剪切波弹性成像对非肿块型乳腺病变良恶性的诊断价值

Diagnostic value of shear wave elastography for benign and malignant non-mass-like breast lesions

目的运用实时剪切波弹性成像(SWE)技术定量测量非肿块型乳腺病变的弹性模量参数,探讨该技术对非肿块型乳腺病变的诊断价值。方法运用实时剪切波弹性成像(SWE)技术定量测量非肿块型乳腺病变的弹性模量参数,探讨该技术对非肿块型乳腺病变的诊断价值。结果45例患者中病理诊断良性22例(23个病灶),恶性23例(24个病灶)。非肿块型乳腺良恶性病灶的Emax值、Emean值比较,差异均有统计学意义(t=-8.42、-6.44,P均<0.05),而良恶性病灶的Emin值比较,差异无统计学意义(t=-1.59,P>0.05)。分别以Emax=63.2kPa和Emean=40.9kPa为诊断界点时,ROC曲线下面积分别为0.929和0.887,诊断的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为85.2%、83.3%、95.7%、95.0%、81.5%和80.7%、79.2%、91.3%、88.9%、72.4%。将BI-RADS分级与Emax值相结合,诊断的准确性和特异度与常规超声相比显著提高(χ^2=5.115、9.610,P均<0.05);将BI-RADS分级与Emean值相结合,诊断的准确性和特异度与常规超声相比显著提高(χ^2=5.109、8.021,P均<0.05)。结论SWE技术有助于非肿块型乳腺病变的诊断,可在一定程度上提高诊断的准确性、特异度及阳性预测值,“硬环征”在一定程度上有助于非肿块型乳腺良恶性病变的鉴别。

Objective The real-time shear wave elastography(SWE)technique was used to quantitatively measure the elastic modulus of non-mass-like breast lesions,and the application value of this technique in the diagnosis of non-mass-like breast lesions was discussed.Methods A total of 45 female patients(47 lesions)who underwent breast surgery from the affiliated hospital of jining medical college from september 2017 to June 2018 were enrolled.SWE was performed before surgery,and the ROC curve was drawn by needle biopsy or surgical pathological results.We analyzed the value of each elastic modulus parameter in the diagnosis of non-mass-like breast benign and malignant lesions.Results Of the 45 patients,22 were benign(23 lesions)and 23 were malignant(24 lesions).There were significant differences in the emax and emean values between the benign and malignant lesions of non-mass-like type breasts(t=-8.42,-6.44,P<0.05),but the Emin values of benign and malignant lesions were not statistically significant(t=-1.59,P>0.05).When Emax=63.2 kPa and Emean=40.9 kPa were used as diagnostic boundaries,the area under the ROC curve was 0.929 and 0.887,respectively.The diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value were 85.2%.83.3%,95.7%,95.0%,81.5%and 80.7%,79.2%,91.3%,88.9%,72.4%respectively.BI-RADS grading with Emax value,the accuracy and specificity of diagnosis are significantly higher than conventional ultrasound(χ^2=5.115,9.610,P<0.05);combining BI-RADS grading with Emean value,the accuracy and specificity of diagnosis were significantly higher than conventional ultrasound(χ^2=5.109,8.021,P<0.05).Conclusion SWE technology is helpful for the diagnosis of non-mass-like breast lesions,which can improve the accuracy,specificity and positive predictive value of the diagnosis to a certain extent.The"stiff rim sign"is a good clinical reference value in the identification of non-mass-like breast benign and malignant lesions.