乳腺剪切波弹性成像的各向异性与组织病理学的相关性

Anisotropy of shear wave elastography in breast lesions and its correlation with histopathology

目的研究乳腺病灶剪切波弹性成像（shearwaveelastography，SWE）弹性模量各向异性与组织病理学的相关性。方法对281例乳腺病灶（179例恶性，102例良性）进行传统超声和SWE检查，分析横切面、纵切面弹性模量值的各向异性差值（anisotropicdifference，AD）和各向异性因子（anisotropyfactors，AF）与术后病理结果的相关性。结果病灶横切面的弹性模量值显著高于纵切面。各参数的AF分别与对应的弹性模量值呈显著正相关（P=0．000），恶性病灶AF显著高于良性病灶（P=0．000）。AF诊断良恶性的曲线下面积显著高于AD（P〈0．001）。浸润性导管癌的AF显著高于导管内原位癌。156例浸润性导管癌病灶中，横切面、纵切面的弹性模量值均与组织学分级呈显著正相关，组织学分级Ⅰ级的病灶AF显著低于Ⅱ级和Ⅲ级的病灶（P=0．000）；ER／PR（＋）的病灶AF显著高于ER／PR（-）的病灶。结论乳腺病灶SWE的各向异性对恶性病灶及乳腺癌的预后具有预测价值。

Objective To retrospectively study the anisotropy of shear wave elastography （SWE） quantitative parameters of breast lesions,and the correlation with histopathology. Methods A total of 281 consecutive women with 281 breast lesions （179 malignant, 102 benign） were included, who underwent conventional ultrasound （US） and 2D SWE before surgical excision. Three acquisitions each for transverse and longitudinal planes were obtained, and maximum elasticity （Emax）, mean elasticity （Emean）, standard deviation （Esd） of the whole lesion and ratio between the elasticity in the mass and the fatty tissue （Eratio） were recorded. Anisotropic difference （AD） and anisotropy factors （AF） were calculated, and correlation with histopathology was analyzed. Results The average Emax, Emean and Esd of transverse planes were significantly higher than those of longitudinal planes. AF showed positive correlation with quantitative elasticity （Emax, Emean, Esd and Eratio） （ P = 0.000）, and was significantly higher in malignant lesions than that in benign besions （ P = 0.000）. AUC of AF was significantly higher than that of AD （ P 〈0.001 ）. AF was significantly higher in invasive ductal carcinoma than that in ductal carcinoma in situ. Higher AF was associated with higher histopathological grades of invasive ductal carcinoma （ P = 0. 000）, and correlated with ER/PR（ ＋ ）. Conclusions Anisotropy of SWE is an indicator of malignancy of breast lesions, and is of predictive value for prognosis in breast cancer.