Objective: To evaluate the differential diagnosis of idiopathic granulomatous mastitis (IGM) and invasive ductal carcinoma. Methods: The ultrasonographic data of 37 IGM patients and 50 cases of IDC were analyzed retrospectively. The shape, growth direction, margin, internal echo, posterior echo, calcification, Adler blood flow classification, PSV(peak sestolic velocity), RI (resistance index)and elasticity scores were analyzed by χ(2) test and independent sample t test. The optimal cutoff values of age, PSV and RI were calculated by receiver operating characteristic (ROC) curve. Logistic regression analysis was used to calculate the odds ratio (OR) of ultrasonic variates in the diagnosis of both diseases. Results: There were no significant differences in the shape, margin, internal echo and blood flow grading between the two groups. The age, lesion growth direction, posterior echo, calcification, PSV, RI and elasticity were statistically different. The cut-of value of Age, PSV and RI were 38.5 years old, 13.20 cm/s, and 0.655. Logistic regression multi-variated analysis revealed that elastic score (OR=9.806) had the best value of the differential diagnosis, as well as calcification (OR=6.937), posterior echo decay (OR=4.613), RI (OR=3.257), lesion growth orientation (OR=3.198), and PSV (OR=1.202). Lesion shape, margin, internal echo, and Adler blood flow classification did not help in differential diagnosis. Conclusion: Ultrasound multi-parameter analysis has high value in IGM and IDC differential diagnosis.
目的： 分析超声影像学检查在肉芽肿性乳腺炎(IGM)和浸润性导管癌(IDC)鉴别诊断中的价值。 方法： 回顾性分析经病理证实的37例IGM与50例IDC患者的超声检查资料，分析病灶形状、生长方向、边缘、内部回声、后方回声、钙化、Adler血流分级、血流峰值流速(PSV)、阻力指数(RI)和弹性评分在IGM和IDC间的分布差异。采用受试者工作特征曲线(ROC)计算年龄、PSV和RI的最佳截点值，采用logistic回归分析超声影像学特征对鉴别诊断IGM和IDC的优势比(OR)。 结果： IGM和IDC的病灶形状、边缘、内部回声和血流分级的差异均无统计学意义(均P>0.05)，而患者的年龄、病灶生长方向、后方回声、钙化、PSV、RI和弹性评分的差异均有统计学意义(均P<0.05)。ROC曲线分析的结果显示，患者年龄、PSV和RI的最佳截点值分别为38.5岁、13.20 cm/s和0.655。logistic回归分析显示，弹性评分的鉴别诊断IGM和IDC的能力最强(OR＝9.806)，其次为钙化(OR＝6.937)、后方回声是否衰减(OR＝4.613)、RI(OR＝3.257)、病灶生长方向(OR＝3.198)和PSV(OR＝1.202)，病灶形状、边缘、内部回声以及Adler血流分级对鉴别诊断IGM和IDC几乎没有帮助。 结论： 多因素综合分析超声影像学特征在鉴别诊断IGM和IDC中有较高的临床应用价值。.
Keywords: Breast neoplasms; Color Doppler flow imaging; Elastography; Idiopathic granulomatous mastitis; Invasive ductal carcinoma; U1trasonography.