声脉冲辐射力成像鉴别诊断良、恶性BI-RADS 4级乳腺肿块

目的 评价声脉冲辐射力成像(ARFI)在乳腺影像学报告及数据系统(BI-RADS)4级乳腺肿块良、恶性诊断中的价值。 方法 用ARFI对68例共75个常规超声诊断为BI-RADS 4级的乳腺肿块进行成像,测量声触诊组织成像(VTI)模式下肿块面积与常规二维超声肿块面积比值(AR),并测量声触诊量化成像(VTQ)模式下肿块剪切波速度(SWV);以病理结果(恶性34个,良性41个)为金标准,构建ROC曲线,评价ARFI的2种成像模式对BI-RADS 4级乳腺肿块的诊断价值。 结果 良、恶性BI-RADS 4级乳腺肿块的AR值差异有统计学意义(P<0.05),ROC曲线下面积(AUC)为0.851,敏感度、特异度、准确率分别为82.40%、80.50%、81.30%。良、恶性BI-RADS 4级乳腺肿块的SWV值差异有统计学意义(P<0.05)。SWV值AUC为0.861,敏感度、特异度、准确率分别为85.30%、85.40%、85.30%。二者AUC差异无统计学意义(Z=1.47,P>0.05)。二者联合诊断的敏感度、特异度、准确率分别为88.20%、87.80%、88.00%。 结论 ARFI对鉴别BI-RADS 4级乳腺肿块的良、恶性具有较高价值;联合应用VTI和VTQ可以提高诊断效能。

Acoustic radiation force impulse in differential diagnosis of benign and malignant BI-RADS 4 breast lesions

Objective To observe the value of acoustic radiation force impulse (ARFI) in differential diagnosis of benign and malignant breast imaging-reporting and data system (BI-RADS) 4 breast lesions. Methods Seventy-five BI-RADS 4 breast lesions (34 malignant, 41 benign) from 68 consecutive patients were analyzed. The area ratio (AR) of the lesions between two-dimensional ultrasonography and virtual touch tissue imaging (VTI), as well as the shear wave velocity (SWV) of the lesions were all recorded. The diagnostic performances of VTI and SWV were evaluated with ROC based on the pathologic diagnosis. The diagnostic value of the two different methods was evaluated. Results AR had statistical difference between benign and malignant breast lesions (P<0.05). The area under the ROC curve (AUC) was 0.851, the sensitivity, specificity and accuracy was 82.40%, 80.50% and 81.30% respectively. There was significant difference between benign and malignant lesions about SWV (P<0.05). The AUC was 0.861, the sensitivity, specificity and accuracy was 85.30%, 85.40% and 85.30%, respectively. AUC had no significant difference between AR and SWV (Z=1.47, P>0.05). The comprehensive sensitivity, specificity and accuracy of combing of these two methods was 88.20%, 87.80% and 88.00%, respectively. Conclusion ARFI has significant value for differential diagnosis of benign and malignant breast lesions of BI-RADS 4. The combination of VTI and VTQ could be beneficial.