剪切波弹性成像联合BI-RADS分类鉴别诊断最大径≤2 cm乳腺癌的价值

Value of shear wave elastography combined with BI-RADS classification in the differential diagnosis of maximum diameter≤2 cm breast cancer

目的探讨剪切波弹性成像(SWE)联合乳腺影像报告和数据系统(BI-RADS)分类对最大径≤2 cm乳腺癌(以下简称小乳腺癌)的鉴别诊断价值。方法选取经病理证实的171例乳腺病变患者共177个乳腺病变(最大径≤2 cm),其中良性155个,恶性22个。术前均行BI-RADS分类和SWE检查,获得病灶最大弹性值(Emax)、平均弹性值(Emean)、最小弹性值(Emin)及标准差(Esd),比较良恶性病灶间的差异。绘制受试者工作特征(ROC)曲线,确定Emax的诊断临界值,根据4a类病变的Emax调整其BI-RADS分类;比较SWE、BI-RADS分类单独及联合应用对BI-RADS 4a类病灶的诊断效能。结果177个病灶中,BI-RADS分类显示3类57个,4a类94个,4b类13个,4c类8个,5类5个。恶性病灶的Emax、Emean、Emin及Esd均大于良性病灶,差异均有统计学意义(均P<0.05)。以Emax 87.5 kPa作为诊断临界值,71个BI-RADS 4a类病变降为3类,漏诊5个恶性病变。Emax联合BI-RADS分类诊断小乳腺癌的敏感性77.3%,特异性82.6%,准确率79.1%,曲线下面积0.861(95%可信区间0.801~0.909),与BI-RADS分类单独应用的诊断效能比较差异均有统计学意义(均P<0.05)。结论相较于单独BI-RADS分类,SWE与其联合应用可提高小乳腺癌的诊断特异性和准确率,减少临床诊疗中对4a类病变不必要的穿刺和手术,具有较好的应用价值。

Objective To explore the value of shear wave elastography(SWE)combined with breast imaging reporting and data system(BI-RADS)classification in the differential diagnosis of breast cancer with a maximum diameter≤2 cm(hereinafter referred to as small breast cancer).Methods A total of 177 small breast lesions(maximum diameter≤2 cm)were selected from 171 patients with breast lesions confirmed by pathology,among which 155 were benign and 22 were malignant.Preoperative BI-RADS classification and SWE were performed to obtain maximum elasticity value(Emax),average elasticity value(Emean),minimum elasticity value(Emin)and standard deviation(Esd),the differences between benign and malignant lesions were compared.The receiver operating characteristic(ROC)curve was drawn to determine the diagnostic critical value of Emax,and the BI-RADS classification was adjusted according to the Emax of category 4a lesions.The diagnostic efficacy of SWE and BI-RADS classification alone and in combination for BI-RADS 4a lesions was compared.Results Among the 177 lesions,BI-RADS classification showed 57 lesions were category 3,94 lesions were category 4a,13 lesions were category 4b,8 lesions were category 4c,and 5 lesions were category 5.Emax,Emean,Emin and Esd were significantly higher in malignant compared with benign lesions(all P<0.05).By using cutoff of Emax 87.5 Kpa for downgrading BI-RADS category 4a lesions to category 3,71 category 4a lesions were downgraded and 5 cancers were missed.The sensitivity,specificity,accuracy and the area under the ROC curve of Emax combined with BI-RADS in the diagnosis of small breast cancer were 77.3%,82.6%,79.1%and 0.861(95%CI:0.801~0.909),there were statistically significant differences compared with those of BI-RADS classification alone(all P<0.05).Conclusion Compared with the BI-RADS classification alone,the combined application of SWE can improve the specificity and accuracy in the diagnosis of small breast cancer,and reduce the unnecessary puncture and surgery for 4a lesions in the clinical diagnosis and treatment,with good application value.