实时剪切波弹性成像定量评价乳腺良恶性病变

Real-time shear wave elastography in quantitative differential diagnosis of breast tumors

目的应用剪切波弹性成像技术定量测定乳腺实性病灶的弹性模量值,评价该技术对乳腺实性病灶定性诊断的价值。方法对108例女性患者(124个病灶)行实时剪切波弹性成像检查,以手术病理为诊断金标准,获得乳腺病灶的定量弹性模量值,并用ROC曲线得出不同性质病灶的弹性参考数值。结果病理诊断良性87例(103个病灶),恶性21例(21个病灶)。恶性病灶表现的平均、最大弹性模量值分别为(47.92±32.54)kPa和(113.18±47.48)kPa;良性病灶表现的平均、最大弹性模量值分别为(25.87±12.50)kPa和(39.50±17.98)kPa,良恶性间的弹性最大值和平均值差异均有统计学意义(P<0.01)。实时组织定量分析乳腺病灶弹性最大值与弹性平均值对诊断乳腺良恶性病灶的ROC曲线下面积分别为0.944和0.756(P<0.05)。分别以乳腺病灶弹性模量值的最大值60.12 kPa和平均值42.08 kPa作为诊断界值时,诊断的敏感度、特异度为90.50%、88.30%和57.10%、92.20%。结论根据病灶的弹性平均值与弹性最大值可定量评价肿物硬度,为判断乳腺病灶良恶性提供诊断依据。

Objective To obtain the elasticity value of solid breast lesions with supersonic shear wave elastrography（SWE）,in order to observe the value of quantitative elastography with SWE in differential diagnosis of breast tumors.Methods SWE quantitative elastography was performed in 108 female patients with 124 breast lesions.Taking pathologic results as reference,quantitative elasticity value of the lesions were measured,and ROC curves were used to assess diagnostic performance.Results There were 103 benign lesions in 87 patients and 21 malignant lesions in 21 patients.The mean elasticity value of malignant lesions was（47.92±32.54）kPa,and the maximum value was（113.18±47.48）kPa,whereas of benign ones was（25.87±12.50）kPa and（39.50±17.98）kPa,respectively（P0.01）.The area under the ROC curve（Az） of the maximum and mean elasticity value was 0.944 and 0.756（P0.05）,respectively.Taking 60.12 kPa as the threshold of the maximum elasticity value,the sensitivity was 90.50% and the specificity was 88.30%.Taking 42.08 kPa as the threshold of the mean elasticity value,the sensitivity was 57.10% and the specificity was 92.20%.Conclusion SWE provides quantitative elasticity measurements,thus adding complementary information that can potentially help in differential diagnosis of breast lesions.