比较二维与三维剪切波弹性成像对乳腺癌的诊断价值

Comparison the two dimensional and three dimensional shear wave elasticity imaging in breast cancer diagnosis

目的比较二维、三维剪切波弹性成像（SWE）对早期乳腺癌的诊断价值。方法选取2014年12月～2016年12月经病理证实的84例乳腺疾病患者（94个病灶），所有患者均行二维、三维彩超和基于2者的SWE检查。采用受试者操作特性曲线（ROC）确定诊断乳腺良恶性病变的最佳二维、三维SWE弹性模量最大值和平均值。依据病理检查结果，评价二维与三维SWE诊断乳腺良恶性病变的敏感度、特异性和准确性并进行比较。结果鉴别乳腺良恶性病变的最佳二维SWE弹性模量最大值为98．82kPa，平均值为43．88kPa；最佳三维SWE弹性模量最大值为102．54kPa，平均值为53．87kPa。二维与三维SWE诊断乳腺癌的敏感度分别为89．5％和86．3％，差异无统计学意义（P〉0．05）；二维SWE诊断乳腺癌的特异性（95．3％）、准确性（92．7％）明显高于三维SWE（83．9％、85．1％），差异均具有统计学意义（均P〈0．05）。结论二维SWE检查对乳腺良恶性病变的诊断效能明显高于三维SWE，为乳腺良恶性病变的鉴别诊断提供了可靠依据，值得临床推广应用。

Objective To compare the two-dimensional （2D） and three-dimensional （3D） shear wave elastography （SWE） technology in the diagnosis of early stage breast cancer. Methods 84 patients （94 breast lesions） with breast disease confirmed by pathological examination were enrolled from December 2014 to December 2016. All patients underwent 2D and 3D color Doppler ultrasound and the relevant SWE examinations. The optimal maximum and mean elastic modulus of 2D and 3D SWE for diagnosing the benign and malignant breast lesions were obtained by the receiver operating characteristic curve （ROC）. Based on the results of pathological examinations, the sensitivity, specificity and accuracy of 2D SWE and 3D SWE in benign and malignant breast lesions diagnosis were evaluated and compared. Results The optimal maximum and mean elastic modulus of 2D SWE for diagnosing the benign and malignant breast lesions were 98.82 kPa and 43.88 kPa respectively, while the corresponding modulus of 3D SWE were 102.54 kPa and 53.87 kPa. The sensitivity of 2D SWE and 3D SWE in breast cancer diagnosis was 89.5% and 86.3% respectively, and the difference was not statistically significant （P〉0.05）. The specificity and the accuracy of 2D SWE in breast cancer diagnosis were 95.3% and 92.7% respectively, which was significant higher than 83.9% and 85.1% of 3D SWE, and the differences were statistically significant （all P〈0.05）. Conclusions The efficiency of 2D SWE examination is significantly higher than the 3D SWE in benign and malignant breast lesions diagnosis, which can provide a reliable diagnostic basis and is worthy for clinical application.