Value of multimodal ultrasound combined with serum tumor markers in differential diagnosis of benign and malignant peripheral pulmonary lesions

doi:10.3877/cma.j.issn.1672-6448.2024.11.007

Abstract

Abstract:

Objective

To evaluate the value of multimodal ultrasound consisting of grayscale ultrasound, color Doppler flow imaging, and contrast-enhanced ultrasound (CEUS) combined with serological tumor markers in the differential diagnosis of benign and malignant peripheral pulmonary lesions.

Methods

A retrospective analysis was performed on 65 patients who underwent contrast-enhanced ultrasound examination for peripheral pulmonary lesions at the First Affiliated Hospital, Anhui University of Chinese Medicine from January 2022 to December 2023. They were divided into either a benign group or a malignant group according to the pathological results. All patients underwent multimodal ultrasound examination and detection of serological tumor markers. Lesion maximum diameter, lesion morphology, blood flow morphology, blood flow signal grade, internal echo, boundary, bronchial sign,necrosis, contrast agent arrival time (AT), the difference of arrival time between the lesion and the surrounding lung tissue (T_AT), contrast agent enhancement mode, perfusion mode, and the combination of serum tumor markers were recorded for univariate analysis. All factors considered statistically significant in the univariate analysis were included in Logistic regression analysis. A multi-factor combined prediction model for peripheral pulmonary lesions was established and receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficiency of the model.

Results

Univariate analysis showed that there were statistically significant differences in lesion morphology on gray-scale ultrasound, blood flow morphology on Doppler flow imaging, AT and T_AT on contrast-enhanced ultrasound, and the combination of serum tumor markers between benign and malignant peripheral pulmonary lesions (P＜0.05). Logistic regression analysis showed that lesion morphology on gray-scale ultrasound, blood flow morphology on color Doppler flow imaging, T_AT on contrast-enhanced ultrasound, and the combination of serum tumor markers were statistically significant in the differentiation of benign and malignant peripheral pulmonary lesions. The regression equation is: Logit(P)=-6.996+0.909X^lesion^morphology+1.521X^blood^flow^morphology+2.927X^TAT+2.553X^the^combination^of^serum^tumor^markers. The ROC curves of lesion morphology on gray-scale ultrasound,blood flow morphology on color Doppler flow imaging, T_AT on contrast-enhanced ultrasound, the combination of serum tumor markers, multimodal ultrasound, and multimodal ultrasound combined with serological tumor markers for the prediction of the nature of peripheral pulmonary lesions were plotted. The area under the curve of multimodal ultrasound combined with serological tumor markers was the largest (0.904).

Conclusion

Lesion morphology on gray scale ultrasound, blood flow morphology on color Doppler flow imaging, T_AT on contrast-enhanced ultrasound, and the combination of serum tumor markers each have appreciated diagnostic value in differentiating benign and malignant peripulmonary lesions, but their combination has higher diagnostic efficacy.

Key words: Contrast agent, Peripheral pulmonary lesion, Arrival time, Serum tumor markers

Rui Wang, Wei Chen, Jinping Wang, Baoqi Li. Value of multimodal ultrasound combined with serum tumor markers in differential diagnosis of benign and malignant peripheral pulmonary lesions[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(11): 1048-1056.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2024.11.007

https://chaosheng.cma-cmc.com.cn/EN/Y2024/V21/I11/1048

Figures/Tables 6

组别	例数	性别（例）		年龄（岁， $\bar{x}$ ±s）	吸烟史（例）
组别	例数	男	女	年龄（岁， $\bar{x}$ ±s）	有	无
恶性组	39	27	12	68.15±9.48	19	20
良性组	26	17	9	63.23±12.21	14	12
统计值		χ ²=0.106		t=1.826	χ ²=0.164
P值		0.745		0.073	0.685

组别	例数	性别（例）		年龄（岁， $\bar{x}$ ±s）	吸烟史（例）
组别	例数	男	女	年龄（岁， $\bar{x}$ ±s）	有	无
恶性组	39	27	12	68.15±9.48	19	20
良性组	26	17	9	63.23±12.21	14	12
统计值		χ ²=0.106		t=1.826	χ ²=0.164
P值		0.745		0.073	0.685

组别	例数	最大径线（mm， $\bar{x}$ ±s）	病灶形态			血流形态			血流信号分级
组别	例数	最大径线（mm， $\bar{x}$ ±s）	楔形	类圆形	不规则形	无血流	树枝状	点线状	0～1级	2～3级
恶性组	39	65.72±26.57	4	10	25	13	7	19	26	13
良性组	26	59.46±24.88	16	5	5	6	14	6	16	10
统计值		t=0.954	χ ²=20.417			χ ²=9.450			χ ²=0.179
P值		0.344	＜0.001			0.009			0.672
组别	例数	内部回声		支气管征		边界		坏死		血清学肿瘤标志物组合
组别	例数	均匀	不均匀	无	有	清晰	不清晰	无	有	阳性	阴性
恶性组	39	5	34	35	4	29	10	22	17	33	6
良性组	26	5	21	19	7	20	6	19	7	6	20
χ ²值		0.492		3.082		0.055		1.861		24.615
P值		0.483		0.079		0.814		0.173		＜0.001
组别	例数	AT		T_AT		增强模式		灌注模式
组别	例数	＜10 s	≥10 s	＜2.5 s	≥2.5 s	均匀	不均	非向心型	向心型
恶性组	39	1	38	5	34	11	28	12	27
良性组	26	11	15	22	4	8	18	10	16
χ ²值		16.369		33.112		0.050		0.412
P值		＜0.001		＜0.001		0.824		0.521

组别	例数	最大径线（mm， $\bar{x}$ ±s）	病灶形态			血流形态			血流信号分级
组别	例数	最大径线（mm， $\bar{x}$ ±s）	楔形	类圆形	不规则形	无血流	树枝状	点线状	0～1级	2～3级
恶性组	39	65.72±26.57	4	10	25	13	7	19	26	13
良性组	26	59.46±24.88	16	5	5	6	14	6	16	10
统计值		t=0.954	χ ²=20.417			χ ²=9.450			χ ²=0.179
P值		0.344	＜0.001			0.009			0.672
组别	例数	内部回声		支气管征		边界		坏死		血清学肿瘤标志物组合
组别	例数	均匀	不均匀	无	有	清晰	不清晰	无	有	阳性	阴性
恶性组	39	5	34	35	4	29	10	22	17	33	6
良性组	26	5	21	19	7	20	6	19	7	6	20
χ ²值		0.492		3.082		0.055		1.861		24.615
P值		0.483		0.079		0.814		0.173		＜0.001
组别	例数	AT		T_AT		增强模式		灌注模式
组别	例数	＜10 s	≥10 s	＜2.5 s	≥2.5 s	均匀	不均	非向心型	向心型
恶性组	39	1	38	5	34	11	28	12	27
良性组	26	11	15	22	4	8	18	10	16
χ ²值		16.369		33.112		0.050		0.412
P值		＜0.001		＜0.001		0.824		0.521

因素	B值	SE值	P值	OR值	OR值的95%CI
病灶形态	0.909	0.425	0.033	2.481	1.079～5.709
血流形态	1.521	0.764	0.047	4.579	1.024～20.483
AT	2.035	1.387	0.142	7.651	0.505～65.955
T_AT	2.927	1.110	0.008	8.667	2.122～74.241
血清学肿瘤标志物组合	2.553	1.193	0.032	7.841	1.238～69.193
常量	-6.996	2.087	0.001	0.001

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