定量分析周围区域弹性硬度在评估乳腺病灶良恶性中的价值

目的 探讨剪切波弹性成像定量分析乳腺病灶周边硬度对判断病灶良、恶性的诊断价值。方法 回顾性分析2018年12月至2020年5月经中国科学技术大学附属第一医院（安徽省立医院）南区诊断为乳腺癌的60例患者临床资料,共60个病灶,其中良性病灶31个,恶性病灶29个。测量并记录每个病灶弹性模量值最大值（E_max）、最小值（E_min）、平均值（E_mean）、标准差（E_sd）]和病灶周围区域（Shell 1.0、2.0、3.0 mm）的弹性模量值,同时比较"硬环征"的表现情况。比较良、恶性病灶及周围组织弹性模量值之间的差异。以病理诊断为金标准,绘制受试者工作特性曲线（ROC）,比较各弹性模量的曲线下面积（AUC）,获得诊断价值最大的弹性模量。最后比较BI-RADS分类、弹性成像及两者联合的诊断价值。结果 良性组患者年龄小于恶性组,差异有统计学意义（P<0.05）。良、恶性组病灶最大径的差异无统计学意义（P>0.05）。恶性组"硬环征"发生率高于良性组,差异有统计学意义（P<0.05）。良、恶性组病灶内部及周围的弹性模量E_min比较,差异无统计学意义（P>0.05）;恶性组E_mean、E_max、E_sd均高于良性组,差异有统计学意义（P<0.05）。各组弹性模量（E_mean、E_max、E_sd）的ROC显示,Shell 2.0 mm E_max的AUC为所有弹性模量中最大,为0.843,截断值为97.06,敏感度82.76%,特异度74.19%。BIRADS分类、Shell 2.0 mm E_max两者联合获得的ROC曲线,AUC值为0.965,敏感度93.1%,特异度93.5%。结论 常规超声BI-RADS分类、剪切波超声弹性成像技术相联合,能明显提高乳腺癌患者良、恶性病灶诊断准确率。

The diagnostic value of evaluation of the surrounding hardness by using shear wave elastography in breast lesions

Objective To investigate the diagnostic value of shear wave elastography in quantitative analysis of peripheral stiffness of breast lesions. Methods The clinical data of 60 patients diagnosed in the South District of the First Affiliated Hospital of University of Science and Technology of China from December 2018 to may 2020 were retrospectively analyzed, including 60 lesions, 31 benign lesions and 29 malignant lesions. The elastic modulus of the lesions (Emax, Emin, Emean, and Esd) and the surrounding area (shell 1.0, 2.0, and 3.0 mm) were measured and recorded, and the performance of "hard ring sign" was compared. The elastic modulus values of benign and malignant lesions and surrounding tissues were compared. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) of each modulus of elasticity was compared to obtain the modulus of elasticity with the greatest diagnostic value. Lastly, the diagnostic value of BI-RADS classification, elastography and their combination were compared. Results The age of benign group was younger than that of malignant group, and the difference was statistically significant (P<0.05). There was no significant difference in the maximum diameter of lesions between benign and malignant groups (P>0.05). The incidence of "hard ring sign" in malignant group was higher than that in benign group (P<0.05). There was no significant difference in the elastic modulus of Emin between benign and malignant groups (P> 0.05); the elastic modulus of Emean, Emax and Esd in malignant group were higher than those in benign group (P<0.05). ROC of elastic modulus (Emean, Emax, Esd) showed that AUC of shell 2.0 mm Emax was the largest, which was 0.843, cut-off value was 97.06kPa, sensitivity was 82.76%, specificity was 74.19%. The AUC value was 0.965, the sensitivity was 93.1%, and the specificity was 93.5%. Conclusions The combination of conventional ultrasound BI-RADS classification and shear wave ultrasound elastography can significantly improve the diagnostic accuracy of benign and malignant breast lesions.