SWE结合BI-RADS分级对乳腺肿块鉴别诊断价值及其与病理特征关系的研究

The Value of SWE Combined with BI-RADS Grading in the Differential Diagnosis of Breast Masses and the Relationship with Pathological Features

目的:探究剪切波弹性成像(SWE)结合乳腺影像报告与数据系统(BI-RADS)分级对乳腺肿块的鉴别诊断价值及其与病理特征的关系。方法:96例乳腺肿块患者均行乳腺常规超声检查、SWE检查,进行BI-RADS分级、改良SWE弹性评分评估,以病理学诊断结果为金标准,通过受试者工作特征(ROC)曲线下面积(AUC)评价BI-RADS分级及其与SWE联合对乳腺肿块鉴别的诊断效能。SWE检查时测量正常组织、肿块组织的超声弹性成像应变比值,分析其与病理特征的关系。结果:96例患者经病理确诊良性、恶性肿块67例、29例,良、恶性肿块BI-RADS分级、SWE弹性评分分布比较有统计学意义(P<0.05)。ROC曲线显示BI-RADS分级、SWE联合BI-RADS分级鉴别良恶性乳腺肿块的AUC分别为0.83、0.91。SWE联合BI-RADS分级诊断良恶性乳腺肿块的特异度、阳性预测值、阴性预测值均明显高于BI-RADS分级诊断。96例患者中弹性成像应变比值<3.08、≥3.08的患者分别为68例、28例,二者在肿块形态、边界、纵横比、回声、钙化、血流等病理特征方面比较差异有统计学意义(P<0.05),且Logistic回归多因素分析显示肿块形态、边界、纵横比、回声、钙化、血流是弹性成像应变比值≥3.08的独立影响因素(P<0.05)。结论:SWE结合BI-RADS分级可全面了解乳腺肿块的组织、病理特征,有助于乳腺良、恶性肿块的鉴别诊断。

Objective:To explore the value of shear wave elastography(SWE)combined with breast imaging reporting and data system(BI-RADS)grading in the differential diagnosis of breast masses and its relationship with pathological features.Methods:96 patients with breast masses were examined by conventional breast ultrasonography and SWE,and the BI-RADS grading and modified SWE scoring were performed.With the diagnostic results of pathology as the golden standard,the diagnostic efficiency of BI-RADS grading and its combination with SWE in the differential diagnosis of breast masses was evaluated by the area under receiver operating characteristic(ROC)curve(AUC).The strain ratio of ultrasonic elastography of normal tissues and mass tissues was measured by SWE,and its relationship with pathological features was analyzed.Results:In the 96 patients,there were benign and malignant masses in 67 cases and 29 cases respectively diagnosed by pathology.There were statistically significant differences of BI-RADS grade and SWE score between benign and malignant masses(P<0.05).The ROC curve showed that the AUC of BI-RADS grading and SWE combined with BI-RADS grading in the differential diagnosis of breast masses were 0.83 and 0.91 respectively.The specificity,positive predictive value,negative predictive value of SWE combined with BI-RADS grading in the diagnosis of benign and malignant breast masses were significantly higher than those of BI-RADS grading alone.In the 96 patients,the strain ratio of ultrasonic elastography was lower than 3.08 in 68 cases and more than 3.08 in 28 cases,with statistically significant differences between the two in the shape of masses,boundary,aspect ratio,echo,calcification,blood flow and other pathological features(P<0.05).Logistic regression and multivariate analysis showed that shape of masses,boundary,aspect ratio,echo,calcification and blood flow were independent influencing factors of elasticity strain ratio larger than 3.08(P<0.05).Conclusion:SWE combined with BI-RADS grading can fully display the histological and pathological features of breast masses,which is helpful for the differential diagnosis of benign and malignant breast masses.