乳腺放射状瘢痕与乳腺癌的临床及超声影像对比研究

摘要：目的　对比分析乳腺放射状瘢痕（RS）与乳腺癌的临床及超声特征。方法　选取2015年2月—2017年12月经病理科确诊并行乳腺超声检查的40例RS和40例浸润性导管癌（IDC）患者，收集2组患者的基线资料：年龄、月经状态、哺乳史、流产史、病灶侧别、既往同侧乳腺手术史、临床症状；术前乳腺超声检查结果：超声图像（形态、边缘、内部回声、后方回声、周围高回声晕、钙化）、血流信号及弹性评分，比较2组患者间临床及超声特征的差异。以病理诊断为金标准，采用受试者工作特征（ROC）曲线评估彩色多普勒超声联合弹性成像技术对两者的诊断效能。结果　RS组和IDC组临床均多表现为乳腺肿物。与IDC组相比，RS组超声图像多表现为形态尚规则、边缘清晰、周围无高回声晕、内部回声均匀、不伴钙化、无血流信号、后方回声无改变或增强、弹性评分良性（P＜0.05）。ROC曲线提示二维超声乳腺影像报告和数据系统分类、彩色血流信号和弹性评分三者联合对RS和IDC的诊断效能较好，曲线下面积（AUC）为0.802（95%CI：0.673~0.930，P＜0.05），敏感度为0.833，特异度为0.652。结论　RS组和IDC组的超声特征有差异，彩色多普勒超声联合弹性成像检查对于鉴别诊断2种病变有一定意义。

A comparative study on the clinical features and ultrasound images ofbreast radial scars and breast cancer#br#

Abstract: Objective　To compare and analyze the clinical and ultrasonographic characteristics of breast radial scar (RS) and breast cancer. Methods　From February 2015 to December 2017, 40 patients with RS and 40 patients with invasive ductal carcinoma (IDC) confirmed by the Department of Pathology of Tianjin Medical University Cancer Hospital and examined by breast ultrasound were selected. The baseline data were collected in the 2 groups of patients including age, menstrual status, history of lactation, history of abortion, lesion side, history of ipsilateral breast surgery and clinical symptoms. Results of preoperative breast ultrasound examination, ultrasound images (morphology, margin, internal echo, posterior echo, peripheral hyperecho halo, calcification), blood flow signal and elasticity score were also collected. The changes in clinical and ultrasonic characteristics were compared between the two groups. With pathological diagnosis as the gold standard, receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of color doppler ultrasound combined with elastography. Results　Both the RS and IDC groups were mostly breast masses. Compared with the IDC group, the RS group showed regular shape, well-defined margins, no peripheral hyperechoic halo, homogeneous internal echogenicity, no calcification, no blood flow signal, no alteration/enhancement of posterior echogenicity and benign elasticity score (P＜0.05). The ROC curve indicated that the combined prediction of RS and IDC by two-dimensional ultrasound BI-RADS, color blood flow signal and elasticity score had a good diagnostic efficiency. The area under the curve (AUC) was 0.802 (95%CI: 0.673-0.930, P＜0.05), the sensitivity was 0.833, and the specificity was 0.652. Conclusion　The ultrasonic characteristics of the RS group and the IDC group are different. Color doppler ultrasonography combined with elastography is of great significance for the differential diagnosis of the two lesions.