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。

Shear wave elastography parameters for differentiating breast imaging reporting and data system (BI-RADS) 4 breast masses

Objective To explore the value of shear wave elastography (SWE) for differentiating breast imaging reporting and data system (BI-RADS) 4 breast masses. Methods A total of 96 BI-RADS 4 beast masses proved by postoperative pathology were retrospectively analyzed. The maximum elasticity (SWE_max), minimum elasticity (SWE_min) and mean elasticity (SWE_mean) of SWE parameters were compared between the benign group (n=43) and the malignant group (n=53), and the receiver operating characteristic (ROC) curves were created to determine the cut-off values of SWE_max, SWE_min and SWE_mean, the area under the curve (AUC) and the sensitivity, specificity, accuracy of these parameters as well as the diagnostic accuracy of SWE to BI-RADS 4a, 4b and 4c lesions were compared. Results SWE_max and SWE_mean of benign group were all lower than those of malignant group (both P<0.01), while SWE_min had no significant difference between groups (P>0.05). AUC of SWE_max was 0.86, of SWE_mean was 0.83, all higher than that of SWE_min (0.59, both P<0.01). The sensitivity, specificity and accuracy of SWE_max was 96.22%,81.40% and 89.58%, of SWE_mean was 94.34%, 76.74% and 86.46%, respectively, evidently higher than those of SWE_min (34.00%, 37.21% and 35.42%, all P<0.01). No significant difference of AUC, sensitivity, specificity nor accuracy of SWE_max and SWE_mean was detected for differentiate benign and malignant BI-RADS 4 beast masses. The diagnostic accuracy of SWE_max and SWE_mean to BI-RADS 4a, 4b and 4c lesions were all higher than those of SWE_min (all P<0.05). Conclusion Malignant BI-RADS 4 breast masses had higher SWE_max and SWE_mean than benign ones. SWE of high frequency ultrasound could effectively differentiate benign and malignant BI-RADS 4 beast masses, and SWE_max and SWE_mean showed better diagnostic efficiency than SWE_min.