实时剪切波弹性成像定量分析在乳腺良恶性病灶鉴别诊断中的应用价值

Real-time quantitative shear wave elastography for differentiating benign from malignant lesions of the breast

目的分析实时剪切波弹性成像(SWE)技术在乳腺良、恶性病灶定性诊断中的应用价值。方法收集2014年10月至2015年2月浙江大学附属第一医院乳腺外科就诊的患者61例(63个病灶),术前行SWE检测,以手术或穿刺病理为金标准,绘制ROC曲线,分析其在乳腺良恶性病灶诊断方面的价值。结果 61例患者中病理诊断良性38例(40个病灶),恶性23例(23个病灶)。恶性病灶的最大弹性模量Emax值为(82.26±41.37)k Pa、良性病灶为(20.97±7.31)k Pa;乳腺良、恶性病灶的Emax值比较,差异具有统计学意义(P<0.01)。以病灶周边腺体为参照,良性病灶Eratio值为1.59±0.54,恶性病灶为5.26±2.19,良、恶性病灶Eratio值比较,差异具有统计学意义(P<0.01)。SWE定量分析乳腺病灶的Emax界点值为55.8 k Pa时,ROC曲线下面积为0.963,敏感度为91.3%,特异度为95.0%,准确性为93.%7;病灶的Eratio界点值为3.45时,ROC曲线下面积为0.948,敏感度为91.3%,特异度为92.5%,准确性为92.1%。结论 SWE技术对乳腺病灶良、恶性病灶的诊断有较高的准确性。

Objective To assess the value of real-time shear wave elastography（SWE） in the differential diagnosis of benign and malignant lesions of the breast. Methods Sixty-one female patients（63 lesions） who underwent breast surgery at the First Affiliated Hospital of Zhejiang University were included. Elastic modulus was measured by SWE before surgery. Using pathological diagnosis as the golden standard, the receiver operating characteristic（ROC） curves of quantitative parameters of real-time SWE were plotted to assess their clinical value in distinguishing benign and malignant breast lesions. Results Pathology revealed 38 benign cases（40 lesions） and 23 malignant cases（23 lesions）. Maximum elasticity（Emax） of malignant lesions was significantly higher than that of benign lesions [（82.26 ± 41.37） k Pa vs（20.97 ± 7.31） k Pa, P〈 0.01]. Mean lesion-to-gland elasticity ratio（Eratio） for benign lesions was significantly lower than that for malignant lesions（1.588±0.543 vs 5.260±2.190, P 〈0.01）. Using 55.8 k Pa as a threshold for Emax, the area under the ROC curve（AUC） was 0.963, with a sensitivity of 0.913, specificity of 0.950, and accuracy of 0.937. Using 3.45 as a threshold for Eratio, the AUC was 0.948, with a sensitivity of 0.913, specificity of 0.925, and accuracy of 0.921. Conclusion Quantitative elastic modulus can improve the differential diagnosis between benign and malignant breast lesions.