两种弹性定量方法评估良恶性乳腺实性肿块硬度的对比研究

Comparison study of two elastic quantification methods in assessing benign and malignant breast solid mass hardness

目的对比分析声触诊组织量化(VTQ)和声触诊组织成像(VTI)联合Adobe Photoshop灰度定量两种弹性定量方法在鉴别诊断乳腺实性肿块良恶性中的应用价值。方法选取98例乳腺肿瘤患者(108个乳腺实性肿块),应用VTQ获得代表肿块中央局部硬度的剪切波速度(VS),同时应用VTI联合Adobe Photoshop灰度定量技术计算VTI弹性图中病灶整体灰度平均值,代表乳腺肿块整体硬度。与病理结果对照,分别比较良恶性乳腺肿块中央局部硬度和整体硬度的差异,获得最佳截断值,比较两个指标的诊断效能。结果恶性和良性乳腺肿块的局部硬度VS值分别为(6.96±2.50)m/s和(2.62±1.82)m/s,差异有统计学意义(P=0.000)。ROC曲线获得最佳截断值为2.78 m/s,以肿块中央局部硬度VS>2.78 m/s诊断恶性乳腺肿块的敏感性、特异性及准确率分别为91.18%、88.64%及89.74%,与病理结果高度一致(校正χ2=0.125,P=0.724;Kappa=0.793,P=0.000)。恶性和良性乳腺肿块整体硬度灰度平均值分别为39.21±16.60和63.94±19.42,差异有统计学意义(P=0.000)。ROC曲线获得最佳截断值为50.75,以肿块整体硬度灰度平均值<50.75诊断恶性乳腺肿块的敏感性、特异性及准确率分别为79.41%、77.27%及78.21%,与病理结果中度一致(校正χ2=0.235,P=0.628;Kappa=0.561,P=0.000)。结论 VTQ诊断效能高于VTI联合Adobe Photoshop灰度定量技术,但二者均有助于鉴别乳腺实性肿块性质。

Objective To analyze the application value of two elastic quantification methods which were virtual touch quantification（VTQ）and virtual touch imaging（VTI）combined with Adobe Photoshop gray quantitative technique in identifying benign and malignant breast solid masses.Methods The VS which represented hardness of the center part in 98 patients with breast tumor（108 breast solid masses）were obtained by VTQ technology.The lesions tissue elastic graphs were obtained in the same patients by VTI technology,then the elastic graphs were imported into Adobe Photoshop image processing system to calculate the lesions overall gray-scale average value,which representing the overall hardness of breast lesions.Compared with the pathological results,the difference between benign and malignant breast lesions of the central local hardness and overall hardness were compared.The best cutoff value of the two indexes in identifying solid benign and malignant breast lesions were obtained,and the diagnostic efficiencies were compared.Results The average VS representing local hardness of malignant lesions was（6.96±2.50）m/s,while that of the benign lesions was（2.62±1.82）m/s,there was significant difference（P=0.000）.The best cutoff value of VS was 2.78 m/s,with sensitivity of 91.18%,specificity of 88.64%,accuracy of 89.74%,which was highly consistent with the pathological result（correction χ2=0.125,P=0.724,Kappa=0.793,P=0.000）.The gray-scale average value representing the overall hardness of malignant lesions was 39.21±16.60,while that of the benign lesions was 63.94±19.42,there was significant difference（P=0.000）.The best cutoff value of gray-scale average value was 50.75,with sensitivity of 79.41%,specificity of 77.27%,accuracy of 78.21%,which was moderate consistent with the pathological result（correction χ~2=0.235,P=0.628,Kappa=0.561,P=0.000）.Conclusion The diagnostic efficiency of VTQ is higher than that of VTI combined with Adobe Photoshop gray quantitative technique.They are both help to differentiate the benign and malignant breast solid masses.