超声应变弹性成像技术对乳腺BI-RADS 4类结节级别调整的诊断价值

The diagnostic value of strain elastography in the adjustment of BI-RADS 4 nodules

目的探讨超声应变弹性成像技术中的弹性评分及应变比值(SR)对乳腺影像报告和数据系统(BI-RADS)4类结节级别调整的诊断价值。方法收集200个常规超声BI-RADS分级诊断为BI-RADS 4类结节行应变弹性成像,获得弹性评分值和SR,并计算出两者的良恶性界值,联合这两项指标,对结节的分级重新调整。以病理结果为金标准,分别比较常规超声BI-RADS分类、弹性评分、SR及三者联合对该组乳腺结节良恶性的诊断价值。结果恶性病变弹性评分明显高于良性病变,差异有统计学意义(Z=-7.237,P<0.05)。良性病变SR明显高于恶性病变,差异有统计学意义(Z=-7.152,P<0.05)。弹性评分和SR联合常规超声BI-RADS分类联合诊断该组乳腺结节的良恶性AuC为0.9,与单独运用常规超声BI-RADS分类、弹性评分、SR诊断该组乳腺结节良恶性的AuC相比,差异均有统计学意义(P<0.05)。结论应变弹性技术中的弹性评分及SR能够定性及半定量评价组织的相对硬度,将两者与常规超声乳腺BI-RADS分类联合,可以提高乳腺BI-RADS 4类结节的诊断效能。

Objective To discuss the value of elasticity score method and strain ratio method in the diagnostic of benign and malignant breast of strain elastography BI-RADS 4 nodules.Methods Two hundred nodules with BI-RADS grade 4 diagnosed by conventional ultrasound were collected for strain elastography.The elasticity score and strain ratio were obtained.The cut-off values of benign and malignant were calculated and combined with these two indexes to readjust the grading of nodules.Based on the pathological results as the gold standard,the diagnostic value of ultrasound BI-RADS rating,elasticity score method,strain ratio method and the combination of these three diagnostic values in benign and malignant evaluation of BI-RADS 4 nodules were compared.Results The elasticity score of malignant nodules was significantly higher than that of benign nodules(Z=-7.237,P<0.05).The strain ratio of benign nodules was significantly higher than that of malignant nodules(Z=-7.152,P<0.05).The AuC of the combination of elasticity score,strain ratio and ultrasound for the diagnosis of benign and malignant breast nodules was 0.9,which was significantly higher than that of ultrasound BI-RADS score,elasticity score method and strain ratio method alone(P<0.05).Conclusion The elasticity score method and SR method of strain elasticity technology can qualitatively and semi quantitatively evaluate the relative hardness of tissue.Combining these two methods with conventional ultrasound BI-RADS grading can improve the diagnostic efficiency of BI-RADS grade 4 nodules.