声脉冲辐射力成像在新版BI-RADS分级诊断乳腺肿瘤中的价值

Value of acoustic radiation force impulse imaging in the diagnosis of breast tumor in the new edition of BI-RADS

选取122例患者共124个肿块进行常规超声、声触诊组织量化(VTQ)、声触诊组织成像(VTI)检查及BI-RADS分级,得出肿块的剪切波速度值及平均光密度值,以病理结果为金标准,绘制ROC曲线,比较VTQ、VTI及声脉冲辐射力成像(ARFI)与BI-RADS分级联合这三种方法的诊断价值,评价ARFI在新版BI-RADS分级中的意义。经病理证实,124个乳腺肿块中恶性病灶50个、良性病灶74个。VTQ的ROC曲线下面积(AUC)为0.900,所对应的界值为3.49 m/s,VTI的平均光密度值的AUC为0.923,所对应的界值为202.20。恶性病灶VTQ≥3.49 m/s个数为38,<3.49 m/s个数为12。良性病灶VTQ≥3.49 m/s个数为3,<3.49 m/s个数为71(P=0.000)。恶性病灶平均光密度值≥202.20的个数为45,<202.25的个数为5。良性病变平均光密度值≥202.20的个数为7,<202.25的个数为67(P=0.000)。三者联合方法在诊断乳腺肿瘤的敏感度(92.0%)、特异度(93.2%)、阳性预测值(88.5%)、阴性预测值(94.5%)、准确率(92.7%)及约登指数(0.917)。声脉冲辐射力成像联合超声BI-RADS分级诊断乳腺肿瘤有较高的应用价值。

A total of 124 breast lesions were selected for routine ultrasound. Acoustic touch tissues quantification （ VTQ）, acoustic palpation of tissue imaging （VTI） examination and BI - RADS classification, then the shear wave velocity（SWV） and average optical density of the tumor were obtained. The diagnostic value of VTQ, VTI and combined ARFI and BI-RADS classification were compared with pathological results. Finally, the significance of ARFI to the new version of BI - RADS classification was evaluated. All 124 pathologically confirmed breast tumors included 74 benign lesions and 50 malignant. The area under the ROC curve of VTQ was O. 900 and the value was 3.49 m/s. Similarly, the AUC of VTI mean density was 0. 923 and the corresponding boundary value was 202.20. 38 malignant lesions VTQ value ≥3.49 m/s and the other 12 malignant lesions VTQ value 〈 3.49 m/s. 71 benign lesions VTQ value 〈3.49 m/s, only 3 benign lesions ≥3.49 m/s（P =0. 000）. In this article, the value of 202.20 was used to evaluate the VTI as the threshold. 45 malignant lesions mean density ≥202.02, only 5 ma- lignant lesions 〈 202.02. 67 benign lesions mean density 〈 202. 02 and 7 benign lesions mean density ≥ 202.02 （P = 0. 000 ）. The sensitivity, specificity, PPV, NPV and accuracy, Youden index of combined method were 92. 0 % （46/50）, 93.2 % （ 69/74 ）, 88.5 % （ 46/52 ）, 94.5 % （ 69/73 ）, 92. 7 % （ 115/124 ） 0. 917, respectively. Acoustic radiation force impulse imaging combined with ultrasound BI-RADS classification for the diagnosis of breast neoplasms has a high value.