剪切波弹性成像定量分析与硬环征在鉴别诊断乳腺肿块良恶性中的意义

Evaluation stiff rim sign in breast lesions by shear wave elastography with quantative values

目的分析乳腺肿块及其周缘范围剪切波弹性成像（shear wave elastography，SWE）定量指标与定性指标硬环征在诊断乳腺肿块良恶性中的价值。 方法收集从2016年8月至2017年5月于浙江大学医学院附属第二医院乳腺外科就诊的患者65例（65个病灶），术前行灰阶超声、SWE定性观察肿块是否有硬环征，定量测量肿块及其周缘1 mm、2 mm、3 mm范围SWE弹性模量值，以手术或病理穿刺为金标准，ROC曲线分析得出诊断乳腺良、恶性肿块效能最佳的定性和定量指标，并分析二者的相关性。用最佳定性和定量指标联合灰阶超声对BI-RADS分类进行降级或升级，依照新的分级评价乳腺良恶性肿块的诊断效能。 结果65例患者中良性32例，恶性33例。灰阶超声BI-RADS分类最大截点值为4a和4b之间，ROC曲线下面积（AUC）为0.935（0.845－0.981），敏感性和特异性分别为84.8%、90.6%。恶性肿块周缘2 mm区域弹性最大值（E2Smax）明显高于良性肿块（P＝0.001），在SWE定量指标中具有最高的AUC值，其AUC值为0.773（0.652－0.868），截点值为127.4 kPa，敏感性和特异性分别为78.8%、71.9%。肿块＂硬环征＂ AUC值为0.800，敏感性和特异性为81.8%、78.1%。硬环征与E2Smax呈中度相关（r＝0.630）。硬环征联合BI-RADS系统其AUC值为0.937，敏感性和特异性分别为81.8%、90.6%。E2Smax联合BI-RADS系统其AUC值为0.902，敏感性和特异性分别为93.9%、75.0%。 结论乳腺肿块及周缘范围内剪切波弹性成像定量和定性指标对诊断乳腺良、恶性肿块具有良好的应用价值，其中以E2Smax和硬环征最佳，二者之间呈中度相关。将E2Smax和硬环征分别与灰阶超声联合，其诊断效能有一定程度的提高。

ObjectiveTo evaluate the diagnostic performance of shear wave elastography （SWE） with quantitative analysis and qualitative analysis of stiff rim sign between benign and malignant breast lesions. MethodsSixty-five female patients（65 lesions） underwent breast surgery or aspiration biopsy at the Second Affiliated Hospital of Zhejiang University were included. Elastic modulus of breast lesions and its rim in 1 mm, 2 mm, 3 mm were quantitive analyzed by SWE before surgery or aspiration biopsy, Stiff rim sign was observed at the same time. Then, the areas of receiver operating characteristic curves（AUC） of quantitative parameters of SWE and stiff rim sign were calculated to assess their clinical values in differentiating benign and malignant breast lesions, and the correlation between them was evaluated. Afterwards, BI-RADS category was adjusted according to the optimal parameters combining the performance of SWE feature and conventional US features, which could be used to evatulate the diagnostic effectiveness in differentiating benign and malignant breast lesions. ResultsThe pathological results demonstrated 32 benign cases and 33 malignant cases in all patients.The maximum cut-off point of BI-RADS category was set between 4a and 4b.AUC value was 0.935（0.845-0.981）, while the sensitivity and specificity were 84.8% and 90.6%, respectively.Maximum elasticity of 2 mm（E2Smax） area surrounding the malignant lesions were significantly higher than those in benign lesions（P=0.001）. Among all quantitative SWE features, E2Smax showed the highest AUC（0.773）, with sensitivity of 78.8% and specificity of 71.9%. In addition, the stiff rim sign as qualitative parameter showed the highest AUC（0.800）, with sensitivity 81.8% and specificity 78.1%. The correlation coefficient between E2Smax and stiff rim sign was 0.63, which was regarded as moderate correlation. the AUC of combination of stiff rim sign or E2Smax and conventional US features was 0.937 and 0.902, and the sensitivities were 81.8%, 93.9%, the specificities were 90.6% and 75.0%. ConclusionsSWE features, especially E2Smax and hard rim sign are found moderate correlation, and can improve a more accurate diagnosis in differentiating benign and malignant breast lesions combining with conventional US features.