Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No.31, Longhua Road, Haikou, 570102, China.
Sci Rep. 2024 Feb 25;14(1):4578. doi: 10.1038/s41598-024-55298-w.
The aim of this study was to quantify the orientation of breast masses and determine whether it can enhance the utility of a not parallel orientation in predicting breast mass malignancy. A total of 15,746 subjects who underwent breast ultrasound examinations were initially enrolled in the study. Further evaluation was performed on subjects with solid breast masses (≤ 5 cm) intended for surgical resection and/or biopsy. The orientation angle, defined as the acute angle between the align of the maximal longitudinal diameter of the breast mass and the surface of the breast skin, was measured. Receiver operating characteristic (ROC) curve analysis was conducted, and various performance measures including sensitivity, specificity, positive and negative predictive values, accuracy, odds ratio, and the area under the ROC curve (AUC) were calculated. Multivariate analysis was performed to determine if the orientation angle was an independent predictor of breast malignancy. Decision curve analysis (DCA) was also conducted to assess the net benefit of adopting the orientation angle for predicting breast mass malignancy. The final analysis included 83 subjects with breast cancer and 135 subjects with benign masses. The intra-group correlation coefficient for the measurement of the orientation angle of breast masses was 0.986 (P = 0.001), indicating high reproducibility. The orientation angles of malignant and benign breast masses were 36.51 ± 14.90 (range: 10.7-88.6) degrees and 15.28 ± 8.40 (range: 0.0-58.7) degrees, respectively, and there was a significant difference between them (P < 0.001). The cutoff value for the orientation angle was determined to be 22.9°. The sensitivity, specificity, positive and negative predictive values, accuracy, odds ratio, and AUC for the prediction of breast malignancy using the orientation angle were 88.0%, 87.4%, 81.1%, 92.2%, 87.6%, 50.67%, and 0.925%, respectively. Multivariate analysis revealed that the orientation angle (> 22.9°), not circumscribed margin, and calcifications of the breast mass were independent factors predicting breast malignancy. The net benefit of adopting the orientation angle for predicting breast malignancy was 0.303. Based on these findings, it can be concluded that quantifying the orientation angle of breast masses is useful in predicting breast malignancy, as it demonstrates high sensitivity, specificity, AUC, and standardized net benefit. It optimizes the utility of the not parallel orientation in assessing breast mass malignancy.
本研究旨在量化乳腺肿块的方位，并探讨其是否能提高非平行方位在预测乳腺肿块良恶性中的应用价值。共纳入 15746 例行乳腺超声检查的受试者。进一步评估了拟行手术切除和/或活检的直径≤5cm 的实性乳腺肿块患者。测量乳腺肿块最长径线与乳腺皮肤表面所形成夹角的方位角。进行受试者工作特征（ROC）曲线分析，并计算各种性能指标，包括敏感性、特异性、阳性和阴性预测值、准确性、优势比和 ROC 曲线下面积（AUC）。进行多因素分析以确定方位角是否为乳腺恶性肿瘤的独立预测因素。还进行了决策曲线分析（DCA）以评估采用方位角预测乳腺肿块良恶性的净获益。最终分析纳入 83 例乳腺癌患者和 135 例良性肿块患者。乳腺肿块方位角测量的组内相关系数为 0.986（P=0.001），提示高度可重复性。恶性和良性乳腺肿块的方位角分别为 36.51±14.90（范围：10.7-88.6）度和 15.28±8.40（范围：0.0-58.7）度，两者之间存在显著差异（P<0.001）。方位角的截断值确定为 22.9°。使用方位角预测乳腺恶性肿瘤的敏感性、特异性、阳性和阴性预测值、准确性、优势比和 AUC 分别为 88.0%、87.4%、81.1%、92.2%、87.6%、50.67%和 0.925%。多因素分析显示，方位角（>22.9°）、边界不清和乳腺肿块钙化是预测乳腺恶性肿瘤的独立因素。采用方位角预测乳腺恶性肿瘤的净获益为 0.303。基于这些发现，可以得出结论，量化乳腺肿块的方位角有助于预测乳腺恶性肿瘤，因为其具有较高的敏感性、特异性、AUC 和标准化净获益，并优化了非平行方位在评估乳腺肿块良恶性中的应用价值。
