剪切波弹性成像异质性分析校正乳腺病灶BI-RADS分类的价值

Value of elastic heterogeneity analysis based on shear wave elastography in correcting BI-RADS category of breast lesions

目的探讨剪切波弹性成像(SWE)异质性分析校正乳腺病灶乳腺影像报告与数据系统(BI-RADS)分类的价值。方法选取经病理证实的132例乳腺病灶患者,共135个病灶,其中良性75个,恶性60个,应用常规超声及SWE检查评估乳腺病灶BI-RADS分级及弹性成像特征,获取SWE弹性模量参数,包括最大弹性值(Emax)、平均弹性值(Emean)、弹性值标准差(Esd),计算刚度梯度(SG)。绘制受试者工作特征曲线评估SWE各参数对乳腺良恶性病灶的鉴别诊断效能,并依据最佳SWE诊断参数对常规BI-RADS分类进行调整,比较校正前、后BI-RADS分类鉴别乳腺良恶性病灶的诊断效能。结果恶性病灶SWE各参数均高于良性病灶,差异均有统计学意义(均P<0.001)。SG、Esd、Emax、Emean诊断截断值分别为120.2、12.4、68.8、27.0 kPa,鉴别诊断乳腺良恶性病灶的曲线下面积分别为0.925、0.903、0.923、0.837;其中以SG的曲线下面积最高,其对应的敏感性为88.3%,特异性为96.0%,准确率为92.6%。以BI-RADS 4b类为诊断截断值,校正前与SG校正后BI-RADS分类鉴别诊断乳腺良恶性病灶的曲线下面积为0.914、0.964,敏感性为88.3%、90.0%,特异性为82.7%、92.0%,准确率为85.2%、91.1%;SG校正后BI-RADS分类鉴别诊断乳腺良恶性病灶的曲线下面积及特异性均高于校正前,差异均有统计学意义(均P<0.05);敏感性和准确率与校正前比较差异均无统计学意义。结论SWE异质性分析在鉴别乳腺良恶性病灶中具有重要的临床价值,经SG校正后BI-RADS分类的诊断效能较常规超声BI-RADS分类高。

Objective To explore the value of elastic heterogeneity analysis based on shear wave elastography(SWE)in correcting BI-RADS category of breast lesions.Methods A total of 132 pathologically confirmed patients were selected,including 135 breast lesions(75 benign lesions and 60 malignant lesions).BI-RADS category and elastic imaging characteristics of breast lesions were evaluated by conventional ultrasound and SWE.Elastic modulus parameters of SWE were obtained,including maximum elasticity value(Emax),average elasticity value(Emean)and standard deviation of elasticity(Esd),and stiffness gradient(SG)was calculated.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of SWE parameters for benign and malignant breast lesions.Conventional BI-RADS category was adjusted according to the optimal SWE diagnostic parameter,and the diagnostic efficacy of BI-RADS category before and after correction was compared in distinguishing benign and malignant breast lesions.Results The SWE parameters of malignant lesions were higher than those of benign lesions,and the differences were statistically significant(all P<0.001).The cut-off values of SG,Esd,Emax and Emean were 120.2,12.4,68.8 and 27.0 kPa,respectively,and the area under the curve for distinguishing benign and malignant breast lesions were 0.925,0.903,0.923 and 0.837,respectively.The area under curve of SG was the highest,the corresponding sensitivity,specificity and accuracy were 88.3%,96.0%and 92.6%,respectively.Taking BI-RADS 4b category as diagnostic cut-off value,the area under the curve of BI-RADS category before and after SG correction were 0.914 and 0.964,the sensitivity were 88.3%and 90.0%,the specificity were 82.7%and 92.0%,and the accuracy were 85.2%and 91.1%.The area under the curve and specificity of BI-RADS category after SG correction to distinguish benign and malignant breast lesions were higher than those before correction,and the differences were statistically significant(both P<0.05).There were no statistical differences in the sensitivity and accuracy before and after correction.Conclusion Elastic heterogeneity analysis base on SWE has important clinical value in distinguishing benign and malignant breast lesions.SG-corrected BI-RADS category has improved diagnostic efficiency compared with conventional ultrasound BI-RADS category.