乳腺良恶性肿块的超声造影与弹性成像对比分析

Comparison of contrast-enhanced ultrasound and ultrasonic elastography in differentiating diagnosis of breast lesions

目的：探讨超声造影与超声弹性成像技术在乳腺肿块良恶性鉴别诊断中的临床价值。方法对82例患者的96个乳腺肿块进行超声造影及弹性成像检查，分析其图像特征，并对照穿刺活检或手术病理结果，分别评估两者单独及联合应用的灵敏度、特异度和准确性。结果96个乳腺肿块经组织病理学诊断为恶性39个，良性57个。超声造影显示，良性肿块造影剂的到达时间、达峰时间均晚于恶性肿块，峰值强度常低于恶性肿块，消退时间较恶性肿块长，差异均有统计学意义（P＜0？05）。弹性成像显示，恶性肿块主要为评分4分及弹性应变率比值（SR）≥3？03，良性肿块主要为评分1～2分及3分（ SR＜3？03）。超声造影和弹性成像诊断乳腺肿块的灵敏度、特异度和准确性分别为71？8％、89？5％、82？3％和82？1％、86？0％、84？4％，而超声造影联合弹性成像的诊断效率最高，依次为94？9％、96？5％和95？8％，差异均有统计学意义（ P＜0？05）。结论超声弹性成像及超声造影检查对乳腺肿块的良恶性鉴别有较大的应用价值，联合检测更有助于提高乳腺癌的诊断率。

Objective To evaluate the value of contrast-enhanced ultrasound （ CEUS） and ultrasonic elastography （ UE） in differentiating diagnosis of breast malignant lesions from benign. Methods Eighty-two patients with 96 breast lesions were underwent CEUS and UE. All cases were proved by surgical pathology.The sensitivity, specificity and diagnostic rates of CEUS and UE were eval-uated. Results There were 57 benign lesions and 39 malignant lesions among 96 breast nodules confirmed by pathohistology. CEUS showed that the malignant group presented with longer arrival time and peak time, stronger peak intensity, and shorter fade time com-pared with benign lesions（P〈0？05）. UE showed that the malignant lesions were mainly in score 4 or strain ratio（SR）≥3？03, while the benign lesions were in score 1？2 or SR〈3？03. The sensitivity, specificity, and diagnostic rates of CEUS and UE were 71？8%, 89？5%,82？3% and 82？1%,86？0%,84？4%. The sensitivity,specificity and diagnostic rates of UE combined with CEUS were 94？9%, 96？5% and 95？8%. The difference had statistical significance compared with CEUS and UE（ P〈0？05） . Conclusion Both CEUS and UE have high value in differentiating diagnosis of breast malignant lesions from benign,and the combination of the two methods can im-prove diagnostic rates.