The clinic value of ultrasound determination of PI,RI,Vmax combined with serum sE-cadherin and CYFRA21-1 for diagnosis of benign and malignant breast cancer and lymph node metastasis
Objective To explore the values of pulsatility index(PI),resistance index(RI),maximum flow value(Vmax)mea-sured by ultrasound combined with serum sE-cadherin and cytokeratin 19 fragment antigen 21-1(CYFRA21-1)in the diagno-sis of benign and malignant breast cancer and lymph node metastasis.Methods A total of 242 patients with breast mass were enrolled,which aged 43-67 years old with mean age of 55.23 years old;body mass index was 19.5-28.9 kg/m2 with mean body mass index of 24.12 kg/m2;course of disease was 4-8 months with mean course of 6.45 months.All patients were ad-mitted for the first time.The PI,RI and Vmax were measured by color Doppler ultrasonography,and fasting peripheral blood was collected before operation,the serum levels of sE-cadherin and CYFRA21-1 were measured by enzyme-linked im-munosorbent assay.According to histopathological results,all of them were divided into breast cancer group(n=132)and be-nign breast group(n=110),and breast cancer patients were divided into axillary lymph node metastasis group(n=74)and ax-illary lymph node non-metastasis group(n=58).The clinical data were analyzed by univariate analysis,Logistic regression was used to analyze the independent influencing factors of breast cancer and axillary lymph node metastasis.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of each index and regression analysis.Results The ROC curve for the differentiation of benign and malignant lesions showed that PI cut-off value was 1.34,sensitivity was 69.70％,speci-ficity was 70.91％,and area under curve(AUC)was 0.801[95％confidence interval(CI)0.750-0.852].The critical value of RI diagnosis was 0.69,sensitivity was 65.15％,specificity was 65.45％,and AUC was 0.762(95％CI 0.707-0.812).The critical value of Vmax was 13.11 m/s,sensitivity was 59.85％,specificity was 60.00％,and AUC was 0.627(95％CI 0.564-0.699).The critical value of serum sE-cadherin was 24.18 ng/mL,sensitivity was 62.88％,specificity was 58.18％,and AUC was 0.709(95％CI 0.645-0.771).The critical value of serum CYFRA21-1 was 9.55 g/mL,sensitivity was 74.24％,specificity was 75.45％,and AUC was 0.817(95％CI 0.769-0.865).When the regression prediction equation was taken as novel variable P,sensitivity of re-gression analysis was 81.82％,specificity was 79.09％,and AUC was 0.867(95％CI 0.829-0.908)at optimal critical point,and the sensitivity of regression analysis was significantly higher than that of each index alone(P＜0.05).The ROC curve analysis of lymph node metastasis in breast cancer showed that the critical value of PI was 1.58,sensitivity was 79.73％,specificity was 68.97％,and AUC was 0.815(95％CI 0.727-0.902).The critical value of RI diagnosis was 0.83,sensitivity was 63.51％,speci-ficity was 70.69％,and AUC was 0.701(95％CI 0.558-0.844).The critical value of Vmax was 17.36 m/s,sensitivity was 54.05％,specificity was 55.17％,and AUC was 0.516(95％CI 0.384-0.649).The critical value of serum sE-cadherin was 34.52 ng/mL,sensitivity was 82.43％,specificity was 60.34％,and AUC was 0.755(95％CI 0.653-0.856).The critical value of serum CYFRA21-1 was 13.10 g/mL,sensitivity was 60.81％,specificity was 65.52％,and AUC was 0.563(95％CI 0.426-0.701).The regression prediction equation was set as novel variable P,sensitivity of regression analysis was 85.14％,specificity was 84.48％,and AUC was 0.893(95％CI 0.816-0.970)at optimal critical point,and the sensitivity of regression analysis was sig-nificantly higher than that of single index(P＜0.05).Conclusion It is demonstrated that the abnormal expression ultrasound pa-rameter as well as serum levels of sE-cadherin and CYFRA21-1 are found in breast cancer and axillary lymph nodes,and PI,RI,Vmax,serum levels of sE-cadherin and CYFRA21-1 and Logistic regression analysis all could be used for prediction and diagno-sis of breast malignant lesions and lymph node metastasis.
NETL
NSTL
万方数据
维普
