超声弹性成像与常规超声的病灶测值变化对乳腺病变的诊断价值

Breast tumor size assessment： comparison of conventional ultrasound and real-time ultrasonic elastography

目的 对比不同乳腺病变在超声弹性成像和灰阶超声两种方法中的测值差异，探讨测值增大征象对乳腺恶性病变的诊断价值及其与灰阶超声中病灶的边界特征之间的关系。方法308例患者332个乳腺病变，术前经常规超声及实时超声弹性成像检查，观察病变的灰阶超声边界特征，在病灶最大切面上分别进行灰阶超声和弹性图病灶测量。全部病变均获得手术病理。结果332个乳腺病变中，良性166个（50．0％），恶性163个（49．1％），交界性3个（0．9％）。弹性成像病灶测值增大的病变共99个，其中恶性病变91个（91．9％），良性病变8个（8．1％），该征象诊断乳腺癌的敏感性为55．8％，特异性为96．9％，准确性为75．7％，阳性预测值91．9％，阴性预测值68．7％。以乳腺病灶的手术病理大小为金标准，弹性成像相比灰阶超声更易高估病变（t=-11．0，P〈0．05）。测值增大组中，边界模糊、边缘成角以及毛刺的比例均高于测值减小组和测值不变组（P〈0．05）。结论弹性成像测值增大对诊断乳腺癌的特异性高。灰阶超声表现边界模糊、边缘成角以及毛刺的病变，更易出现弹性成像病灶测值增大。

Objective Tumor size discrepancy in measurement between real-time ultrasonic elastography and conventional ultrasound（US） was found in some breast lesions. The study was designed to investigate the value of the feature in the diagnosis of breast cancer, and its relationship with the margin features on gray-scale US. Methods Both US and real-time elastogram using a Hitachi EUB-8500 US system were performed in 308 consecutive patients. The margin features on US and the size measured on both methods were documented. A lesion was defined as a significant size discrepancy when a larger size measured at elastogram. Sensitivity, specificity, and overall accuracy of feature to diagnosis malignancy were determined by surgical pathology as gold standard. Results There were total 166 benign, 163 malignant and 3 borderline lesions. Of 99 lesions with larger measurement on elastography, there were 91 malignant lesions and 8 benign lesions. By the feature of size discrepancy, the sensitivity, specificity and accuracy was achieved 55.8 %,96.9 %,75.7 %, respectively. The size measured on elastogram was statistically larger than that on gray scale US（ t = - 11.0, P〈0.05）. The ratio of indistinct,angular and spiculated margin characteristics were significantly higher in breast cancers with larger size measurement than those with unchanged or decreased size measurement（ P 〈0.05）. Conclusions The increased size-measurement at elastography is helpful to diagnosis breast cancers. And it is more likely to be present in breast cancers with indistinct,angular or spiculated margin.