基于Image Pro Plus软件支持的应变超声弹性成像在乳腺影像报告和数据系统4类结节诊断中的应用

Application of strain ultrasonic elastography based on Image Pro Plus software in the diagnosis of Breast Imaging Reporting and Data System category 4 nodules

目的探讨在Image Pro Plus(IPP)软件支持下应用应变超声弹性成像(SUE)技术鉴别诊断乳腺影像报告和数据系统(BI-RADS)4类结节良恶性的价值。方法回顾性分析于2020年1月至2021年1月就诊于天津医科大学肿瘤医院192例经乳腺超声检查诊断为BI-RADS 4类结节女性患者的临床及超声影像资料,每例患者选择1个结节,共192个乳腺实性结节。术前对每个结节进行超声图像、SUE图像采集,随后进行BI-RADS分类评分、SUE评分。应用IPP软件勾画所有结节的感兴趣区,软件自动统计所有结节的SUE面积比(SUE-IPP-AR);以病理结果为金标准,按受试者工作特征曲线(ROC)确定的SUE-IPP-AR判断良恶性的最佳临界值进行SUE-IPP评分。ROC曲线分析BI-RADS评分、SUE评分、SUE-IPP评分及SUE-IPP+BI-RADS联合评分在乳腺结节良恶性鉴别中的效能。应用Kappa系数分析评估SUE和SUE-IPP的观察者间一致性。结果192个结节中,病理诊断良性结节58个,恶性结节134个;BI-RADS分类4A类46个,4B类57个,4C类89个;SUE图像分级1~6级分别有12、14、41、51、42、32个。ROC曲线分析显示,SUE-IPP判断BI-RADS 4类乳腺结节良恶性的最佳临界值为58%[曲线下面积(AUC)=0.729,灵敏度73%,特异度69%];SUE-IPP+BI-RADS联合评分判断结节良恶性的AUC最大(0.871),高于BI-RADS评分(AUC=0.829,Z=2.51,P=0.012)、SUE-IPP评分(AUC=0.729,Z=3.56,P<0.001)及SUE评分(AUC 0.695,Z=4.37,P<0.001)。SUE-IPP+BI-RADS联合评分≥3分诊断恶性结节的灵敏度为86.6%,特异度为82.8%,SUE-IPP+BI-RADS诊断乳腺结节良恶性的效能最好。具有5年以上工作经验及不足5年工作经验超声科医师间应用SUE诊断乳腺恶性结节性质的一致性较好(Kappa=0.768,95%CI 0.711~0.825),应用SUE-IPP诊断的一致性非常好(Kappa=0.946,95%CI 0.919~0.974)。结论SUE-IPP可以提高BI-RADS 4类恶性乳腺结节的诊断能力,可作为超声诊断的辅助工具。

Objective To explore the diagnostic value of strain ultrasonic elastography(SUE)supported by Image Pro Plus(IPP)software in distinguishing benign and malignant Breast Imaging Reporting and Data System(BI-RADS)category 4 nodules.Methods The clinical and ultrasound imaging data of 192 female patients with BI-RADS category 4 nodules diagnosed by breast ultrasound in Tianjin Medical University Cancer Institute and Hospital from January 2020 to January 2021 were retrospectively analyzed.One nodule was selected for each patient,and a total of 192 nodules were analyzed.The ultrasound images and SUE images of each nodule were acquired before surgery,followed by BI-RADS classification scoring and SUE scoring.The IPP software was applied to outline the region of interest of all nodules,and the software automatically counted the SUE area ratio(SUE-IPP-AR)of all nodules.Using pathological diagnosis as the gold standard,SUE-IPP scoring was performed based on the optimal cut-off value of SUE-IPP-AR for distinguishing benign and malignant nodules according to receiver operating characteristic(ROC)curve.The efficacy of BI-RADS classification,SUE score,SUE-IPP score,and SUE-IPP+BI-RADS combined score in the differentiation of benign and malignant breast nodules were analyzed by ROC curve.Kappa coefficient was used to assess inter-observer agreement for SUE and SUE-IPP-AR.Results Of the 192 nodules,58 were benign nodules and 134 were malignant nodules diagnosed by pathology.These nodules were classified by BI-RADS,with 46 nodules in BI-RADS category 4A,57 nodules in BI-RADS category 4B and 89 nodules in BI-RADS category 4C.SUE images 1-6 level were 12,14,41,51,42,and 32 nodules,respectively.ROC curve analysis showed that the optimal cut-off value of SUE-IPP for determining benign and malignant BI-RADS category 4 breast nodules was 58%[area under the curve(AUC)=0.729,sensitivity 73%,specificity 69%].The AUC of SUE-IPP+BI-RADS combined score for determining benign and malignant nodules was the largest(0.871),which was higher than that of BI-RADS score(AUC=0.829,Z=2.51,P=0.012),SUE-IPP score(AUC=0.729,Z=3.56,P<0.001)and SUE score(AUC=0.695,Z=4.37,P<0.001).The sensitivity of SUE-IPP+BI-RADS combined score≥3 points for diagnosing malignant nodules was 86.6%,while the specificity was 82.8%.Therefore,SUE-IPP+BI-RADS score had the best efficacy for determining benign and malignant nodules.There was good agreement between sonographer with more than 5 years of experience and those with less than 5 years of experience in applying SUE to diagnose breast malignant nodules(Kappa=0.768,95%CI 0.711-0.825),and very good diagnostic agreement in applying SUE-IPP(Kappa=0.946,95%CI 0.919-0.974).Conclusions SUE-IPP can improve the diagnostic ability for BI-RADS category 4 breast malignant nodules and can be used as an adjunct to ultrasound diagnosis.