超声BI-RADS分类联合血清FGFR1、GDF3在乳腺肿块良恶性鉴别诊断中的应用价值

doi:10.11958/20241974

天津医药 ›› 2025, Vol. 53 ›› Issue (3): 247-251.doi: 10.11958/20241974

超声BI-RADS分类联合血清FGFR1、GDF3在乳腺肿块良恶性鉴别诊断中的应用价值

李娜¹(), 贺英¹, 滕飞¹, 贺文姝¹, 郭彩凤¹, 钟娜¹, 吴琼¹^,^△(), 李军²

1 榆林市第四医院/榆林市星元医院超声医学科（邮编719000）
2 榆林市第四医院/榆林市星元医院乳腺外科（邮编719000）

收稿日期:2024-12-04 修回日期:2025-01-23 出版日期:2025-03-15 发布日期:2025-03-31
通讯作者: △E-mail：623570609@qq.com
作者简介:李娜（1989），女，主治医师，主要从事甲状腺、乳腺及腹部疾病超声诊断及超声造影、介入治疗方面研究。E-mail：puyao613253224@163.com
基金资助:
榆林市科技计划项目(2023-SF-51)

The application value of ultrasound BI-RADS classification combined with serum FGFR1 and GDF3 in the differential diagnosis of benign and malignant breast masses

LI Na¹(), HE Ying¹, TENG Fei¹, HE Wenshu¹, GUO Caifeng¹, ZHONG Na¹, WU Qiong¹^,^△(), LI Jun²

1 Department of Ultrasound Medicine, 4th (Xing Yuan) Hospital of Yulin, Yulin 719000, China
2 Department of Breast Surgery, 4th (Xing Yuan) Hospital of Yulin, Yulin 719000, China

Received:2024-12-04 Revised:2025-01-23 Published:2025-03-15 Online:2025-03-31
Contact: △E-mail：623570609@qq.com

李娜, 贺英, 滕飞, 贺文姝, 郭彩凤, 钟娜, 吴琼, 李军. 超声BI-RADS分类联合血清FGFR1、GDF3在乳腺肿块良恶性鉴别诊断中的应用价值[J]. 天津医药, 2025, 53(3): 247-251.

LI Na, HE Ying, TENG Fei, HE Wenshu, GUO Caifeng, ZHONG Na, WU Qiong, LI Jun. The application value of ultrasound BI-RADS classification combined with serum FGFR1 and GDF3 in the differential diagnosis of benign and malignant breast masses[J]. Tianjin Medical Journal, 2025, 53(3): 247-251.

摘要/Abstract

摘要：

目的探讨超声乳腺影像学报告及数据系统（BI-RADS）分类联合血清成纤维细胞生长因子受体1（FGFR1）、生长分化因子3（GDF3）在乳腺肿块良恶性鉴别诊断中的应用价值。方法选择159例乳腺肿块患者，依据术后病理诊断分为良性肿块组83例和恶性肿块组76例。所有患者均进行超声检查，采用酶联免疫吸附试验（ELISA）检测血清FGFR1、GDF3水平；受试者工作特征（ROC）曲线分析超声BI-RADS分类与血清FGFR1、GDF3水平对乳腺肿块良恶性的诊断价值；采用Kappa检验分析各诊断方法与病理诊断的一致性。结果恶性肿块组患者血清FGFR1、GDF3水平，形态不规则、边界不清晰、有毛刺征、有微钙化灶、血流分级Ⅱ—Ⅲ级、后方回声衰减比例，阻力指数，搏动指数高于良性肿块组（P<0.05）。血清FGFR1、GDF3和超声BI-RADS分类单独及联合鉴别诊断乳腺肿块良恶性的曲线下面积（AUC）分别为0.802（95%CI：0.732~0.871）、0.817（95%CI：0.751~0.884）、0.848（95%CI：0.784~0.912）和0.956（95%CI：0.918~0.993），联合诊断的效能优于各指标单独诊断。三者单独及联合鉴别诊断乳腺肿块良恶性与病理诊断的一致性结果显示，Kappa值分别为0.517、0.514、0.688和0.912，联合诊断的一致性最高。结论超声BI-RADS分类联合血清FGFR1、GDF3鉴别诊断乳腺肿块良恶性具有较高的应用价值。

关键词: 乳腺肿瘤, 超声检查, 受体, 成纤维细胞生长因子, 1型, 生长分化因子3, 诊断, 鉴别, 乳腺肿块, 乳腺影像学报告及数据系统

Abstract:

Objective To explore the application value of combining the ultrasound breast imaging reporting and data system (BI-RADS) classification with serum fibroblast growth factor receptor 1 (FGFR1) and growth differentiation factor 3 (GDF3) in the differential diagnosis of benign and malignant breast masses. Methods A total of 159 patients with breast masses were selected and divided into the benign mass group (n=83) and the malignant mass group (n=76) based on postoperative pathological diagnosis. All patients underwent ultrasound examination, and enzyme-linked immunosorbent assay (ELISA) was applied to detect serum levels of FGFR1 and GDF3. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of ultrasound BI-RADS classification and serum FGFR1 and GDF3 levels for benign and malignant breast masses. Kappa test was applied to analyze the consistency between various diagnostic methods and pathological diagnosis. Results The serum levels of FGFR1 and GDF3, the proportions of irregular morphology, unclear boundaries, spiculation, microcalcifications, blood flow grade Ⅱ-Ⅲ and posterior echo attenuation, RI and PI were higher in the malignant tumor group than those in the benign tumor group (P<0.05). The area under the curve (AUC) of FGFR1, GDF3 and ultrasound BI-RADS classification in the differential diagnosis of benign and malignant breast masses separately and in combination was 0.802 (95%CI: 0.732-0.871), 0.817 (95%CI: 0.751-0.884), 0.848 (95%CI: 0.784-0.912) and 0.956 (95%CI: 0.918-0.993), respectively. The combined diagnosis was more effective than that of the individual diagnosis of each indicator. The consistency between the individual and combined diagnosis of benign and malignant breast masses and pathological diagnosis showed that the Kappa values were 0.517, 0.514, 0.688 and 0.912, respectively, with the highest consistency observed in the combined diagnosis (P<0.05). Conclusion Ultrasound BI-RADS classification combined with serum FGFR1 and GDF3 has high application value in the differential diagnosis of benign and malignant breast masses.

Key words: breast neoplasms, ultrasonography, receptor, fibroblast growth factor, type 1, growth differentiation factor 3, diagnosis, differential, breast lump, breast imaging reporting and data system

中图分类号:

R445.1，R737.9

图/表 6

参考文献 24

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组别			n	年龄/岁					BMI/（kg/m²）
良性肿块组			83	50.24±10.68					22.79±3.04
恶性肿块组			76	50.33±10.82					22.91±2.95
t				0.053					0.252
组别		饮酒史				糖尿病	高血压			冠心病
良性肿块组		12（14.46）				5（6.02）	31（37.35）			13（15.66）
恶性肿块组		15（19.74）				7（9.21）	36（47.37）			10（13.16）
χ²		0.784				0.577	1.633			0.201
组别	TG/ （mmol/L）				TC/ （mmol/L）			LDL-C/ （mmol/L）			HDL-C/ （mmol/L）
良性肿块组	1.67±0.42				5.04±1.26			1.89±0.47			1.10±0.22
恶性肿块组	1.62±0.38				5.12±1.33			1.82±0.51			1.09±0.25
t	0.785				0.389			0.901			0.268

组别			n	年龄/岁					BMI/（kg/m²）
良性肿块组			83	50.24±10.68					22.79±3.04
恶性肿块组			76	50.33±10.82					22.91±2.95
t				0.053					0.252
组别		饮酒史				糖尿病	高血压			冠心病
良性肿块组		12（14.46）				5（6.02）	31（37.35）			13（15.66）
恶性肿块组		15（19.74）				7（9.21）	36（47.37）			10（13.16）
χ²		0.784				0.577	1.633			0.201
组别	TG/ （mmol/L）				TC/ （mmol/L）			LDL-C/ （mmol/L）			HDL-C/ （mmol/L）
良性肿块组	1.67±0.42				5.04±1.26			1.89±0.47			1.10±0.22
恶性肿块组	1.62±0.38				5.12±1.33			1.82±0.51			1.09±0.25
t	0.785				0.389			0.901			0.268

组别	n	FGFR1/（μg/L）	GDF3/（ng/L）
良性肿块组	83	7.45±2.32	92.38±24.12
恶性肿块组	76	11.75±3.68	129.85±35.71
t		8.891^＊	7.811^＊

组别	n	FGFR1/（μg/L）	GDF3/（ng/L）
良性肿块组	83	7.45±2.32	92.38±24.12
恶性肿块组	76	11.75±3.68	129.85±35.71
t		8.891^＊	7.811^＊

组别	n	形态不规则	边界不清晰	有毛刺征	有微钙化灶
良性肿块组	83	27（32.5）	22（26.5）	25（30.1）	13（15.7）
恶性肿块组	76	68（89.5）	66（86.8）	55（72.4）	42（55.3）
χ²		53.490^＊	58.439^＊	28.326^＊	27.498^＊
组别	血流分级（0—Ⅰ级/Ⅱ—Ⅲ级）		后方回声衰减	RI	PI
良性肿块组	56/27		10（12.1）	0.64±0.11	0.89±0.21
恶性肿块组	30/46		36（47.4）	0.76±0.15	1.64±0.41
χ²或t	12.522^＊		24.071^＊	5.785^＊	14.695^＊

超声BI-RADS分类联合血清FGFR1、GDF3在乳腺肿块良恶性鉴别诊断中的应用价值

The application value of ultrasound BI-RADS classification combined with serum FGFR1 and GDF3 in the differential diagnosis of benign and malignant breast masses

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指标	AUC	95%CI	临界值	准确度/%	敏感度/%	特异度/%	阳性预测值/%	阴性预测值/%	约登指数
FGFR1	0.802	0.732~0.871	9.42 μg/L	76.10	64.47	86.75	81.67	72.73	0.51
GDF3	0.817	0.751~0.884	106.04 ng/L	75.47	86.84	65.06	69.47	84.38	0.52
超声BI-RADS分类	0.848	0.784~0.912	-	84.28	96.05	73.49	76.84	95.31	0.70
联合	0.956	0.918~0.993	-	95.60	94.74	96.39	96.00	95.24	0.91

诊断方法	病理诊断		Kappa值
诊断方法	良性肿块（n=83）	恶性肿块（n=76）	Kappa值
FGFR1
良性肿块（n=99）	72	27	0.517^＊＊
恶性肿块（n=60）	11	49	0.517^＊＊
GDF3
良性肿块（n=64）	54	10	0.514^＊＊
恶性肿块（n=95）	29	66	0.514^＊＊
超声BI-RADS分类
良性肿块（n=64）	61	3	0.688^＊＊
恶性肿块（n=95）	22	73	0.688^＊＊
联合
良性肿块（n=84）	80	4	0.912^＊＊
恶性肿块（n=75）	3	72	0.912^＊＊

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