剪切波弹性成像与Kindlin-2对乳腺结节纤维化程度的评估作用

目的探索剪切波弹性成像（SWE）和Kindlin-2用来判断乳腺结节纤维化程度的价值。 方法选取2016年9月至12月于解放军总医院第一医学中心就诊的102例乳腺结节患者，共102个结节，每例患者在手术或粗针穿刺前均行SWE检查。取得的组织进行天狼猩红染色和免疫组织化学染色检测胶原纤维和Kindlin-2水平。依据病理结果分为良性（64例共64个结节：43例纤维腺瘤、11例腺病和10例导管内乳头状瘤）和恶性（38例共38个结节：均为浸润导管乳腺癌）2组。2组间SWE指标（Emax、Emean和Emin）、胶原纤维和Kindlin-2表达水平的比较采用t检验，应用受试者操作特征曲线分析Emax和Emean的诊断效能，所有乳腺结节中胶原纤维强度和Kindlin-2表达水平与SWE指标的相关性用Pearson相关分析。 结果浸润性导管癌的Emax、Emean、胶原纤维和Kindlin-2表达明显高于乳腺良性结节，差异均有统计学意义（139.74±98.77）kPa vs（35.42±19.42）kPa，（65.91±60.71）kPa vs（18.29±13.83）kPa，80.25±8.51 vs 30.77±5.32，231.77±4596.01 vs 885.75±417.77；t=9.830、7.196、36.17、14.3，P均<0.05]。Emax与Emean值诊断恶性结节的最佳截断值是55.86 kPa和20.40 kPa，敏感度分别为83.30%和72.20%，特异度分别为88.90%和77.80%。胶原纤维强度、Kindlin-2表达均与Emax呈正相关（r=0.89、0.88，P均<0.001），但是与Emean无相关性。 结论Emax、Kindlin-2和胶原纤维水平与乳腺结节恶性程度有关，SWE与Kindlin-2结合可判断乳腺结节纤维化程度，可用于诊断浸润性导管癌。

Effect of chear wave elastography and Kindlin-2 on the evaluation of breast nodules fibrosis

ObjectiveTo explore the value of shear wave elastography (SWE) and kindlin-2 were used to determine the degree of breast nodule fibrosis. MethodsA total of 102 breast nodules from 102 patients who underwent ultrasound elastography before surgery or core needle biopsy were included in this study. The obtained tissues were subjected to Sirius red staining and immunohistochemical staining. According to the pathological results, they was divided into two groups: benign (64 nodules from 64 patients: 43 cases of fibroadenoma, 11 cases of adenopathy, and 10 cases of intraductal papilloma) and malignant (38 nodules from 38 patients: all were invasive ductal carcinoma). The SWE parameters (Emax, Emean, and Emin) and collagen and Kindlin-2 expression levels were compared between the two groups by the t test. The diagnostic efficaly of Emax and Emean was analysised by the operating charaeterist cure. Pearson correlation analysis was performed to explore the correlation of collagen and Kindlin-2 expression levels with SWE parameters. ResultsEmax, Emean, collagen expression, and Kindlin-2 expression were significantly higher in invasive ductal carcinoma than in benign nodules (139.74±98.77) kPa vs (35.42±19.42) kPa, (65.91±60.71) kPa vs (18.29±13.83) kPa, 80.25±8.51 vs 30.77 ±5.32, 231.77±4596.01 vs 885.75±417.77; t=9.830, 7.196, 36.170, 14.300; P<0.05 for all]. The best cutoff values of Emax and Emean for malignant nodules were 55.86 kPa and 20.40 kPa, respectively; the sensitivities were 83.30% and 72.20%, and specificities were 88.90% and 77.80%, respectively. Both collagen expression (r=0.89, P<0.001) and Kindlin-2 expression (r=0.88, P<0.001) were correlated with Emax. ConclusionEmax and Kindlin-2 and collagen expression levels are related to the malignant degree of breast nodules. SWE combined with Kindlin-2 can determine the degree of breast nodule fibrosis and be used to diagnose invasive ductal carcinoma.