剪切波弹性成像在乳腺结节BI-RADS 3、4a类中的应用价值

目的比较单独应用BI-RADS分类与其联合SWE评价乳腺良恶性病变的诊断效能,分析SWE对BI-RADS 3、4a类乳腺病变的诊断价值。方法穿刺或手术前对132个乳腺肿块行常规超声BI-RADS分类、SWE检查,测定Emax、Emean、Eratio和Esd值。以病理结果为金标准,比较BI-RADS分类及其联合Emax评价乳腺良恶性病变的诊断效能,分析Emax对BI-RADS 3、4a类乳腺病变的诊断价值。结果132个乳腺肿块,良性113个,恶性19个。恶性组SWE各值均高于良性组(P<0.001)。其中Emax的AUC最大(0.89),诊断临界值为43.8 kPa。调整前与联合Emax调整后的BI-RADS分类对乳腺肿块诊断的灵敏度、特异度、准确度分别为89.5%、89.5%;32.7%、89.4%;40.9%、89.4%;调整后的AUC为0.90,明显高于调整前0.61(P<0.05)。以Emax评价BI-RADS 3、4a病变,可使98.5%的4a类病变正确降级为3类。结论BI-RADS分类联合Emax可提高乳腺良恶性肿块诊断的准确度和特异度,有效减少BI-RADS4a类乳腺肿块不必要的穿刺活检或手术。

Application Value of Shear-wave Elastography in Category BI-RADS 3 and 4a of Breast Lesions

Objective The diagnostic efficacy of BI-RADS classification alone and SWE combined to evaluate benign and malignant breast lesions was compared,and the diagnostic value of SWE for BI-RADS 3 and 4 a breast lesions was analyzed.Methods Routine ultrasound BI-RADS classification and SWE examination were performed on 132 breast masses before puncture or surgery,and Emax,Emean,Eratio and Esd values were determined.Taking pathological results as the gold standard,the diagnostic efficacy of the classification of BI-RADS and its combination with Emax in evaluating benign and malignant breast lesions was compared,and the diagnostic value of Emax in breast lesions of BI-RADS 3 and 4 a was analyzed.Results There were 132 breast masses,113 benign and 19 malignant.SWE values of malignant group were higher than those of benign group(P<0.001).Among them,the AUC of Emax was the largest(0.89)and the diagnostic critical value was 43.8 kPa.The sensitivity,specificity and accuracy of BI-RADS classification for breast mass diagnosis before adjustment and after adjustment with Emax were 89.5%,89.5%;32.7%,89.4%;40.9%,89.4%;respectively.The AUC after the adjustment was 0.90,which was significantly higher than that before the adjustment(P<0.05).Evaluation of BI-RADS 3 and 4 a lesions by Emax could correctly degrade 98.5%of 4 a lesions to 3.Conclusions BI-RADS classification combined with Emax can improve the diagnostic accuracy and specificity of benign and malignant breast masses,and effectively reduce unnecessary needle biopsy or surgery for BI-RADS4 a breast masses.