中国全科医学2026，Vol.29Issue(17)：2368-2375,8.DOI:10.12114/j.issn.1007-9572.2025.0346
基于超声生境成像对乳腺叶状肿瘤良恶性鉴别的效能研究
Study on the Diagnostic Performance of Ultrasound Habitat Imaging for the Differentiation between Benign and Malignant Phyllodes Tumors of the Breast
摘要
Abstract
Background Benign and malignant phyllodes tumors of the breast(PTB)exhibit significant differences in surgical strategies,recurrence risks,and metastasis risks.Preoperative differentiation between the two subtypes is crucial for treatment decision-making.Conventional ultrasound has inherent limitations in diagnosis,while the diagnostic performance of ultrasound habitat imaging for distinguishing benign from malignant PTB remains not systematically validated.Objective To evaluate the diagnostic efficacy of ultrasound habitat imaging in differentiating benign from malignant PTB.Methods A retrospective analysis was performed on clinical and ultrasound data of 102 patients with pathologically confirmed PTB who underwent surgery at Daping Hospital,Army Medical University,from September 2014 to June 2024.Patients were divided into the benign group(n=54)and the borderline/malignant group(n=48,including 30 borderline cases and 18 malignant cases)based on pathological findings.Ultrasound images were recorded,and the tumor region of interest(ROI)was manually segmented using ITK-SNAP software.The ROI was divided into 3 habitat subregions via K-means clustering,and habitat features were extracted using PyRadiomics.Optimal features were selected using random forest(RF)algorithm,and a habitat score(Hab-score)was calculated to construct the habitat model.The conventional ultrasound model was established by incorporating conventional ultrasound variables with statistically significant differences in univariate analysis.A combined model was constructed by integrating conventional ultrasound features and Hab-score.Receiver operating characteristic(ROC)curves and Delong test were used to compare the diagnostic efficacy of the three models,and decision curve analysis(DCA)was employed to evaluate their clinical applicability.Results Statistically significant differences were observed between the two groups regarding maximum tumor diameter,internal echo,boundary clarity,and cystic changes(all P<0.05).The conventional ultrasound model was built by including these 4 variables;7 habitat features(including 3 first-order features and 4 texture features)were retained after RF selection for Hab-score calculation and habitat model construction;the combined model was established by adding Hab-score to the 4 conventional ultrasound variables.The areas under the ROC curve(AUC)of the conventional ultrasound model,habitat model,and combined model were 0.718,0.725,and 0.799,respectively.Delong test results indicated that the AUC of the combined model was significantly higher than those of the other two models(both P<0.05).DCA curve analysis demonstrated that the combined model yielded the highest clinical net benefit for PTB differentiation within the threshold range of 0.4-0.9.Conclusion Ultrasound habitat imaging is effective for differentiating benign from malignant PTB.When combined with conventional ultrasound,it further improves diagnostic efficacy and reduces the risks of missed diagnosis and misdiagnosis associated with a single technical approach,thus holding substantial potential for clinical application.关键词
乳腺叶状肿瘤/生境成像/超声特征/良恶性鉴别Key words
Phyllodes tumors of the breast/Habitat imaging/Ultrasound features/Benign-malignant differentiation分类
医药卫生引用本文复制引用
谢丹翎,刘博雅,李晓光,王瀚苇,马强,方靖琴,王舒楠..基于超声生境成像对乳腺叶状肿瘤良恶性鉴别的效能研究[J].中国全科医学,2026,29(17):2368-2375,8.基金项目
重庆市科卫联合医学科研项目(2025QNXM014) （2025QNXM014）
重庆市影像医学与核医学临床研究中心科技计划项目(CSTC2015YFPT-gcjsyjzx0175) （CSTC2015YFPT-gcjsyjzx0175）
