| 剪切波弹性成像鉴别诊断乳腺BI-RADS 4A类病灶良恶性的价值 |
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| 引用本文： | 张一丹,孔文韬,王颖,吴敏.剪切波弹性成像鉴别诊断乳腺BI-RADS 4A类病灶良恶性的价值[J].临床超声医学杂志,2021,23(4):271-275. |
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| 作者姓名： | 张一丹 孔文韬 王颖 吴敏 |
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| 作者单位： | 210008 南京市,南京大学医学院附属鼓楼医院超声诊断科 |
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| 基金项目： | 南京市卫生科技发展专项(YKK18065)。 |
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| 摘 要： | 目的探讨剪切波弹性成像鉴别诊断乳腺影像报告和数据系统(BI-RADS)4A类病灶良恶性的价值。方法回顾性分析131例乳腺病变患者(共133个BI-RADS 4A类病灶)的常规超声及剪切波弹性成像检查资料,根据病理结果分为良性组110个和恶性组23个。获取并比较两组病灶的剪切波速度最大值(SWVmax)、剪切波速度最小值(SWVmin)、剪切波速度差值(ΔSWV)及弹性彩色模式。以病理结果为金标准,绘制上述各参数诊断乳腺BI-RADS 4A类病灶良恶性的受试者工作特征(ROC)曲线,计算并比较其曲线下面积(AUC)。将剪切波弹性成像各参数联合临床资料、常规超声特征构建Logistic回归模型并验证其诊断效能。结果两组年龄、Adler血流分级、SWVmax、SWVmin、ΔSWV及弹性彩色模式比较,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,SWVmax、SWVmin、ΔSWV及弹性彩色模式鉴别乳腺病灶良恶性的AUC分别为0.767、0.643、0.755及0.780,敏感性分别为65.2%、60.9%、69.6%及69.6%,特异性分别为90.0%、60.9%、86.4%及86.4%,SWVmax、ΔSWV及弹性彩色模式的AUC比较差异均无统计学意义,但均高于SWVmin(均P<0.05)。将年龄(X1)、Adler血流分级(X2)及弹性彩色模式(X3)纳入回归模型,建立的Logistic回归方程为:Logistic(P)=-7.579+1.078X1+4.986X2+7.376X3,其AUC、敏感性及特异性分别为0.864、78.3%及90.9%,诊断效能明显大于剪切波弹性成像各参数(均P<0.05)。结论剪切波弹性成像在乳腺BI-RADS 4A类病灶良恶性的鉴别诊断中有一定价值,其中SWVmax、ΔSWV及弹性彩色模式的诊断性能较高,弹性彩色模式联合年龄、Alder血流分级可提高BIRADS 4A类恶性病灶的检出率。
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| 关 键 词： | 弹性成像 剪切波 乳腺病灶 良恶性 乳腺影像报告和数据系统 |
Value of shear wave elastography in the differential diagnosis of BI-RADS category 4A lesions |
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| ZHANG Yidan,KONG Wentao,WANG Ying,WU Min.Value of shear wave elastography in the differential diagnosis of BI-RADS category 4A lesions[J].Journal of Ultrasound in Clinical Medicine,2021,23(4):271-275. |
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| Authors: | ZHANG Yidan KONG Wentao WANG Ying WU Min |
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| Affiliation: | (Department of Ultrasound,Nanjing Drum Tower Hospital,Nanjing Medical School,Nanjing 210008,China) |
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| Abstract: | Objective To explore the value of shear wave elastography(SWE)in the differential diagnosis of breast imaging reporting and data system(BI-RADS)category 4A lesions.Methods Conventional ultrasound and SWE data from 131 patients with 133 breast lesions which were classified as BI-RADS category 4A were analyzed retrospectively.According to the pathological results,lesions were divided into two groups(110 lesions in benign group and 23 lesions in malignant group).The maximum shear wave velocity(SWVmax),minimum shear wave velocity(SWVmin),shear wave velocity difference(ΔSWV)and elastic color pattern of each lesion were obtained.Taking pathological results as the gold standard,the ROC curve was drawn,and the area under the ROC curve(AUC)of different parameter was achieved.The parameters of SWE were combined with clinical data and conventional ultrasound features to construct a Logistic regression model,the diagnostic efficacy of this model was obtained and compared with the parameters of SWE.Results There were statistically significant difference in patient’s age,the Adler blood flow grading,SWVmax,SWVmin,ΔSWV and elasitc color pattern between benign and malignant lesions(all P<0.05).The ROC curve analysis showed that AUCs of SWVmax,SWVmin,ΔSWV and color pattern in distinguishing benign and malignant lesions were 0.767,0.643,0.755 and 0.780,the sensitivity were 65.2%,60.9%,69.6%and 69.6%,the specificity were 90.0%,60.9%,86.4%and 86.4%,respectively.The AUCs of SWVmax,ΔSWV and color pattern were not statistically significant difference,but all higher than that of SWVmin(all P<0.05).The Logistic regression analysis showed that patient’s age(X1),the Adler blood flow grading(X2)and elastic color pattern(X3)were included in the equation,Logistic(P)=-7.579+1.078X1+4.986X2+7.376X3.The AUC,sensitivity and specificity of the model were 0.864,78.3%and 90.9%,respectively,which were higher than each parameters of SWE alone(all P<0.05).Conclusion SWE has a certain value in differential diagnosis of breast BI-RADS category 4A lesions,especially SWVmax,ΔSWV and elastic color pattern shows a better diagnostic efficacy.The combination of elastic color pattern with patient’s age and the Adler blood flow grading could improve the detection rate of malignant lesions. |
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| Keywords: | Elastography shear wave Breast lesion benign and malignant BI-RADS |
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