摘要
目的研究超声测定的搏动指数(PI)、血流阻力指数(RI)、最大血流值(Vmax)结合血清可溶性E-钙黏连蛋白(sE-cadherin)、细胞角蛋白19片段(CYFRA21-1)对乳腺癌良恶性及腋窝淋巴结转移的诊断价值。方法选择242例乳腺肿块女性患者,年龄43~67岁,平均年龄55.23岁;身体质量指数19.5~28.9 kg/m^(2),平均身体质量指数24.12 kg/m^(2);病程4~8个月,平均病程6.45个月;均为初次入院就诊。彩色多普勒超声仪测定PI、RI和Vmax,并在术前采集空腹外周血,酶联免疫吸附分析测定血清sE-cadherin和CYFRA21-1。根据病理组织诊断结果将患者分成乳腺癌组(n=132)和乳腺良性组(n=110),并将乳腺癌患者分成腋窝淋巴结转移组(n=74)和腋窝淋巴结未转移组(n=58)。单因素分析临床资料,Logistic回归分析乳腺癌发生和腋窝淋巴结转移的独立影响因素,通过受试者工作特性(ROC)曲线分析各指标及回归分析诊断效能。结果乳腺良恶性病变区分ROC曲线结果表明,PI临界值1.34,灵敏度为69.70%,特异度为70.91%,曲线下面积(AUC)为0.801[95%可信区间(CI)0.750~0.852];RI诊断的临界值为0.69,灵敏度为65.15%,特异度65.45%,AUC为0.762(95%CI 0.707~0.812);Vmax诊断的临界值为13.11 m/s,灵敏度为59.85%,特异度60.00%,AUC为0.627(95%CI 0.564~0.699);血清sE-cadherin诊断的临界值为24.18 ng/mL,灵敏度为62.88%,特异度58.18%,AUC为0.709(95%CI 0.645~0.771);血清CYFRA21-1诊断的临界值为9.55 g/mL,灵敏度为74.24%,特异度75.45%,AUC为0.817(95%CI 0.769~0.865)。将回归预测方程作为新变量P,在最佳临界切点时,回归分析灵敏度81.82%,特异度79.09%,AUC为0.867(95%CI 0.829~0.908),回归分析灵敏度显著高于各指标单独检测(P<0.05)。乳腺癌淋巴结转移分析ROC曲线结果表明,PI临界值1.58,灵敏度为79.73%,特异度为68.97%,AUC为0.815(95%CI 0.727~0.902);RI诊断的临界值为0.83,灵敏度为63.51%,特异度70.69%,AUC为0.701(95%CI 0.558~0.844);Vmax诊断的临界值为17.36 m/s,�
Objective To explore the values of pulsatility index(PI),resistance index(RI),maximum flow value(Vmax)measured by ultrasound combined with serum sE-cadherin and cytokeratin 19 fragment antigen 21-1(CYFRA21-1)in the diagnosis 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/m^(2) with mean body mass index of 24.12 kg/m^(2);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 immunosorbent assay.According to histopathological results,all of them were divided into breast cancer group(n=132)and benign breast group(n=110),and breast cancer patients were divided into axillary lymph node metastasis group(n=74)and axillary 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%,specificity 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 va
作者
李海芬
邓亚云
李洪来
戴林
汪凤勃
LI Hai-fen;DENG Ya-yun;LI Hong-lai;DAI Lin;WANG Feng-bo(Health Examination Center,Xingtai Third Hospital,Xingtai 054000,Hebei,China;Functional Room,Xingtai Third Hospital,Xingtai 054000,Hebei,China;Department of Radiology,The Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China)
出处
《生物医学工程与临床》
CAS
2024年第1期56-62,共7页
Biomedical Engineering and Clinical Medicine
基金
邢台市科技局重点研发计划项目(2020ZC287)。
