三维剪切波弹性成像技术在鉴别诊断乳腺良恶性结节中的应用价值

目的探讨三维剪切波弹性成像（SWE）技术在乳腺良恶性结节鉴别诊断中的应用价值。 方法对2015年8月至2016年6月哈尔滨医科大学附属第一医院收治的128例乳腺占位性病变女性患者149个乳腺结节行常规超声、二维及三维SWE检查。所有病例均经病理证实。绘制SWE定量参数以及常规二维超声及常规二维超声联合SWE鉴别诊断乳腺良恶性结节的受试者操作特征（ROC）曲线，得出曲线下面积（AUC）并采用Z检验进行比较，得出相应的敏感度、特异度并采用McNemar比较。 结果三维SWE中，灰阶图像上测量的标准差（E_SD^U）和弹性图像上测量的标准差（E_SD^E）鉴别诊断乳腺良恶性结节的AUC分别为0.887和0.909，差异无统计学意义（P>0.05）。三维SWE的E_SD^E鉴别诊断乳腺良恶性结节的特异度高于E_SD^U（90.2% vs 82.6%），且差异有统计学意义（P=0.023）。二维SWE的E_SD^E鉴别诊断乳腺良恶性结节的AUC大于E_SD^U（0.933 vs 0.908），且差异有统计学意义（P=0.04）。二维SWE的E_SD^E、E_SD^U与三维SWE的E_SD^E、E_SD^U鉴别诊断乳腺良恶性结节的AUC差异均无统计学意义。常规二维超声联合二维、三维SWE鉴别诊断乳腺良恶性结节的AUC均高于常规二维超声，且差异均有统计学意义（P<0.05）；除了三维SWE的E_SD^U，其余常规二维超声联合二维、三维SWE鉴别诊断乳腺良恶性结节的特异度均高于常规二维超声，且差异均有统计学意义（P均<0.05）。 结论三维SWE在乳腺良恶性结节的鉴别中显示了良好的诊断效能，其中E_SD^E较E_SD^U具有更高的临床应用价值。

Application of three-dimensional quantitative elastography in differentiating benign and malignant breast masses

ObjectiveTo evaluate the application value of three-dimensional (3D) shear wave elastography (SWE) in differentiating benign and malignant breast masses, and compare it with two-dimensional (2D) SWE. MethodsOne hundred and forty-nine breast masses in 128 female patients admitted to the First Affiliated Hospital of Harbin Medical University from August 2015 to June 2016 were examined by B-mode ultrasound (US), 2D and 3D SWE. All cases were confirmed by pathology. The diagnostic performance of SWE quantitative parameters, conventional 2D ultrasound, and conventional 2D ultrasound combined with SWE in diagnosing benign and malignant breast masses was assessed by receiver operating characteristic (ROC) curve analysis. The calculated areas under the curves (AUCs) were compared using the Z-test, and sensitivities and specificities were calculated and compared using the McNemar test. ResultsIn 3D SWE, the AUC of the standard deviation (E_SD^U) measured on the grayscale image and the standard deviation (E_SD^E) measured on the elastic image for diagnosing benign and malignant breast masses were 0.887 and 0.909, respectively, which had no significant difference (P>0.05). In 3D SWE, the specificity of E_SD^E for diagnosing benign and malignant breast masses was significantly higher than that of E_SD^U (90.2% vs 82.6%, P=0.023). In 2D SWE, the AUC of E_SD^E in diagnosing benign and malignant breast masses was significantly higher than that of E_SD^U (0.933 vs 0.908, P=0.04). In comparison of 2D and 3D SWE data, no significant differences were found in AUCs for either E_SD^E or E_SD^U. The AUCs of conventional 2D ultrasound combined with 2D and 3D SWE in diagnosing benign and malignant breast masses were significantly higher than that of conventional 2D ultrasound (P<0.05). Except for the E_SD^U in 3D SWE, the specificities of other conventional 2D ultrasound data combined with 2D and 3D SWE in diagnosing benign and malignant breast masses were significantly higher than that of conventional 2D ultrasound (P<0.05). Conclusion3D SWE has good diagnostic performance in differentiating benign and malignant breast masses, and the measurement of E_SD^E has better clinical value than E_SD^U.