analysis results show that PI has a medium-low diagnostic efficiency in the differential diagnosis of ER negative expression and PR negative expression. The cutoff point of PI is 12.975dB, and the standard errors are 0.073 (95%CI: 0.562-0.849), 0.074 (95%CI: 0.540-0.828), sensitivity and specificity were 77.40%, 72.20%, 65.20%, 66.70%, and the area under the curve was 0.705, 0.688, respectively.ConclusionPI, TTP, RT can reflect the blood perfusion in the lesion, which is helpful to the prognosis assessment of patients with invasive breast cancer.