Diagnostic Performance of Ultrasound Shear Wave Elastography in Solid Small (≤4 cm) Renal Parenchymal Masses

The aim of the study was to analyze the diagnostic performance of shear wave elastography (SWE) in differentiating between malignant and benign solid renal parenchymal masses ≤4 cm, compared with conventional ultrasound. A total of 20 healthy volunteers and 117 patients had been included in this study. Conventional ultrasound and SWE were performed in all volunteers and patients. The elasticity of healthy cortex and the elastic parameters of tumors such as mean elasticity (E_mean), minimum elasticity (E_min), maximum elasticity (E_max), standard deviation and elasticity ratio of the lesion to surrounding cortex (E_ratio) were measured on SWE images. Diagnostic performance of SWE was compared with that of conventional ultrasound. The cortical elasticity values of healthy right and left kidneys were 4.7 ± 1.7 and 4.5 ± 1.5 kPa, respectively. Of the 117 renal tumors, 68 were renal cell carcinomas (RCCs) and 49 were benign. E_mean, E_min and E_ratio were significantly lower in RCCs compared with benign lesions: E_mean 7.2 ± 2.5 kPa versus 10.0 ± 2.4 kPa, E_min 2.5 ± 2.4 kPa versus 5.6 ± 2.3 kPa, E_ratio 1.6 ± 0.5 versus 2.2 ± 0.6 (all p values < 0.001). The cutoff values of 9.15 kPa for E_mean, 3.55 kPa for E_min and 1.99 for E_ratio had the highest areas under the receiver operating characteristics curve (0.801 for E_mean, 0.832 for E_min and 0.806 for E_ratio). Combining E_mean, E_min and E_ratio with conventional ultrasound improved the specificity for predicting RCCs to 87.8%, but the sensitivity was not increased.     

Screening Breast Lesions Using Shear Modulus and Its 1-mm Shell in Sound Touch Elastography

The aim of the study described here was to screen breast lesions using either or both shear modulus (G) and its 1-mm shell (S) in sound touch elastography through a retrospective study of 209 consecutive women with breast lesions. The ability of G and S data to differentiate between malignant and benign lesions was evaluated using the receiver operating characteristic (ROC) curve. The optimal cutoff point, sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR–) were calculated. Then, the parameters were pooled to determine the area under the summary receiver operating curve (AUSROC). The pooled sensitivity (PSen), pooled specificity (PSpe), pooled LR+ (PLR+), pooled LR– (PLR–) and diagnostic score (DS) were calculated. Pathologic examination results were used as the reference. In total, 209 patients with 155 benign and 54 malignant lesions were enrolled. For G_max, G_mean and G_sd, the cutoff values were 35.15 kPa (p?=?0.0001), 10.18 kPa (p?=?0.0001) and 5.18 kPa (p?=?0.0001), respectively. For S_max, S_mean and S_sd, the cutoff values were 40.94 kPa (p?=?0.001), 13.12 kPa (p?=?0.0001) and 7.97 kPa (p?=?0.0001), respectively. There were no significant differences in G_min and S_min between benign and malignant lesions. For the pooled six parameters, the PSen, PSpe, PLR+, PLR–, DS and AUSROC were 86% (95% confidence interval: 82%–89%), 82% (80%–85%), 4.90 (4.24–5.68), 0.17 (0.13–0.22), 3.36 (3.00–3.72) and 91% (88–93%), respectively. The G and S parameters of sound touch elastography could provide valuable data for the evaluation of breast lesions. Additionally, use of multiple parameters or combined use of the six parameters may be more effective in the evaluation of breast lesions.     

Quantitative Elastography of Rectal Lesions: The Value ofShear Wave Elastography in Identifying Benign and Malignant Rectal Lesions

We evaluate the value of shear wave elastography (SWE) in diagnosing benign and malignant rectal lesions. A total of 96 lesions were reviewed in this study; endorectal ultrasound (ERUS) and SWE examinations were performed before surgery in all cases. Elasticity parameters including mean elastographic index (E_mean), maximum elastographic index (E_max) and minimum elastographic index (E_min) were analyzed. Correlations between elastographic parameters and histopathological results were studied. Inter-observer and intra-observer agreement was analyzed. Of the 96 rectal lesions, 72 were malignant and 24 were benign. Compared with ERUS, ERUS?+?SWE had higher sensitivity (93.0% vs. 88.9%), specificity (83.3% vs. 79.2%), positive predictive value (94.4% vs. 92.7%), negative predictive value (80.0% vs. 70.4%) and overall accuracy (90.6% vs. 86.4%). In receiver operating characteristic curve analysis, E_mean and E_max had larger areas under the curve: 0.92 and 0.91, respectively. The optimal cutoff value was 61.3 kPa for E_mean (sensitivity?=?88.9%, specificity?=?87.5%) and 63.4 kPa for E_max (sensitivity?=?94.4%, specificity?=?83.3%). We obtained κ values of 0.83 (95% confidence interval [CI]: 0.72–0.95) for ERUS and 0.90 (95% CI: 0.81–0.99) for ERUS?+?SWE of differential diagnosis in two observers. The intra-class correlation coefficients for intra-observer variability of stiffness (E_mean) in malignant lesions, benign lesions, surrounding normal rectal wall in malignant lesions and surrounding normal rectal wall in benign lesions were 0.91 (95% CI: 0.86–0.94), 0.94 (95% CI: 0.88–0.97), 0.92 (95% CI: 0.88–0.95) and 0.89 (95% CI: 0.77–0.95), respectively. SWE is a promising tool that yields valuable quantitative data additional to that provided by ERUS examination in rectal lesions. The cutoff value 61.3 kPa for E_mean may serve as a complementary tool in diagnosis of rectal lesions.     

实时剪切波弹性成像调整圆形Q-Box法与手动描绘Q-Box法鉴别诊断乳腺良恶性病变

目的 比较实时剪切波弹性成像（SWE）技术探讨调整圆形Q-Box法和手动描绘Q-Box法鉴别诊断乳腺良恶性病变的价值。方法 选取经SWE检查并经病理证实的乳腺肿物患者133例,共152个病灶,其中良性病灶115个,恶性病灶37个。分别采用调整圆形Q-Box法和手动描绘Q-Box法选取ROI,测量弹性模量平均值（E_mean）、弹性最大值（E_max）和弹性模量离散度值（SD）,并进行统计学分析。结果 两种方法测量恶性病灶的E_mean、E_max、SD均高于良性病灶（P均<0.05）。两种方法测量所有病灶E_mean、E_max、SD的差异均无统计学意义（P均>0.05）。两种方法测量E_mean、E_max、SD的AUC差异均无统计学意义（P均>0.05）。调整圆形Q-Box法测量E_mean的AUC较SD和E_max的AUC小（P均<0.05）,手动描绘Q-Box法测量E_mean的AUC较SD的AUC小（P<0.05）,余相同测量方法测量不同弹性模量的AUC两两比较,差异均无统计学意义（P均>0.05）。结论 调整圆形Q-Box法鉴别诊断乳腺良恶性病变的诊断效能与手动描绘Q-Box法相似,E_max与SD诊断效能相似。     

Similar Reproducibility for Strain and Shear Wave Elastography in Breast Mass Evaluation: A Prospective Study Using the Same Ultrasound System

The objective of this study was to evaluate the inter-operator reproducibility of strain elastography (SE) and shear wave elastography (SWE) in three groups: all lesions, benign lesions and malignant lesions. Ninety-one lesions from ninety-one women were examined by SE and SWE from January 2017 to December 2017 by two radiologists. The reproducibility of elastic score, SE strain ratio and SWE Young's modulus between operators was prospectively evaluated. There was good agreement on elasticity score, with κ values of 0.711, 0.640 and 0.766. The intra-class correlation coefficients of the strain ratio, mean elastic modulus (E_mean), maximum elastic modulus (E_max) and elastic modulus standard deviation (E_sd) ranged from 0.723–0.876, which indicated good and excellent agreement. We concluded that both SE and SWE had good reproducibility among different operators using the same probe in the same ultrasound instrument. Strain elasticity score was more consistent among operators in malignant breast tumors. There was better agreement on strain elastic ratio and shear wave elasticity among operators in benign breast lesions.     

Quantification of Pediatric Burn Scar Stiffness Using Acoustic Radiation Force Impulse Ultrasound Elastography

The purpose of this study was to quantify the stiffness of hypertrophic scars using acoustic radiation force impulse ultrasound elastography. Sixteen pediatric patients with hypertrophic scars resulting from burn injuries participated in this study (mean age: 5.13, standard deviation: 3.20). Values for the elastic modulus (E) of scar and control sites were obtained. Scarred areas were found to be almost four times stiffer than control sites (scar E_mean = 39.29 kPa compared with control E_mean = 10.19 kPa) (p = 0.0004). Correlations between scar stiffness and clinician-reported subjective scar scale scores were not observed (r_s = 0.30, p = 0.27 and r_s = 0.25, p = 0.35 respectively). We found that acoustic radiation force impulse imaging can discriminate between hypertrophic scars and normal skin and should be considered a potentially valuable tool in the armamentarium of objective scar measures. Future research should focus on evaluating the technology's ability to detect scar change over time in order to determine responsiveness to treatment.     

Value of Shear Wave Elastography in the Diagnosis of Gouty and Non-Gouty Arthritis

Our aim was to analyze the diagnostic performance of shear wave elastography (SWE) in the diagnosis of gouty arthritis (GA) and non-gouty arthritis (non-GA). Thirty-nine patients in the GA group and 55 patients in the non-GA group were included in the study. Based on the echo intensity of the joint lesions, the GA group was subdivided into hypo-echoic GA, slightly hyper-echoic GA and hyper-echoic GA subgroups. Quantitative SWE features were evaluated and receiver operating characteristic analysis was performed. On the basis of the study, the elastic modulus (E_max), mean elastic modulus (E_mean), minimum elastic modulus (E_min) and elastic modulus standard deviation (E_SD) were significantly higher in the GA group than in the non-GA group and were highest in the hyper-echoic GA subgroup (p < 0.01 for all). E_min, E_mean and E_max were significantly higher in the hyper-echoic GA subgroup than in the hypo-echoic GA subgroup and non-GA group (p < 0.001 for all), and E_SD was significantly higher in the hyper-echoic GA subgroup than in the non-GA group (p = 0.001). E_min, E_mean, E_max and E_SD were higher in the hypo-echoic GA subgroup than in the non-GA group, and the differences were significant (p < 0.001 for all). Based on the hypo-echoic GA subgroup and non-GA group, areas under the receiver operating characteristic curves for the prediction of GA were 0.749 for E_min, 0.877 for E_mean, 0.896 for E_max and 0.886 for E_SD, with optimal cutoff values of 29.40 kPa for E_min, 45.35 kPa for E_mean, 67.54 kPa for E_max and 7.85 kPa for E_SD. Our results indicate that SWE can differentially diagnose GA and non-GA, especially when the ultrasound manifestations are not typical.     

Characterization of Suspicious Microcalcifications on Mammography Using 2D Shear-Wave Elastography

Our aim was to investigate the correlations between the findings of two-dimensional shear-wave elastography (2D-SWE) and the histopathologic results of microcalcifications (MCs) visualized using ultrasonography (USG). Fifty people with suspicious MCs without accompanying mass were evaluated. They underwent USG and 2D-SWE before USG-guided tru-cut biopsy. SWE values and histopathologic features were compared statistically. The variables between groups were analyzed using the Mann–Whitney U test. Receiver operating characteristic analysis was performed and cut-off values determined to discriminate malignancy, invasiveness and high grade. Pathology confirmed 27 malignant lesions (18 invasive ductal carcinomas, one invasive lobular and eight ductal carcinomas in situ) and 23 benign ones. There was a statistically significant difference between the SWE values of malignant and benign MCs (p < 0.001). The diagnostic performance of SWE for malignancy, invasiveness and high grade were as follows, repectively: sensitivity (93%, 83%, 88%), specificity (91%, 88%, 53%), positive predictive value (93%, 94%, 44%), negative predictive value (91%, 70%, 90%) and area under the curve (0.952, 0.885, 0.776). Cut-off values were determined as 57 kPa for malignancy, 124 kPa for invasiveness and 124.5 kPa for high grade. In conclusion, SWE is a useful method in clinical practice for characterizing MCs that can be visualized with USG.     

Prediction of Invasive Breast Cancer Using Mass Characteristic Frequency and Elasticity in Correlation with Prognostic Histologic Features and Immunohistochemical Biomarkers

This purpose of this study is to correlate a new shear-wave elastography (SWE) parameter, mass characteristic frequency (f_mass) and other elasticity measure with the prognostic histological factors and immunohistochemical (IHC) biomarkers for the evaluation of heterogeneous breast carcinomas. The new parameter, f_mass, first introduced in this paper, is defined as the ratio of the averaged minimum shear wave speed taken spatially within regions of interest to the largest mass dimension. 264 biopsy-proven breast cancerous masses were included in this study. Mean (E_mean), maximum (E_max), minimum (E_min) shear wave elasticity and standard deviation (E_sd) of shear wave elasticity were found significantly correlated with tumor size, axillary lymph node (ALN) status, histological subtypes and IHC subtypes. The areas under the curve for the ALN prediction are 0.73 (95% confidence interval [CI]: 0.67–0.80) and 0.75 (95% CI: 0.69–0.81) for the combination of E_mean with Breast Imaging Reporting and Data System (BI-RADS) score and E_max with BI-RADS score, respectively. f_mass was significantly correlated with the presence of calcifications, ALN status, histological grade, the expressions of IHC biomarkers and IHC subtypes. To conclude, poor prognostic factors were associated with high shear wave elasticity values and low mass characteristic frequency value. Therefore, SWE provides valuable information that may help with prediction of breast cancer invasiveness.     

实时剪切波弹性成像技术鉴别诊断肺良恶性周围型肿块

目的 探讨实时剪切波弹性成像（SWE）技术鉴别诊断肺部良恶性周围型肿块的价值。方法 采用SWE技术测量112例周围型肺部肿块患者的杨氏模量值,分析良恶性组及恶性病变不同病理类型亚组间的杨氏模量最大值（E_max）和平均值（E_mean）的差异。以病理结果为金标准,绘制ROC曲线获得其鉴别诊断良恶性肿块的效能。结果 周围型肺部肿块良恶性组间E_max及E_mean差异均有统计学意义（t=－2.78、－3.28,P均<0.01）,恶性组不同病理类型亚组间E_max及E_mean差异均无统计学意义（P均>0.05）。E_max和E_mean鉴别诊断肺良恶性肿块的阈值分别为10.35 kPa和5.85 kPa,AUC分别为0.74（P=0.003）、0.81（P=0.001）,敏感度、特异度、阳性预测值、阴性预测值分别为74.36%、72.22%、85.29%、57.52%和81.58%、80.78%、89.57%和67.67%。结论 SWE技术可用于评估周围型肺部肿块的弹性特征,为鉴别肺部良恶性周围型肿块提供了重要的影像学手段。     

Shear Wave Elastography (SWE): An Analysis of Breast Lesion Characterization in 83 Breast Lesions

Qualitative and quantitative shear wave elastography (SWE) criteria were assessed to differentiate between malignant and benign breast lesions. This prospective study included 83 lesions. SWE features measured included maximal stiffness values inside the lesion (E_lesion) and in the peri-lesion area (E_perilesion) and ratio values (R_lesion and R_perilesion) according to the formula E_lesion or E_perilesion/E_fat, with E_fat corresponding to normal fatty tissue. We compared ultrasonography (B-mode), SWE and histologic sizes. With qualitative and quantitative SWE analysis, sensitivity was 94% and specificity 73%. Malignant lesions appeared more heterogeneous, with higher stiffness and ratio values than benign lesions (p < 0.001). For malignant lesions, SWE size was better correlated to histologic size than B-mode size. Using benign SWE signs to selectively downgrade category 4a and 4b lesions, the specificity improved from 13% to 51% without loss in sensitivity (100%) compared to ultrasound.     

Correlation of Stiffness of Prostate Cancer Measured by Shear Wave Elastography with Grade Group: A Preliminary Study

The aim of study was to explore the correlation between shear wave elastography (SWE) and grade group (GG) of prostate cancer (PCa). This retrospective study involved prostate-specific antigen elevated patients with elevated prostate-specific antigen levels who underwent SWE before transrectal ultrasound-guided needle biopsy. A total of 49 PCa lesions were reviewed after radical prostatectomy; 3–7 regions of interest were placed within the cancerous area on axial view compared with the tumor foci outlined on the slides by pathologist. The maximum SWE value was measured, quantitative SWE parameters (E_max, E_mean, E_min and standard deviation [SD]) were recorded and correlated with GG and then parameters were compared between indolent (≤2) and aggressive (≥3) GGs. The diagnostic value of each parameter was compared with the receiver operating characteristic curve. Forty-nine PCa foci were divided into two groups on the basis of their GGs. All SWE parameters exhibited a significant linear trend with GG. The area under the receiver operating characteristic curve (AUC) was 0.816 for E_max; with a cutoff point of 84 kPa, sensitivity and specificity were 81.3% and 82.4% to differentiate low and high GGs in PCa. The AUC was 0.776 for E_mean; with a cutoff point of 71 kPa, sensitivity and specificity were 78.1% and 76.5%. For E_min, the AUC was 0.739; with a cutoff point of 60 kPa, sensitivity and specificity were 68.8% and 70.6%. For SD, the AUC was 0.681; with a cutoff point of 8.3 kPa, sensitivity and specificity were 46.9% and 94.1%. There were no significant differences between the four SWE parameters (p < 0.05 for all). SWE features were correlated with GGs, and this correlation may have excellent diagnostic performance in predicting high GG in PCa.     

Shear Wave Elastography of Breast Lesions: Quantitative Analysis of Elastic Heterogeneity Improves Diagnostic Performance

The aim of this study was to evaluate whether quantitative analysis of elastic heterogeneity (EH) could improve the diagnostic performance of shear wave elastography (SWE) in breast lesions. From August 2016 to August 2017, 280 patients were enrolled in this prospective study. All lesions were evaluated with the ultrasound Breast Imaging Reporting and Data System (BI-RADS) and SWE with Virtual Touch tissue imaging quantification. The shear wave velocity (SWV) of the three areas of highest stiffness and lowest stiffness within the lesions were measured to calculate the maximum SWV (SWV_max), mean SWV (SWV_mean) and EH. The EH was determined as the difference between the averaged highest SWV and lowest SWV. The diagnostic performance—including the area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity of BI-RADS, EH, SWV_max and SWV_mean—were analyzed. The AUC of EH, SWV_max and SWV_mean were 0.963, 0.949 and 0.937, respectively. The sensitivity of EH was 93.75%, which was significantly higher than that of SWV_max (84.37%) and SWV_mean (84.37%) (p < 0.001); there was no significant difference in the specificity among EH, SWV_max and SWV_mean (p > 0.05). For category 4A lesions, EH predicted all the malignant lesions, while two cancers were misdiagnosed by SWV_max and SWV_mean, respectively. Quantitative analysis of EH can improve the sensitivity of SWE for the differential diagnosis of breast lesions without loss of specificity.     

Characterization of Benign and Malignant Solid Breast Masses: Harmonic Versus Nonharmonic 3D Power Doppler Imaging

The aim of this study was to compare the diagnostic performance of nonharmonic ultrasound (US) and tissue harmonic imaging (THI) using three-dimensional (3D) power Doppler sonographic technique to classify benign and malignant breast tumors by vascularization. From January 2003 to February 2004, we evaluated 200 patients and one of lobular carcinoma in situ was excluded from the malignant category. One hundred and ninety-nine subjects were enrolled. All subjects with one or more breast masses were studied with 3D power Doppler US nonharmonic and harmonic technologies. Sixteen of 199 subjects were excluded because masses exceeded 3 cm limit of our US probe's footprint (n = 5) or no harmonic Doppler information (n = 11). A total of 97 benign and 86 pathologically proven malignant breast tumor images were analyzed. 3D power Doppler US imaging was performed using a Voluson730 US system. Three histogram indices, the vascularization index (VI), flow index (FI) and vascularization-flow index (VFI), on both nonharmonic and harmonic images were calculated for the intratumor and for shells with an outside thickness of 3 mm surrounding the breast lesion. A multilayer perception (MLP) neural network classifier used the vascularity indices to determine whether the breast tumors are benign or malignant. The receiver operating characteristic (ROC) curves are performed to estimate the diagnostic performances for nonharmonic and harmonic methods. ROC curve analysis used overall age, volume, VI, FI and VFI for both intratumor and shells with an outside thickness of 3 mm surrounding the breast lesions in nonharmonic US and THI. The area under the ROC curve (A_Z) was 0.9086 and 0.9009 (p = 0.3770). The sensitivity was 90.7% and 83.7% (p = 0.72), respectively, and the specificity was 92.8% and 92.8% (p = 1.00), respectively. In conclusion, the performance of 3D power Doppler US with respect to the characterization of solid breast masses as benign or malignant was not significantly improved with tissue harmonic imaging. (E-mail: darren_chen@cch.org.tw)     

Evaluation of Tissue Stiffness Around Lesions by Sound Touch Shear Wave Elastography in Breast Malignancy Diagnosis

The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee–approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, E_max and E_mean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding E_max-shell and E_mean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of E_{max-shell-2.0} was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, E_{max-shell-2.0} and age were independent predictors of malignancy. E_{max-shell-2.0} was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and E_{max-shell-2.0} performs best.     

Breast US in patients with breast cancer presenting as only microcalcifications on mammography: can US differentiate ductal carcinoma in situ from invasive cancer?

Purpose

To retrospectively review sonographic findings of breast cancers presenting as only microcalcifications on mammography and to evaluate factors essential for differentiating ductal carcinoma in situ (DCIS) from invasive cancers.

Methods

We retrospectively reviewed the medical records of 620 consecutive patients with confirmed breast cancer according to surgery performed between March 2008 and October 2011 at our institution. Of these, 53 lesions from 52 patients who had only microcalcifications without a mass or other associated findings on mammography were selected. Sonographic findings of microcalcification areas were analyzed and correlated with the histopathological findings.

Results

Of the 53 lesions, 26 (49.18 %) were classified as invasive cancer and 27 (50.9 %) as DCIS. Ultrasonography (US) showed only echogenic calcifications in five (9.4 %), calcifications within hypoechoic parenchymal thickening in 14 (26.4 %), calcifications within ductal changes in three (5.7 %), and calcifications within a mass in 14 (26.4 %). Seventeen (32.1 %) lesions were not visible on US. Negative findings in US were more frequently observed for DCIS (n = 15, 55.6 %) than for invasive cancers (n = 2, 7.7 %) (p < 0.001). Masses (n = 11, 42.3 % of invasive cancer; n = 3, 11.1 % of DCIS; p = 0.01) were more frequently observed in invasive cancers than in DCIS.

Conclusions

US findings of breast cancers presenting as only mammographic microcalcifications were significantly different between DCIS and invasive cancers. Targeted US of microcalcifications might be helpful for predicting invasive cancers and for determining the clinical preoperative work-up, including axillary staging.     

剪切波弹性成像鉴别乳腺影像报告和数据系统(BI-RADS)4类乳腺肿块

目的探讨剪切波弹性成像(SWE)鉴别乳腺影像报告和数据系统(BI-RADS)4类乳腺肿块的价值。方法回顾性分析经术后病理证实的96个BI-RADS 4类乳腺肿块,比较良性(良性组,n=43)及恶性肿块(恶性组,n=53)剪切波参数,包括弹性最大值(SWE max)、最小值(SWE min)和平均值(SWE mean);以受试者工作特征(ROC)曲线确定SWE max、SWE min及SWE mean的截断值,比较其ROC曲线下面积(AUC)、敏感度、特异度和准确率,评价并比较SWE对BI-RADS 4a、4b及4c亚分类的诊断准确率。结果良性组SWE max和SWE mean均低于恶性组(P均<0.01),组间SWE min差异无统计学意义(P>0.05);SWE max、SWE mean的AUC分别为0.86、0.83,均高于SWE min的AUC(0.59,P均<0.01);SWE max诊断敏感度、特异度和准确率分别为96.23%、81.40%和89.58%,SWE mean分别为94.34%、76.74%和86.46%,均明显高于SWE min的34.00%、37.21%和35.42%(P均<0.01);SWE max和SWE mean的AUC及其诊断BI-RADS 4类乳腺良恶性肿块的敏感度、特异度、准确率差异均无统计学意义(P均>0.05)。SWE max和SWE mean对BI-RADS 4a、4b及4c乳腺肿块的诊断准确率明显高于SWE min(P<0.05)。结论BI-RADS 4类乳腺恶性肿块的SWE max和SWE mean均高于良性肿块。高频超声SWE可有效鉴别BI-RADS 4类乳腺良恶性肿块,SWE max和SWE mean的诊断效能优于SWE min。     

Utility of B-Mode,Color Doppler and Elastography in the Diagnosis of Breast Cancer: Results of the CD-CONFIRM Multicenter Study of 1351 Breast Solid Masses

The usefulness of color Doppler ultrasound (CD) in distinguishing between benign and malignant breast lesions remains controversial. Our prior study, the Japan Association of Breast and Thyroid Sonology (JABTS) BC-04 study (malignant: 839, benign: 569), found CD was useful in breast cancer diagnosis, and we developed CD diagnostic criteria. The first aim of the current study (the CD-CONFIRM study) was to evaluate the usefulness of the CD diagnostic criteria. The second aim was to evaluate the relationship between CD and elastography. We evaluated ultrasound images of breast masses from 13 institutions (malignant: 639, benign: 712). While the sensitivity of B-mode alone was very high and was not significantly improved with CD, the specificity was significantly improved with CD (61.2%–69.2%, p < 0.0001). Furthermore, the specificity of the combination of B-mode and CD improved significantly with the addition of elastography (72.8%–79.0%, p < 0.0001). This study found that the CD criteria are useful, and CD and elastography are independent.     

剪切波弹性成像联合CEUS校正乳腺影像报告和数据系统3~5类乳腺病变

目的 探讨剪切波弹性成像（SWE）联合CEUS在校正乳腺影像报告和数据系统（BI-RADS）3~5类乳腺肿瘤中的应用价值。方法 收集50例乳腺病变患者（57个病灶）,其中良性病灶28个,恶性29个。对所有病灶术前行常规超声、SWE和CEUS检查,以常规超声进行BI-RADS分类,并采用SWE、CEUS及SWE联合CEUS对BI-RADS分类进行校正。以病理结果为金标准,计算常规超声、SWE、CEUS及SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率。结果 SWE参数最大杨氏模量值（E_max）诊断乳腺良恶性病灶的临界值为87.2 kPa,CEUS的临界值为8.5分,SWE联合CEUS的多因素Logistic回归模型为Y（P）=-18.785+0.161X₁+11.822X₂,X₁为E_max,X₂为增强后病灶大小改变。SWE联合CEUS将11个病灶正确降为3级,4个病灶误诊;SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率分别为100%（29/29）、85.71%（24/28）和92.98%（53/57）。结论 SWE联合CEUS对BI-RADS 3~5类乳腺病灶具有良好的校正作用,可提高超声诊断正确率。     

Prediction of Axillary Lymph Node Metastasis in Invasive Breast Cancer by Sound Touch Elastography

The aims of this study were to investigate the value of sound touch elastography (STE) in predicting axillary lymph node metastasis (ALNM) in patients with invasive breast cancer (IBC) and to explore whether lysyl oxidase (LOX) is correlated with increasing stiffness and promotion of metastasis in IBC. A total of 142 lesions in 142 patients were assessed by STE. The STE values of IBCs in the two groups were compared and the best cutoff values for diagnosing ALNM determined. Immunohistochemistry was used to detect LOX expression. Collagen fiber and elastic fiber content was determined by Masson and Weigert elastic fiber staining. Correlation analyses were performed to identify the associations of the data. The optimal cutoff values of E_max (maximum stiffness value of the tumor) and S_max (maximum stiffness value of the shell) for predicting ALNM of IBC were 94.58 and 148.78 kPa. Immunohistochemistry and Masson and Weigert elastic fiber staining were performed on 67 samples. LOX expression and collagen volume fraction were significantly higher in the ALNM+ group than in the ALNM– group (p = 0.04 and 0.03), except for elastic fiber content (p = 0.628). Moreover, E_max, S_max and LOX expression were positively correlated with collagen volume fraction (r = 0.624, 0.512, and 0.533, respectively). E_max and S_max were found to be predictors for ALNM of IBC. STE could serve as a non-invasive method for assessing lymph node status before surgery. Overexpression of LOX and increased collagen fiber contributed to the increased stiffness in the lesions and metastases of IBC.