摘要
目的 探究乳腺淋巴瘤误诊乳腺癌的超声表现及误诊原因.方法 选择2018 年6 月至2023 年6 月经手术病理确诊的乳腺淋巴瘤患者60 例为研究对象,据术前超声诊断和手术病理结果分为正确诊断组32 例和乳腺癌组28 例,分析2 组患者临床资料、超声影像特征、超声血流参数.采用多因素Logistic回归分析乳腺淋巴瘤误诊乳腺癌的影响因素.构建结构方程模型并验证,分析各因素对乳腺淋巴瘤误诊乳腺癌的影响及路径.构建乳腺淋巴瘤误诊乳腺癌的列线图预测模型并验证.结果 2 组肿块大小、肿块纵横比、肿瘤形态、肿瘤边界、后方回声、毛刺征、钙化灶比较差异均有统计学意义(P＜0.05,P＜0.01).多因素Logistic回归分析结果显示:肿块纵横比、肿瘤形态、肿瘤边界、后方回声、毛刺征是乳腺淋巴瘤误诊乳腺癌独立影响因素(P＜0.05,P＜0.01).结构方程模型各项指标均符合要求,模型拟合较好,各变量间的独立性较高,区分度较好,肿块纵横比＞1、肿瘤形态不规则、肿瘤边界不清晰、毛刺征、后方回声衰减对乳腺淋巴瘤误诊乳腺癌有着显著的正向影响.构建列线图模型预测乳腺淋巴瘤误诊乳腺癌的风险,验证前后曲线下面积分别为0.925(95%CI:0.578,0.976)和0.912(95%CI:0.841,0.967),校准曲线平均绝对误差为0.014.结论 乳腺淋巴瘤误诊乳腺癌患者超声检查显示肿块多≤2 cm,肿块纵横比多＞1,肿瘤形态多不规则,肿瘤边界多不清晰,内部回声多为低/混合回声,后方回声多衰减,多为富血供,多出现毛刺征、钙化灶及皮肤橘皮样改变.肿块纵横比、肿瘤形态、肿瘤边界、后方回声、毛刺征是乳腺淋巴瘤误诊乳腺癌独立影响因素.肿块纵横比＞1、肿瘤形态不规则、肿瘤边界不清晰、毛刺征、后方回声衰减对乳腺淋巴瘤误诊乳腺癌有着显著正向影响.
Abstract
Objective To investigate the ultrasonographic manifestations and causes of misdiagnosis of breast lympho-ma as breast cancer.Methods A total of 60 patients with breast lymphoma diagnosed by surgical pathology from June 2018 to June 2023 were selected as the research subjects,and were divided into a correct diagnosis group(n=32)and a breast cancer group(n=28)according to preoperative ultrasound diagnosis results and surgical pathology results.Clinical data,ul-trasound image characteristics and ultrasound blood flow parameters of the two groups were analyzed.Multivariate Logistic re-gression was used to analyze the influencing factors of breast lymphoma misdiagnosed as breast cancer.The structural equation model was constructed and verified to analyze the impact and path of various factors on misdiagnosis of breast lymphoma as breast cancer.The nomogram prediction model of breast lymphoma misdiagnosed as breast cancer was constructed and veri-fied.Results There were significant differences in tumor size,tumor aspect ratio,tumor shape,tumor boundary,posterior echo,burr sign and calcification foci between the two groups(P＜0.05,P＜0.01).Multivariate Logistic regression analysis showed that tumor aspect ratio,tumor shape,tumor boundary,posterior echo and burr sign were independent influencing fac-tors for misdiagnosis of breast lymphoma as breast cancer(P＜0.05,P＜0.01).All indexes of the structural equation model met the requirements,the model was well fitted,the independence of variables was high,and the differentiation was good.The tumor aspect ratio＞1,irregular tumor shape,unclear tumor boundary,burr sign,and posterior echo attenuation had significant positive effects on the misdiagnosis of breast lymphoma as breast cancer.A nomogram model was constructed to pre-dict the risk of breast lymphoma misdiagnosed as breast cancer,and the areas under the curve before and after verification were 0.925(95%CI:0.578,0.976)and 0.912(95%CI:0.841,0.967)respectively,the average absolute error of the calibration curve was 0.014.Conclusion The ultrasonography of patients with breast lymphoma misdiagnosed as breast canc-er shows the masses≤2 cm,tumor aspect ratio of more than 1,irregular tumor shape,unclear tumor boundaries,mostly low/mixed internal echo,more attenuated posterior echo,abundant blood supply,the burr sign,calcification focus and or-ange-peel-like skin.Tumor aspect ratio,tumor shape,tumor boundary,posterior echo and burr sign are all independent fac-tors for misdiagnosis of breast lymphoma as breast cancer.The tumor aspect ratio＞1,irregular tumor shape,unclear tumor boundary,burr sign and attenuation of posterior echo have significant positive effects on misdiagnosis of breast lymphoma as breast cancer.
维普
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