剪切波弹性成像在乳腺良恶性肿块鉴别诊断中应用价值

Application of shear wave elastography in the differential diagnosis of benign and malignant breast tumors

目的探讨剪切波弹性成像在乳腺良恶性肿块鉴别诊断中的应用价值。方法选取自2016年8月至2017年6月于北部战区总医院住院手术或穿刺活检的117例女性患者为研究对象,测定117个乳腺肿块的最大值、标准差,即shell 1 mm最大值、shell 1 mm标准差,shell 2 mm最大值、shell 2 mm标准差,shell 3 mm最大值、shell 3 mm标准差,以及肿块及1 mm"壳"在内的最大值、肿块及1 mm"壳"在内的标准差,肿块及2 mm"壳"在内的最大值、肿块及2 mm"壳"在内的标准差,肿块及3 mm"壳"在内的最大值、肿块及3 mm"壳"在内的标准差。以病理诊断结果为"金标准"绘制受试者工作特征(ROC)曲线,比较得出最有意义的值,并计算诊断临界值。结果通过ROC曲线分析,shell 3 mm最大值曲线下面积最大,为0. 768,敏感性为78. 6%,特异度为64. 0%,杨氏模量值诊断临界值为93. 470 k Pa。肿块周围组织既"壳"的硬度大于肿块的硬度时出现"硬环征","硬环征"曲线下面积为0. 862,敏感性为85. 7%,特异度为86. 7%。结论肿块周围组织既"壳"的厚度为3 mm时,杨氏模量值意义最大。将肿块周围组织既"壳"的厚度为3 mm时杨氏模量值与硬环征结合可增加诊断的准确率。

Objective To investigate application value of shear wave elastography in the differential diagnosis of benign and malignant breast masses. Methods A retrospective study was performed on 117 cases of female patients who were admitted or underwent aspiration biopsy from August 2016 to June 2017. The maximum,standard deviation,shell 1 mm maximum,shell 1 mm standard deviation,shell 2 mm maximum,shell 2 mm standard deviation of 117 breast masses were determined. The maximum value of shell 3 mm,the standard deviation of shell 3 mm,the maximum value of mass and 1 mm shell,the standard deviation of mass and 1 mm shell,the maximum value of mass and 2 mm shell,the standard deviation of mass and 2 mm shell,the maximum value,the standard deviation of the mass and 3 mm shell were calculated. The ROC curves of subjects were drawn with the pathological diagnosis results as the " gold standard",and the most significant values were obtained by comparison,and the diagnostic critical value was calculated.Results Through the analysis of ROC curve,the area under the max curve of the maximum value of shell 3 mm was 0. 768,the maximum sensitivity was 78. 6%,specificity was 64. 0%,the diagnostic critical value was 93. 47 k Pa. The hardness of the surrounding tissue was bigger than the hardness of the lump,the hard ring sign was 0. 862,the sensitivity was 85. 7%,and the specificity was86. 7%. Conclusion The young’s modulus is the most significant when the thickness of the tissue around the mass is 3 mm. The accuracy of the diagnosis can be increased by combining the young’s modulus with the rigid ring sign when the thickness of the tissue around the tumor is 3 mm.