Su Liyang, Xie Qiaojie, Yi Aling, Zhang Qingquan, Chen Jinzhen
Department of Ultrasonography, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China.
Front Oncol. 2025 Apr 17;15:1454951. doi: 10.3389/fonc.2025.1454951. eCollection 2025.
Intraductal Papilloma (IDP) and Ductal Carcinoma (DCIS) are significant benign and pre-invasive breast lesions, respectively. This study aimed to investigate ultrasound features and develop a predictive nomogram for discriminating between IDP and DCIS.
Conducted at Quanzhou First Hospital over a three-year period, 389 patients were enrolled with detailed ultrasound examinations and confirmed pathological diagnoses. IDP was classified into Grades 3, 4, and 5, whereas DCIS presented with a mass-like morphology. Patients meeting the inclusion criteria underwent rigorous analysis, with exclusion criteria eliminating those with incomplete imaging data or confounding comorbidities. Ultrasound characteristics, including lesion size, shape, margin, and echogenicity, etc., were systematically evaluated and compared between the two groups. Univariate and multivariate logistic regression analyses were conducted to identify significant risk factors. Subsequently, based on these characteristics, both static and dynamic nomograms were developed. The performance of the nomograms was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).
The study cohort included 272 patients in the training set and 117 in the validation set. Significant differences were observed between IDP and DCIS in age, size, shape, aspect ratio, margin, duct dilatation, and microcalcification ( < 0.05). Logistic regression analyses identified age, size, aspect ratio, margin, microcalcification, and duct dilatation as independent risk factors. Compared to DCIS, IDP is associated with younger age, smaller size, clearer margins, fewer microcalcifications, and more ductal dilation. The performance of the nomogram developed to predict IDP and DCIS showed an AUC of 0.918 in the training set and 0.888 in the validation set. The calibration curve indicates a strong fit of the predictive model in the validation set, with the Hosmer-Lemeshow test showing high consistency between predicted and actual probabilities (training set, = 0.875; validation set, = 0.751). Additionally, DCA confirms the clinical utility of the model.
The nomogram incorporating key predictors provides a valuable tool for differentiating between IDP and DCIS based on ultrasound characteristics. This approach aids in clinical decision-making and potentially reduces unnecessary biopsies.
导管内乳头状瘤（IDP）和导管原位癌（DCIS）分别是重要的乳腺良性和癌前病变。本研究旨在探讨超声特征，并建立一种预测列线图以鉴别IDP和DCIS。
在泉州市第一医院进行了为期三年的研究，纳入389例患者，进行了详细的超声检查并获得了确诊的病理诊断。IDP分为3级、4级和5级，而DCIS表现为肿块样形态。符合纳入标准的患者接受了严格分析，排除标准排除了那些影像数据不完整或存在混杂合并症的患者。系统评估并比较了两组患者的超声特征，包括病变大小、形状、边界和回声等。进行单因素和多因素逻辑回归分析以确定显著的危险因素。随后，基于这些特征，开发了静态和动态列线图。使用受试者工作特征曲线下面积（AUC）、校准图和决策曲线分析（DCA）对列线图的性能进行评估。
研究队列包括训练集中的272例患者和验证集中的117例患者。在年龄、大小、形状、纵横比、边界、导管扩张和微钙化方面，IDP和DCIS之间存在显著差异（<0.05）。逻辑回归分析确定年龄、大小、纵横比、边界、微钙化和导管扩张为独立危险因素。与DCIS相比，IDP与年龄较小、大小较小、边界更清晰、微钙化较少和导管扩张较多相关。用于预测IDP和DCIS的列线图在训练集中的AUC为0.918，在验证集中为0.888。校准曲线表明预测模型在验证集中拟合良好，Hosmer-Lemeshow检验显示预测概率与实际概率之间具有高度一致性（训练集，=0.875；验证集，=0.751）。此外，DCA证实了该模型的临床实用性。
包含关键预测因素的列线图为基于超声特征鉴别IDP和DCIS提供了有价值的工具。这种方法有助于临床决策，并可能减少不必要的活检。
