摘要
目的：近年来我国乳腺癌发病率明显上升，超声光散射乳腺成像作为新的影像诊断技术已逐步应用于临床，但该方法对乳腺肿瘤的诊断尚缺少系统性研究。本文旨在通过超声光散射乳腺断层成像系统（ optical tomography image ultra?sonography system，OPTIMUS）测量乳腺癌最高血红蛋白浓度（ maximum hemoglobin concentration， MHC），并与病理对照研究，探讨OPTIMUS在乳腺肿块良恶性鉴别诊断中的应用价值。方法收集2009年4月至2014年4月南京医科大学第一附属医院超声科380例乳腺肿瘤患者，包括良性肿瘤210例，恶性肿瘤170例，使用OPTIMUS测量MHC，免疫组化法测定血管内皮生长因子（ vascular endothelial growth factor， VEGF ）、血小板?内皮细胞黏附分子（ platelet endothelial cell adhesion molecule?1， PECAM?1／CD31），采用受试者工作特征（ ROC）曲线评价MHC预测乳腺恶性肿瘤的最佳诊断阈值，并分析MHC值与肿瘤良恶性、淋巴结转移及VEGF、PECAM?1／CD31表达的相关性。结果380例乳腺肿瘤病例中恶性肿瘤的MHC高于良性肿瘤[（215．33±69．31） vs （116．50±55．31）μmol／L，P＜0．01]。评价 MHC预测乳腺恶性肿瘤分析显示 ROC曲线下面积为0．836（95％CI：0．684～0．989），最佳诊断阈值为135．00μmol／L，其敏感度、特异度分别为84．7％和89．0％。肿块≤2 cm时，有淋巴结转移MHC值高于无转移者[（207．73±66．43） vs （184．36±62．13）μmol／L， P＜0．05]。良性肿瘤VEGF、PECAM?1／CD31表达阴性（－）的MHC值较恶性肿瘤VEGF、PECAM?1／CD31阳性（＋）降低[（116．50±55．31） vs （205．73±72．46）μmol／L，P＜0．05]，较VEGF、PECAM?1／CD31强阳性（＋＋）[（244．21±63．56）μmol／L]亦降低（P＜0．05）；VEGF、PECAM?1／CD31强阳性（＋＋）表达的MHC值降阳性（＋）表达升高（ P＜0．05）。结论 OPTIMUS测量MHC良恶性乳腺肿瘤具有一定的诊断价值。
Abstract
Objective The incidence of breast cancer in China obviously keeps rising in recent years. The optical tomo?graphy image ultrasonography system ( OPTIMUS) is gradually applied in clinic as a new imaging diagnostic technique, but few system?atic studies are reported on its application to the diagnosis of breast tumors. The aim of this study was to assess the value of OPTIMUS in differentiating benign and malignant breast masses by measuring the maximum hemoglobin concentration ( MHC) in the lesions using OPTIMUS with the help of the results of controlled pathological study. Methods This prospective study included 380 cases of breast tumor ( 210 benign and 170 malignant ) treated from April 2009 to April 2014. We measured the MHC using OPTIMUS, detected the expressions of VEGF and PECAM?1/CD31 by immunohistochemistry, calculated the optimal threshold valve of MHC in predicting breast malignancy with the ROC curve, and analyzed the correlation of the MHC value with benign and malignant lesions, lymph node metasta?sis, and the expressions of VEGF and PECAM?1/CD31. Results The mean MHC was significantly higher in the malignant than in the benign lesions ([215.33±69.31] vs [116.50±55.31] μmol/L, P<0.01). The area under the ROC curve (AUC) was 0.836 (95%CI 0.684-0.989). The optimal threshold valve in the diagnosis of malignant breast lesions was 135.00 μmol/L, with a sensitivity of 84.7% and a specificity of 89%. When the tumor was≤2 cm, the MHC was significantly higher in the patients with lymph node metas?tasis than in those without ([207.73±66.43] vs [184.36±62.13] μmol/L, P<0.05). However, the MHC was markedly lower in the benign masses with VEGF and PECAM?1/CD31 negative than in the malignant lesions with VEGF and PECAM?1/CD31 positive ([116.50±55.31] vs [205.73±72.46] μmol/L, P<0.05) and strongly positive ([244.21±63.56] μmol/L, P<0.05). Strongly posi?tive expressions of VEGF and PECAM?1/CD31 were positively correlated with MHC ( P<0.05) . Conclusion Measurement of MHC by OPTIMUS contributes to the differential diagnosis of benign and malignant breast lesions and has a potential value for preoperative assessment of the prognosis of breast cancer.
NETL
NSTL
维普
万方数据