应变式弹性成像与剪切波弹性成像在乳腺肿块良恶性判断中的应用价值研究

Study on the application value of strain elastography and shear wave elastography in the determination of benign and malignant breast masses

目的 比较应变式弹性成像与剪切波弹性成像在乳腺肿块良恶性判断中的应用价值。方法 选取2017年9月至2018年10月医院超声影像科检查并经手术病理或穿刺活检证实存在乳腺肿块82例(82个病灶)女性患者进行研究,术前行应变弹性成像和剪切波弹性成像检查。通过应变弹性应变比率(SR)及剪切波最大弹性模量值(Emax)进行鉴别诊断,以病理结果为“金标准”,计算两种技术鉴别诊断乳腺良、恶性肿块的敏感性、特异性及准确性。结果 82例(共82个病灶)乳腺肿块患者经病理检查证实,其中51枚属良性肿块,31枚属恶性肿块;恶性肿块所测SR及Emax平均值均显著高于良性肿块(均P<0.05);应变弹性和剪切波弹性诊断乳腺良恶性肿块的ROC曲线下面积(AUC)分别为0.904、0.838,二者比较差异有统计学意义(P<0.05);以SR=3.65为截点值的应变弹性成像评估良恶性肿块的敏感性、特异性分别为77.4%、78.4%,以Emax=92.33kPa为截点值的剪切波弹性成像评估良恶性肿块的敏感性、特异性分别为74.2%、96.1%。结论 应变弹性成像技术和剪切波弹性成像技术在诊断乳腺良恶性肿块上均具有一定的临床应用价值,剪切波弹性成像技术的准确率更高,不过也存在着一些不足,临床可通过两种技术互补提高乳腺肿块的诊断率。

Objective To compare the application value of strain elastography and shear wave elastography in the determination of benign or malignant breast masses.Methods From September 2017to October 2018,82cases(82lesions)of female patients who were examined by ultrasound imaging department of our hospital and confirmed to have breast masses by surgical pathology or puncture biopsy were selected for study.All patients were preoperatively examined by strain elastography and shear wave elastography.The strain elastic strain ratio(SR)and the maximum elastic modulus of shear wave(Emax)were used for differential diagnosis,and the pathological results were taken as the“gold standard”to calculate the sensitivity,specificity and accuracy of the two techniques for differential diagnosis of benign and malignant breast masses.Results 82cases(82lesions in total)of breast masses were confirmed by pathological examination,of which 51were benign and 31were malignant;The mean values of SR and Emax in malignant tumor were significantly higher than those in benign tumor(all P<0.05);The area under the ROC curve(AUC)for the diagnosis of benign and malignant breast masses by strain elasticity and shear wave elasticity was 0.904and 0.838,and the difference between them was statistically significant(P<0.05);The sensitivity and specificity of strain elastography with SR=3.65% as the cut-off point for evaluating benign and malignant tumors were 77.4%and 78.4%respectively.Meanwhile,shear wave elastography with Emax=92.33kpa were 74.2% and 96.1%.Conclusion Both strain elastography and shear wave elastography have certain clinical application value in the diagnosis of benign and malignant breast masses,and shear wave elastography is more accurate,but it also has some shortcomings,clinical breast tumor diagnosis rate can be improved by two complementary techniques.