三维剪切波弹性成像鉴别诊断乳腺良恶性结节的应用价值

Application of three-dimensional shear wave elastography in the differential diagnosis of benign and malignant breast masses

目的探讨三维剪切波弹性成像(3D-SWE)定量参数与定性指标"硬环征"鉴别乳腺良恶性结节的应用价值。方法对2020年1月至2021年2月苏州大学附属第一医院收治的女性乳腺结节患者117例(121个结节)行常规超声、二维剪切波弹性成像(2D-SWE)及3D-SWE检查。以手术或穿刺病理为金标准,绘制2D-SWE及3D-SWE各项诊断指标的ROC曲线并分析比较,选取最佳定性和定量指标对BI-RADS分类进行优化,根据新的分级评估乳腺良恶性结节的诊断效能。结果常规超声BI-RADS分类ROC曲线下面积(AUC)为0.846,敏感性和特异性分别为89.6%、79.6%。冠状面结节与周围脂肪组织弹性比(Eratio)的AUC为0.869,在各定量参数中最高,且显著大于2D-SWE(P<0.05),冠状面"硬环征"的AUC显著大于2D-SWE、矢状面及横断面(均P<0.05)。经冠状面"硬环征"调整BI-RADS分类后AUC为0.901,显著大于单独使用常规超声(P<0.05)。结论3D-SWE冠状面Eratio和"硬环征"可较2D-SWE显示出更好的诊断效能,采用冠状面"硬环征"对BI-RADS分类进行优化调整,可有效提高诊断效能。

Objective To evaluate the application value of three-dimensional shear wave elastography(3D-SWE)with quantitative parameters and qualitative analysis of stiff rim sign in differentiating benign and malignant breast masses.Methods One hundred and seventeen female patients(121 breast masses)admitted to the First Affiliated Hospital of Soochow University from January 2020 to February 2021 were examined by conventional ultrasound,two-dimensional shear wave elastography(2D-SWE)and 3D-SWE.Surgical or puncture pathology were used as the gold standard,the ROC curves of 2D-SWE and 3D-SWE were drawn to obtain the optimal qualitative and quantitative indicators.Afterwards,BI-RADS category was adjusted according to the optimal indicators,which could be used to evaluate the diagnostic value in differentiating benign and malignant breast masses.Results The area under ROC curve(AUC)of BI-RADS category was 0.846,the sensitivity and specificity were 89.6%and 79.6%,respectively.The AUC value of mass-to-fat elasticity ratio(Eratio)of coronal plane was 0.869,which was the highest among all quantitative parameters and was significantly higher than that of 2D-SWE(P<0.05).In addition,the AUC value of stiff rim sign of coronal plane was significantly higher than those of 2D-SWE,sagittal plane and transverse plane(All P<0.05).The AUC of combination of stiff rim sign of coronal plane and conventional US was 0.901,which was significantly higher than that using conventional ultrasound alone(P<0.05).Conclusions Compared with 2D-SWE,Eratio and stiff rim sign of coronal plane of 3D-SWE yield better diagnostic efficiency.Adjusting stiff rim sign coronal plane to BI-RADS category can effectively improve the diagnostic efficiency.