Ultrasonographic Manifestations of Breast Lymphoma Misdiagnosed as Breast Cancer and Its Influencing Factors

LI Feng; DAI Xiuli

doi:10.3969/j.issn.1002-3429.2024.17.005

Abstract：Objective To investigate the ultrasonographic manifestations and causes of misdiagnosis of breast lympho-ma as breast cancer.Methods A total of 60 patients with breast lymphoma diagnosed by surgical pathology from June 2018 to June 2023 were selected as the research subjects,and were divided into a correct diagnosis group(n=32)and a breast cancer group(n=28)according to preoperative ultrasound diagnosis results and surgical pathology results.Clinical data,ul-trasound image characteristics and ultrasound blood flow parameters of the two groups were analyzed.Multivariate Logistic re-gression was used to analyze the influencing factors of breast lymphoma misdiagnosed as breast cancer.The structural equation model was constructed and verified to analyze the impact and path of various factors on misdiagnosis of breast lymphoma as breast cancer.The nomogram prediction model of breast lymphoma misdiagnosed as breast cancer was constructed and veri-fied.Results There were significant differences in tumor size,tumor aspect ratio,tumor shape,tumor boundary,posterior echo,burr sign and calcification foci between the two groups(P＜0.05,P＜0.01).Multivariate Logistic regression analysis showed that tumor aspect ratio,tumor shape,tumor boundary,posterior echo and burr sign were independent influencing fac-tors for misdiagnosis of breast lymphoma as breast cancer(P＜0.05,P＜0.01).All indexes of the structural equation model met the requirements,the model was well fitted,the independence of variables was high,and the differentiation was good.The tumor aspect ratio＞1,irregular tumor shape,unclear tumor boundary,burr sign,and posterior echo attenuation had significant positive effects on the misdiagnosis of breast lymphoma as breast cancer.A nomogram model was constructed to pre-dict the risk of breast lymphoma misdiagnosed as breast cancer,and the areas under the curve before and after verification were 0.925(95%CI:0.578,0.976)and 0.912(95%CI:0.841,0.967)respectively,the average absolute error of the calibration curve was 0.014.Conclusion The ultrasonography of patients with breast lymphoma misdiagnosed as breast canc-er shows the masses≤2 cm,tumor aspect ratio of more than 1,irregular tumor shape,unclear tumor boundaries,mostly low/mixed internal echo,more attenuated posterior echo,abundant blood supply,the burr sign,calcification focus and or-ange-peel-like skin.Tumor aspect ratio,tumor shape,tumor boundary,posterior echo and burr sign are all independent fac-tors for misdiagnosis of breast lymphoma as breast cancer.The tumor aspect ratio＞1,irregular tumor shape,unclear tumor boundary,burr sign and attenuation of posterior echo have significant positive effects on misdiagnosis of breast lymphoma as breast cancer.