BACKGROUND:The aim of this study was to investigate the ultrasound and hematological indicators, subsequently utilizing them to predict breast cancer and construct predictive models and columnar plots.METHODS:The clinical data of 200 patients with breast tumors receiving ultrasound and blood tests at Henan Provincial People's Hospital from January 2020 to January 2023 were collected. Patients were divided into training and validation sets at a 6:4 ratio using R language. Variables were screened using logistic regression, and a nomogram predicting breast cancer probability was constructed based on the training set. The predictive performance of the nomogram was evaluated in the validation set through receiver operating characteristic, calibration and decision curves. Model robustness was validated by bootstrap resampling.RESULTS:Regression analysis revealed that maximum blood flow velocity within the breast mass ≥ 16.395 m/s, perfusion index ≥ 1.505, cancer antigen 15-3 ≥ 39.620 U/m, cancer antigen 125 ≥ 42.30 U/ml, carcinoembryonic antigen ≥ 6.520 ng/ml, Adler blood flow classification II & III, breast calcification present, and diameter of the lump > 2 cm were independent risk factors for breast cancer. Based on these ultrasonic parameters and blood indicators, the developed nomogram demonstrated excellent discrimination in both the training set (AUC = 0.917) and validation set (AUC = 0.844). The calibration plot showed high consistency between the nomogram-predicted and the actual results. Decision curve analysis indicated higher net benefit of this model.CONCLUSIONS:The nomogram developed in this study demonstrated solid predictive abilities for breast malignancy, indicating potential clinical value pending further research.

目的 探讨眼周皮脂腺癌(periocularsebaceous gland carcinoma,PSGC)的临床及超声影像特征,评价高频超声相关参数在预测PSGC预后中的应用价值.方法 选取本院行超声检查并经术后病理确诊的36例PSGC患者(共36个病灶)资料,根据随访患者术后复发情况,分析复发组(11例)和未复发组(25例)间患者的性别、年龄、病程、病灶位置和大小、病理分型及超声声像图表现等相关参数.结果 36例患者中平均复发率为30.1％.单因素分析显示:患者的病程时间、病灶的位置、形态、液化、血流分级、峰值流速、阻力指数及病理分型在复发组和未复发组间比较差异无统计学意义(P＞0.05);而性别、病灶大小(最大径＞15mm)、病灶内钙化与PSGC复发相关,差异有统计学意义(P＜0.05).采用ROC曲线分析病灶大小对PSGC术后复发的诊断效能,AUC为0.818,当截断值为15mm时特异性为88.0％,敏感性为72.7％,Youden指数为0.607.两因素分析显示:通过调整协变量后,病灶大小诊断复发与否的ROC曲线下面积为0.765,95％CI为(0.573,0.958).结论 高频超声检查有助于PSGC的诊断,超声声像图多表现为低回声包块,中心放射状丰富血流为其特征.病灶大小、有无钙化在评估眼周皮质腺癌复发中有一定的预测价值.

目的 探讨卡波西样血管内皮瘤(KHE)的声像图特征及病理学表现.方法 选取我院收治的经术后病理证实的30例KHE患儿的超声检查资料及病理结果,其中18例临床实验室检查及体格检查符合KHE伴有卡梅现象(KMP).30例患儿均为体表单发病灶伴皮肤或皮下边界不清的红褐色或紫色斑块.所有病灶术前均行超声检查,观察病灶发生部位,总结病灶声像图特征,包括大小、回声、边界、形态、血供情况,对比分析单纯KHE组与KHE伴KMP组的声像图特征.病灶经手术切除后送病理学检查,总结病理组织学及免疫组化表现.结果 30例KHE病灶中12例位于头颈部,10例位于四肢,8例位于躯干;19例仅累及皮下组织,11例累及皮下组织及周围肌层;病灶直径范围约12.0～136.0 mm(平均直径58.0 mm),二维声像图均表现为实性不均质回声,其中27例以低回声为主,3例以高回声为主,27例内部未显示明显管样无回声区,3例内部显示管样无回声区;边界不清晰伴周围组织增厚回声增强者29例,边界清晰者1例.彩色多普勒声像图表现中29例内部显示丰富血流信号呈树枝状分布,1例内部未见明显血流信号.KHE伴KMP组较单纯KHE组病灶直径更大,累及部位更多、范围更广.30例病灶发生部位不同,镜下表现大致相同,可见交叉梭形细胞束,呈弥漫性多结节状浸润性生长,结节之间为多少不等的纤维间隔组织,29例核分裂象少见,1例核分裂象多见.免疫组化中肿瘤细胞VEGFR-3、ERG、CD31、CD34、CD117、DOG-1均呈阳性表达,GLUT-1和HHV8均呈阴性表达,Factor Ⅷ呈阴性或局灶性表达,Ki67增殖指数3％～40％(平均8％),部分病例D2-40、FLI-1呈阳性表达,EMA呈阴性表达.结论 KHE临床较为罕见,部分可伴有KMP现象.KHE的病理学表现及声像图表现具有显著特异性,超声检查可作为首选检查,为临床明确诊断指导治疗提供可靠依据.

目的 观察软组织静脉畸形(venous malformation,VM)患者的彩色多普勒成像技术(color Doppler flow imaging,CDFI)和超微血管成像技术(superb microvascular imaging,SMI)的声像学特征,探讨高频超声联合SMI对软组织VM的诊断价值.方法 软组织VM患者42例,术前均行超声检查,观察软组织VM病灶的二维超声声像图表现及CDFI和SMI血流显像模式的声像图表现和频谱特征,比较2种血流显像模式的血流分级;42例患者术前行MRI检查32例,行X线检查16例,以组织病理检查结果为金标准,比较高频超声联合SMI与MRI诊断软组织VM的准确率、高频超声与X线诊断邻近关节或骨组织受累的准确率.结果 42例软组织VM病灶位于头颈部19例,位于四肢16例,位于躯干7例;二维超声显示病灶累及肌层23例,未累及肌层19例;病灶二维超声声像图表现呈多条管样无回声结构为主的混昆合回声38例,呈低回声4例;边缘清晰36例,边缘不清晰6例;形态规则29例,形态不规则13例;有血栓形成8例;有静脉石形成6例;邻近骨组织受累4例.SMI模式血流分级中、高分级(Ⅱ、Ⅲ级)患者比率(83.3％)多于CDFI模式(61.9％)(P＜0.05),低分级(0、Ⅰ级)患者比率(16.7％)少于CDFI模式(38.1％)(P＜0.05);SMI与CDFI两种血流显像模式的病灶血流分级比较差异有统计学意义(P＜0.05);高频超声联合SMI诊断软组织VM的准确率(93.8％)高于MRI(65.6％)(P＜0.05),高频超声诊断邻近关节或骨组织受累的准确率(25.0％)高于X线(12.5％)(P＜0.05).结论 高频超声联合SMI可清晰显示软组织VM病灶内血流分布情况,可作为软组织VM的首选影像学检查,有助于明确诊断,为临床治疗和随访提供重要依据.

Objective To evaluate the left ventricular systolic and diastolic function in patients with cervical cancer after chemotherapy by layer-specific strain. Methods 90 patients with cervical carcinoma after surgery were enrolled, including 30 patients treated with chemotherapy for 3 months, 30 patients treated with chemotherapy for 6 months and 30 patients without chemotherapy as a control group. Conventional echocardiographic parameters were collected. The global longitudinal peak strain and circumferential peak strain were assessed from endocardium, mid-myocardium, and epicardium (LS-endo, LS-mid, LS-epi, CS-endo, CS-mid, CS-epi) by layer-specific strain. Results LS-endo, LS-mid, LS-epi, CS-endo, CS-mid, CS-epi, e′ in patients with chemotherapy for 6 months and 3 months were lower than those in control group (all P＜0. 05). LS-endo, CS-endo, e′ in patients with chemotherapy for 6 months showed significantly decrease than patients with chemotherapy for 3 months (both P＜0.05). Compared to the control group, E/e' significantly increased in patients treated with chemotherapy for 3 months (P＜0.05), and E/e' further increased in patients treated with chemotherapy for 6 months (P＜0.05). Conclusion Two-dimensional speckle tracking (2 D-STI) layer-specific strain can early evaluate the left ventricular systolic and diastolic function in patients with cervical carcinoma after chemotherapy.

目的 评估三维剪切波成像技术(3-dimensional shear wave elastography,3D SWE)在乳腺 BI-RADS-US 4级肿块中的应用价值.方法 使用具有三维乳腺探头的法国声红超声诊断仪器对74例常规二维超声诊断为 BI-RADS-4级的患者进行检查,三维SWE模式下选取感兴趣区后,自动生成肿块的横断面、矢状面及冠状面的剪切波信息.绘制三维SWE各参数受试者操作特征(receiver operating characteristic,ROC)曲线,并分析其诊断乳腺肿块良恶性的敏感性和特异性.结果 恶性肿块的三维SWE三个正交切面上的Emean、Emax及SD值均高于良性肿块( P <0.001).良、恶性两组间比较,三维SWE三个正交切面上的Emean、Emax及SD值的差异均有统计学意义( P <0.05).三个正交切面上的Emean、Emax及SD值组内比较差异没有统计学意义.结论 三维剪切波成像在BI-RADS 4级乳腺肿块的良恶性诊断方面有较高临床价值.

Objective To investigate the application value of three-dimensional shear wave elastography( 3D-SWE) in diagnosis of malignant and benign breast masses . Methods Sixty-seven patients with total 96 masses diagnosed by ultrasound and verified with surgical pathological analysis were selected . The masses were divided into benign group ( 54 masses ) and malignant group ( 42 masses ) . The quantitative diagnosis was performed using two-dimensional shear wave elastography ( 2D-SWE) and 3D-SWE to evaluate the hardness of the masses . Receiver operating characteristic ( ROC ) curves of 2D-SWE and 3D-SWE were drawn to calculate the sensibility and specificity in diagnosis of breast masses . The qualitative diagnosis was performed according to the elastic color image classification to classify the elastic images of the lesions into type Ⅰ - Ⅳ . Results The quantitative diagnosis:① There were significant differences in Emean ,Emax and SD on planes of 2D-SWE and three orthogonal planes of 3D-SWE between the two groups ( P <0 .05) ;② There was no significant difference in Emean ,Emax and SD of two groups between 2D-SWE and 3D-SWE ( P > 0 .05) ;③ Emean ,Emax and SD on planes of 2D-SWE and three orthogonal planes of 3D- SWE both exhibited high diagnostic performance . However , there was no significant difference in Emean ,Emax and SD between 2D-SWE and 3D-SWE ( P >0 .05) . The qualitative diagnosis of elastic color mode:type Ⅰ and type Ⅱ account for most planes of 2D-SWE and three orthogonal planes of 3D-SWE in benign masses ,while type Ⅲ and type Ⅳ account for most in malignant masses . Among the malignant group ,type Ⅲ on the 3D-SWE coronal planes was significantly more than other three types ( P < 0 .05) .Conclusions For quantitative diagnosis ,2D-SWE and 3D-SWE are both beneficial to differentiate benign from malignant masses ,but there is no difference in diagnostic efficacy ;for qualitative diagnosis ,3D-SWE can provide more diagnostic information than 2D-SWE ,especially on the coronal planes of 3D-SWE .