| ObjectiveBy comparing the features of contrast-enhanced ultrasound,contrast parameters and elastic imaging parameters of BI-RADS 4 nodules in benign group and malignant group,to explore the value of contrast-enhanced ultrasound and elastic imaging in evaluating malignant nodules,and the risk model of breast cancer was constructed by contrast-enhanced ultrasound and elastic imaging,in order to improve the risk evaluation value of malignant lesions of breast,reduce unnecessary puncture biopsy,and provide a clearer direction for clinical diagnosis and treatment MethodsA total of 90 patients with BI-RADS 4 nodules were enrolled in the study.All subjects underwent preoperative contrast-enhanced ultrasound and elastography,and the features of contrast-enhanced ultrasound,contrast parameters,and elastography parameters were analyzed and recorded.According to postoperative pathology,the patients were divided into benign group and malignant group,including 65 cases in benign group and 25 cases in malignant group.The differences of contrast-enhanced ultrasound and elastic imaging parameters in the two groups were analyzed,and multiple factors Logistic regression analysis were performed to construct the prediction model of breast cancer.Results1.Contrast-enhanced ultrasound findings in breast lesionsThe benign and malignant breast lesions showed different angiographic features.The main manifestations of malignant lesions were fast-forward enhancement,nonuniform enhancement,high enhancement,enlargement of enhancement range,unclear boundary after enhancement,slow clearance,filling defect,crab foot sign,trophoblastic vascular sign and other contrast-enhanced ultrasound features.Benign lesions were characterized by equal progression,clear boundary after enhancement and unchanged enhancement range.There was statistical difference between the above two groups(p<0.05).2.Single factor analysis of contrast-enhanced ultrasound and elastic imaging parameters(1)Contrast between benign and malignant parameters of contrast-enhanced ultrasoundThe contrast parameters AS,PI and AUC in malignant group were higher than those in benign group,and there was no statistical difference in TTP between the two groups(P <0.05).When AS,PI and AUC were used as diagnostic indexes of breast cancer,the area under ROC curve(AUC)was 0.680,0.813 and 0.791,the sensitivity was 72.00%,88.00% and 88.00%,the specificity was 61.54%,66.15% and 61.54%,respectively.(2)Contrast between benign and malignant parameters of elastic imaging parametersThe elastic imaging parameters Emean,Emax,Emin and SD in malignant group were higher than those in benign group,P <0.05.When Emean,Emax,Emin and SD were used as the diagnostic indexes of breast cancer,the area under ROC curve(AUC)was 0.908,0.903,0.852 and 0.786,respectively.The sensitivity was76.00%,100.00%,96.00% and the specificity was 90.77%,72.31%,60.00% and76.92%,respectively.3.Construction of breast cancer prediction model by contrast-enhanced ultrasound combined with elastographyThe breast cancer prediction model was established with the elastic parameter Emax and the area under focal curve AUC after contrast enhancement: Logist(P)=-8.136+0.069(Max)+0.001(AUC).The area under ROC curve was 0.919(95%CI:0.842-0.966),the sensitivity,specificity,positive likelihood ratio and negative likelihood ratio were 92.00%,84.62%,5.72 and 0.14,respectively.Based on the results of Logistic regression multivariate analysis,a nomogram was constructed in which the Emax value was the most likely contributing factor to predict breast cancer in breast lesions,followed by AUC,with a total score of 0-140 and a prediction probability of 0.1-0.9.ConclusionsBreast cancer risk assessment models and nomograms constructed with contrast-enhanced ultrasound combined with elastography can be conducive to better risk assessment of BI-RADS 4 nodules.Helps clinicians avoid unnecessary biopsies while not reducing breast cancer detection. |
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