目的：探讨基于超声特征的评分法在腮腺Warthin瘤与混合瘤鉴别诊断中的价值。方法：回顾性分析经超声检查并手术病理证实的40个腮腺Warthin瘤和41个腮腺混合瘤病灶病例资料，选择两组患者性别、年龄、最大径、纵横比、病灶数、回声均匀性、网状条索、形态、边界、后方回声、囊性变、钙化灶和血流分级等指标，通过多元逐步Logistic回归分析筛选独立危险因素建立评分系统，绘制受试者工作特征（ROC）曲线计算评分系统的诊断效能。结果：两组患者在性别、年龄、最大径、纵横比、病灶数、回声均匀性、网状条索、血流分级指标上差异有统计学意义（P＜0.05），其中性别、年龄、纵横比、回声均匀性、血流分级5个指标为Warthin瘤的独立危险因素，对每个指标赋予0分或1分建立评分系统，总分0～5分，以≥3分为参数诊断Warthin瘤效能最高，敏感度97.5%，特异度85.36%，准确率91.35%。结论：基于超声特征的评分法评分≥3时，对鉴别腮腺Warthin瘤与混合瘤具有很好的诊断效能。该方法简单实用，适宜推广应用。
Abstract
Objective: To evaluate the value of ultrasound-based scoring system in differential diagnosis of Warthin tumors and pleomorphic adenomas in parotid gland. Methods: Forty Warthin tumors and 41 pleomorphic adenomas were proved by surgical histopathology after the ultrasonography process. And the parameters including gender, age, maximum diameter, height/width ratio, number of lesions, echogenicity, reticular cord, shape, margin, posterior echogenicity, cystic degeneration, calcification and blood flow were retrospectively compared between the groups mentioned above. After that, the independent risk factors were screened by multivariate stepwise Logistic regression analysis. Then, a scoring system was established. The receiver operating characteristic(ROC) curve was also plotted to calculate the diagnostic efficacy of the scoring system. Results: There were statistically significant differences between the two groups in the next eight parameters including gender, age, maximum diameter, height/width ratio, number of lesions, echogenicity, reticular cord, and blood flow(P＜0.05). Furthermore, among of which, the gender, age, height/width ratio, echogenicity, or blood flow was individually independent risk factors to Warthin tumors. The scoring system was established with 0 or 1 point for each risk factor, and the total scores summed up to 0～5 points. The highest efficiency, the sensitivity, specificity and accuracy of the diagnosis of Warthin tumors were 97.5%, 85.36% and 91.35% while the cut-off value of ≥3 was set, respectively. Conclusion: The ultrasound-based scoring system has highly diagnostic efficiency in differentiating Warthin tumors from pleomorphic adenomas in parotid gland. Though simple, but it is an easy way to perform in clinical practice.
关键词
腮腺肿瘤 /
腺淋巴瘤 /
超声检查 /
多普勒 /
彩色
Key words
Parotid neoplasms /
Adenolymphoma /
Ultrasonography, Doppler, color
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基金
国家自然科学基金资助项目（编号81571677）；上海市松江区科技攻关项目（编号18sjkjgg42）；上海市闵行区自然科学研究课题（编号2019MHZ085）；上海市闵行区中心医院院级课题（编号2018MHLC07）。
