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logistic回归模型评价常规超声及超声造影对胆管细胞癌与肝细胞癌的鉴别诊断价值
Value of conventional ultrasonography and contrast-enhanced ultrasound in the differential diagnosis of intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma: An analysis based on the logistic regression model
文章发布日期:2019年09月29日  来源:  作者:叶显俊, 胡蕾, 何年安, 等  点击次数:252次  下载次数:45次

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【摘要】: 目的 建立胆管细胞癌(ICC)常规超声特征及“周边环状强化”超声造影增强模式为变量的logistic回归模型,评价常规超声以及超声造影在ICC与肝细胞癌(HCC)鉴别诊断中的价值。方法 回顾性分析55例ICC患者以及42例HCC患者的常规超声及超声造影图像特点,以手术病理或活组织检查病理为诊断金标准。评价利用logistic回归模式分析筛选出的病灶回声、血供类型、胆管扩张以及“周边环状强化”超声造影模式4个超声特征在ICC与HCC鉴别诊断中的价值。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验。对单因素分析结果中有统计学意义的因素作为自变量再进行二分类logistic回归分析。对整个模型的拟合情况采用似然比检验,筛选出各个特征中与ICC定性诊断似然比最高者。绘制logistic回归分析模型定性诊断ICC的受试者工作特征曲线(ROC曲线),计算其曲线下面积(AUC)。结果 2组患者在病灶回声(χ2=4.813,P<0.05)、血供类型(χ2=10.222,P<0.01)、胆管扩张(χ2=40.669,P<0.01)以及“周边环状强化”超声造影模式(χ2=8.180,P<0.01)4个超声特征上差异均有统计学意义,其鉴别ICC与HCC的敏感度、特异度分别为58.15%、64.29%;72.73%、59.52%;67.27%、66.4%;69.09%、95.24%。病灶回声类型、血供情况、超声造影周边环状强化和是否合并周边胆管扩张的比值比(OR)分别为3.556、4.107、4.223和5.776,P值均<0.05。二分类logistic回归方程为:Logistic(P)=-2.761+1.272X1+1.430X2 +1.538X3+1.743X4。模型似然比检验结果显示该回归方程差异有统计学意义(χ2=94.691,P<0.001)。该回归方程对ICC做定性诊断的敏感度为74.3%,特异度为82.2%,其AUC为0.856。2组病灶超声造影的达峰时间差异有统计学意义(t=8.497,P<0.01)。结论 Logistic回归模型分析及超声造影定量分析可以提高超声对ICC定性诊断。
【Abstract】: Objective To investigate the value of conventional ultrasonography (US) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC) by establishing a logistic regression model with the variables of US features and CEUS enhancement pattern (circumferential ring enhancement). Methods A retrospective analysis was performed for the US and CEUS features of 55 ICC patients and 42 HCC patients, and the results of surgical pathology or biopsy were used as the golden standard for diagnosis. A logistic regression analysis was used to evaluate the value of four US features, lesion echo, blood supply type, bile duct dilatation, and circumferential ring enhancement of CEUS, in the differential diagnosis of ICC and HCC. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was performed for the factors with statistical significance in univariate analysis. Likelihood ratio was used to evaluate the fitting of the whole model, and the feature with the highest likelihood ratio in the qualitative diagnosis of ICC was screened out. The receiver operating characteristic (ROC) curve was plotted for the logistic regression model in the qualitative diagnosis of ICC, and the area under the ROC curve (AUC) was calculated. Results There were significant differences between the two groups in lesion echo (χ2=4.813, P<0.05), blood supply type (χ2=10.222, P<0.01), bile duct dilatation (χ2=40.669, P<0.01), and circumferential ring enhancement of CEUS (χ2=8.180, P<0.01), and these four features had a sensitivity of 58.15%, 72.73%, 67.27%, and 69.09%, respectively, and a specificity of 64.29%, 59.52%, 66.4%, and 95.24%, respectively, all P<0.05, in the differential diagnosis of ICC and HCC. Type of lesion echo, blood supply, circumferential ring enhancement of CEUS, and presence or absence of bile duct dilatation had an odds ratio of 3.556, 4.107, 4.223, and 5.776, respectively. The binary logistic regression equation was Logistic (P)=-2.761+1.272X1+1.430X2+1.538X3+1.743X4. The likelihood-ratio test of this model showed a significant difference in this regression equation (χ2=94.691, P<0.001). In the qualitative diagnosis of ICC, this regression equation had a sensitivity of 74.3%, a specificity of 82.2%, and an AUC of 0.856. There was a significant difference in time to peak between the two groups (t=8.497, P<0.01). Conclusion The logistic regression model and CEUS qualitative analysis can improve the qualitative diagnosis of ICC.
【关键字】:超声检查; 胆管上皮癌; 癌, 肝细胞
【Key words】:ultrasonography; cholangiocarcinoma; carcinoma, hepatocellular
【引证本文】:YE XJ, HU L, HE NA, et al. Value of conventional ultrasonography and contrast-enhanced ultrasound in the differential diagnosis of intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma: An analysis based on the logistic regression model[J]. J Clin Hepatol, 2019, 35(11): 2502-2507. (in Chinese)
叶显俊, 胡蕾, 何年安, 等. logistic回归模型评价常规超声及超声造影对胆管细胞癌与肝细胞癌的鉴别诊断价值[J]. 临床肝胆病杂志, 2019, 35(11): 2502-2507.

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