应变式弹性成像联合声辐射力脉冲成像对乳腺良恶性肿块的鉴别诊断价值分析

Value of strain elastography combined with acoustic radiation force impulse imaging in differential diagnosis of benign and malignant breast masses

目的 探讨应变式弹性成像(strain elastography,SE)、声辐射力脉冲(acoustic radiation force impulse,ARFI)成像对乳腺良恶性肿块的鉴别诊断价值。方法 本研究属于回顾性研究,选取2018年1月至2022年5月武汉市武昌医院收治的93例单发乳腺肿块患者为研究对象,根据病理结果分为恶性组(33例)与良性组(60例)。比较两组患者的年龄、肿块最大径、常规二维超声、SE与ARFI检查结果,采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)评价各参数对乳腺良恶性肿块的诊断价值。结果 恶性组肿块形态不规则、边缘有毛刺的患者占比均显著高于良性组(均P<0.05),而两组患者的年龄、肿块最大径、内部回声不均匀和微钙化灶的占比比较差异均无统计学意义(均P>0.05)。恶性组患者的弹性应变率比值(strain ratio,SR)、声触诊组织定性成像(virtual touch tissues imaging,VTI)评分、横向剪切波速度(shear wave velocity,SWV)均显著高于良性组(P<0.05)。以病理结果为“金标准”,对SR、VTI评分、SWV绘制ROC曲线,结果表明,SR、VTI评分、SWV均具有一定的诊断价值(AUC>0.7),其中SWV的AUC最高,且SR、VTI评分联合SWV能进一步提高诊断价值(AUC>0.8)。结论 SE与ARFI这两种超声弹性成像技术均能有效鉴别乳腺肿块的良恶性,二者联合后能进一步提高诊断价值。

Objective To investigate the value of strain elastography (SE) combined with acoustic radiation force impulse (ARFI) imaging in differential diagnosis of benign and malignant breast mass.Method Ninety-three patients with single breast mass treated in Wuhan Wuchang Hospital from January 2018 to May 2022 were enrolled for the research and divided into malignant group (33 cases) and benign group (60 cases) according to the pathological results.The age,maximum diameter of tumor,routine two-dimensional ultrasound,SE and ARFI examination results of the two groups were compared.The area under the curve (AUC) of the receiver operator characteristic curve (ROC curve) was performed to evaluate the diagnostic value of each parameter for benign and malignant breast mass.Result The proportion of patients with irregular shape and burr edge in malignant group was significantly higher than that in benign group (all P<0.05),there were no significant differences in age,the largest diameter of the mass,the internal echo non-uniformity and the proportion of microcalcification between the two groups (all P>0.05).The elastic strain ratio (SR),virtual touch tissues imaging (VTI) score and shear wave velocity (SWV) in malignant group were significantly higher than those in benign group (all P<0.05).Taking pathological results as the "gold standard",the ROC curves of SR,VTI score and SWV were drawn.The results showed that SR,VTI score and SWV all had certain diagnostic value (AUC>0.7),of which SWV had the highest AUC,and the combination of SR,VTI score and SWV could further improve the diagnostic value (AUC>0.8).Conclusion Thesetwo ultrasonic elastic imaging technologies (SE and ARFI imaging) can effectively distinguish benign and malignant breast mass,and their combination can further improve the diagnostic value.