声辐射力脉冲弹性成像技术结合三维超声检查鉴别诊断乳腺肿块良恶性的价值

Combination of acoustic radiation force impulse technology and three-dimensional ultrasound in differential diagnosis of breast lessions

目的评价声辐射力脉冲弹性成像(ARFI)技术结合三维超声检查对乳腺影像报告和数据系统(BI-RADS)3级以上乳腺肿块良恶性鉴别诊断的价值。方法选择2012年5—12月上海市第十人民医院经病理证实的BI-RADS 3级以上乳腺肿块女性患者66例,共69个肿块。其中乳腺良性肿块24个,乳腺癌45个。首先对69个肿块进行三维超声检查,观察有无汇聚征;然后应用ARFI技术测量肿块内部及同一深度肿块周围正常组织的剪切波速度值(SWV)。以手术病理结果作为金标准,以SWV值绘制受试者操作特性(ROC)曲线,选取ARFI技术鉴别诊断乳腺肿块良恶性的最佳诊断阈值,并分析三维超声检查、ARFI技术、ARFI技术与三维超声检查结合鉴别诊断乳腺肿块良恶性的准确性、敏感度、特异度。结果三维超声检查结果显示,31个肿块出现汇聚征,其中乳腺癌28个,乳腺良性肿块3个;三维超声检查诊断乳腺肿块良恶性的准确性为71.0%,敏感度62.2%,特异度为87.5%。肿块内部SWV值诊断BI-RADS 3级以上乳腺肿块良恶性的最佳诊断阈值为4.34 m/s,其ROC曲线下面积为0.76,敏感度为64.4%,特异度为87.5%;11个肿块SWV值>4.34 m/s但未出现汇聚征,其中乳腺癌8个,乳腺良性肿块3个;10个肿块出现汇聚征但SWV值≤4.34 m/s,其中乳腺癌5个,乳腺良性肿块5个;21个肿块SWV值>4.34 m/s且出现汇聚征,病理证实均为乳腺癌;ARFI技术结合三维超声检查鉴别诊断乳腺肿块良恶性的准确性为75.4%,敏感度为80.0%,特异度为66.7%。结论对于BI-RADS 3级以上乳腺肿块,ARFI技术和三维超声检查均有一定的鉴别诊断价值,但2种方法结合并不能明显提高单一超声影像技术诊断准确性。

Objective To investigate the value of acoustic radiation force impulse （ARFI） technology, three-dimensional ultrasound and combination of both methods in differentiating benign and malignant breast tumors of over Breast Imaging-Reporting and Data System （BI-RADS） 3. Methods Sixty-nine breast tumors of over BI-RADS 3 in 66 patients in Shanghai Tenth People＇s Hospital from May 2012 to December 2012 underwent three-dimensional ultrasonography and ARFI examination and were compared with pathological results. The number of convergence signs and shear wave velocity （SWV） value of masses were determined. The diagnostic performance of SWV was evaluated with receiver operating characteristic （ROC） curve. The accuracy, sensitivity and specificity of ARFI technology, three-dimensional ultrasound and combination of both methods in differentiating benign and malignant breast tumors were determined. Results Thirty-one out of 69 lesions appeared convergence signs in the three-dimensional ultrasound image in which 28 were malignant and 3 were benign. For differentiating benign and malignant breast tumors of over BI-RADS 3, the accuracy, sensitivity and specificity of the convergence sign was 71.0%, 62.2% and 87.5%. A ROC curve was used to assess the performance of the SWV value. The cut-off was 4.34 rrds and the area under the ROC curve was 0.76. The sensitivity and specificity was 64.4% and 87.5%. For 11 lesions with SWV value ~ 4.34 m/s and without convergence sign, 8 were malignant and 3 were benign. For 21 lesions with SWV value 〉 4.34 m/s and with convergence sign, all were histopathologically confirmed to be malignant. The accuracy, sensitivity and specificity of combination of the two methods was 75.4%, 80.0% and 66.7%. Conelusions ARFI and three-dimensional ultrasound are important in differentiating benign and malignant breast tumors of over BI-RADS 3. But the diagnostic accuracy can not be improved by combination of the two methods.