肿块型乳腺癌的超声造影特征及定量参数与sE-cad、sTNFR-P55的相关性及其诊断价值分析

摘要 目的：探讨肿块型乳腺癌的超声造影（CEUS）特征及定量参数与可溶性E-钙黏蛋白（sE-cad）、可溶性肿瘤坏死因子受体P55（sTNFR-P55）相关性研究，并探讨其对肿块型乳腺癌的诊断价值。方法：选取2019年1月至2021年1月于本院诊治并行CEUS检查的162例乳腺肿块患者，根据病理结果分为肿块型乳腺癌组（82例）和良性组（80例），另选取本院体检健康的80例女性作为对照组。三组均行血清sE-cad、sTNFR-P55水平检测。比较肿块型乳腺癌组与良性组CEUS特征及定量参数的差异，采用Pearson相关分析肿块型乳腺癌患者CEUS定量参数与血清sE-cad、sTNFR-P55水平的相关性。对CEUS、血清sE-cad、sTNFR-P55水平单独或三者联合诊断的方式采用敏感度、特异度、准确性、阳性预测值、阴性预测值指标表达。结果：肿块型乳腺癌组大部分表现为增强后形态不规则、高增强、向心性灌注、造影剂分布不均匀以及呈慢出型的强化方式，且所占比例显著高于良性组（P<0.05）。与良性组相比，肿块型乳腺癌组CEUS定量参数TTP、G显著降低（P<0.05），而PI、K显著升高（P<0.05）。肿块型乳腺癌组血清sE-cad、sTNFR-P55水平显著高于良性组、对照组（P<0.05），且良性组血清sE-cad、sTNFR-P55水平还显著高于对照组（P<0.05）。肿块型乳腺癌患者的CEUS定量参数TTP、G与血清sE-cad、sTNFR-P55水平呈负相关（P<0.05）；而PI、k与血清sE-cad、sTNFR-P55水平呈正相关（P<0.05）。CEUS联合血清sE-cad、sTNFR-P55水平诊断肿块型乳腺癌的准确度、敏感度、特异度、阳性预测值、阴性预测值最高。结论：CEUS特征及定量参数对肿块型乳腺癌具有一定的鉴别诊断价值，而且CEUS定量参数与血清sE-cad、sTNFR-P55水平具有一定的相关性，说明CEUS定量参数可在一定程度上可反映乳腺癌的恶性生物学行为；同时CEUS联合血清sE-cad、sTNFR-P55水平检测有助于提高对肿块型乳腺癌的鉴别诊断价值，进一步为临床医生的定性判断提供更加科学的影像学依据。

Correlation between Contrast-Enhanced Ultrasound Characteristics and Quantitative Parameters of Massive Breast Cancer with sE-cad, sTNFR-P55 and its Diagnostic Value Analysis

ABSTRACT Objective: To investigate the correlation between the contrast-enhanced ultrasound(CEUS) characteristics and quantitative parameters of massive breast cancer with soluble E-cadherin(sE-cad) and soluble tumor necrosis factor receptor P55(sTNFR-P55), and to explore the diagnostic value of it in breast cancer. Methods: A selection of 162 patients with breast masses who were diagnosed and treated in our hospital from January 2019 to January 2021 with CEUS examination. According to the pathological results, they were divided into a mass breast cancer group (82 cases) and a benign group (80 cases). In addition, 80 healthy women who had a physical examination in our hospital were selected as the control group. Serum levels of sE-cad and sTNFR-P55 were detected in the three groups. The differences in CEUS characteristics and quantitative parameters between the mass breast cancer group and the benign group were compared, and the correlation between CEUS quantitative parameters and serum sE-cad and sTNFR-P55 levels in patients with mass breast cancer was analyzed by Pearson correlation. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value index expression of CEUS, serum sE-cad, and sTNFR-P55 levels alone or the combined diagnosis of the three are used. Results: Most of the mass breast cancer group showed irregular shape after enhancement, high enhancement, centripetal perfusion, angiography The distribution of agents was uneven and a slow-out enhancement method, and the proportion was significantly higher than that of the benign group (P<0.05). Compared with the benign group, the CEUS quantitative parameters TTP and G in the mass breast cancer group were significantly lower (P<0.05), while PI and K were significantly lower Increase (P<0.05). Serum sE-cad and sTNFR-P55 levels in the mass breast cancer group were significantly higher than those in the benign group and control group (P<0.05), and the serum sE-cad and sTNFR-P55 levels in the benign group were also significantly higher than those in the control group (P<0.05). The CEUS quantitative parameters TTP and G of patients with massive breast cancer were negatively correlated with serum sE-cad and sTNFR-P55 levels (P<0.05); while PI and k were positively correlated with serum sE-cad and sTNFR-P55 levels (P<0.05). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CEUS combined with serum sE-cad and sTNFR-P55 levels in the diagnosis of mass breast cancer are the highest, and the difference is statistically significant. Conclusion: The characteristics and quantitative parameters of CEUS have a certain differential diagnosis value for mass breast cancer, and the quantitative parameters of CEUS have a certain correlation with serum sE-cad and sTNFR-P55 levels, indicating that the quantitative parameters of CEUS can reflect breast cancer to a certain extent. At the same time, CEUS combined with the detection of serum sE-cad and sTNFR-P55 levels can help improve the value of differential diagnosis of mass breast cancer, and further provide a more scientific imaging basis for the qualitative judgment of clinicians.