导声垫在提高乳腺病变剪切波弹性成像测值稳定性的效果观察

Observation on the ultrasound gel pad in improving the stability of shear wave elastography measurement in breast lesions

目的 比较导声垫与耦合剂辅助剪切波弹性成像(SWE)测量乳腺良恶性病变弹性测值的差异,探讨导声垫在提高乳腺病变SWE测值稳定性的效果观察。方法 选取经病理确诊的147例乳腺病变患者,均为单发病变,其中良性91例,恶性56例,由同一操作者分别借助耦合剂(耦合剂组)和导声垫(导声垫组)对乳腺病变进行SWE测量,比较两组杨氏模量最大值(Emax)、平均值(Emean)、最小值(Emin)及标准差(Esd)的差异;分析两组操作者内重复性测量的一致性。绘制受试者工作特征(ROC)曲线分析两组SWE参数鉴别乳腺良恶性病变的诊断效能;分析两种方法获取测值的诊断结果与病理结果的一致性。结果 导声垫组Emax、Emean、Emin、Esd均较耦合剂组减小,差异均有统计学意义(均P<0.001)。导声垫组Emax、Emean、Esd操作者内重复性测量的一致性均非常好(ICC=0.886、0.825、0.774,均P<0.001),Emin操作者内重复性测量的一致性好(ICC=0.613,P<0.001)。耦合剂组Emax、Emean、Emin、Esd操作者内重复性测量的一致性均好(ICC=0.733、0.405、0.578、0.728,均P<0.001)。耦合剂组和导声垫组乳腺恶性病变Emax、Emean、Esd均较良性病变增大,Emin均较良性病变减小,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,耦合剂组中以Emax鉴别乳腺良恶性病变的曲线下面积(AUC)最高(0.774),其对应的灵敏度、特异度分别为82.14%、68.13%;导声垫组中以Emax鉴别乳腺良恶性病变的AUC最高(0.910),其对应的灵敏度、特异度分别为87.50%、86.81%。导声垫组Emax鉴别乳腺良恶性病变的AUC、灵敏度、特异度均较耦合剂组高,差异均有统计学意义(均P<0.05)。导声垫组Emax鉴别乳腺良恶性病变的诊断结果与病理结果的一致性较高(Kappa=0.717,P<0.05);耦合剂组Emax鉴别乳腺良恶性病变的诊断结果与病理结果的一致性一般(Kappa=0.460,P<0.05)。结论 使用导声垫可提高SWE测值的稳定性,在辅助鉴别诊断乳腺良恶性病变方面有一定的临床应用价值。

Objective To compare the difference of elastic measurement of breast lesions between ultrasound gel pad and coupling agent assisted shear wave elastography(SWE),and to explore the efficacy of ultrasound gel pad in improving the stability of SWE measurement in breast lesions.Methods A total of 147 patients with pathologically confirmed breast lesions were selected,all of which were single lesions,including 91 cases of benign and 56 cases of malignant.SWE measurement of breast lesions was performed by the same operator with the aid of coupling agent(coupling agent group)and ultrasound gel pad(ultrasound gel pad group).The maximum value(Emax),mean value(Emean),minimum value(Emin)and standard deviation(Esd)of Young’s modulus were compared between the two groups.The consistency of repeatability measurements between the two groups of operators was analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of SWE parameters of two groups for differentiating benign and malignant breast lesions.The consistency of the diagnostic results obtained by the two different methods and the pathological results was analyzed.Results The Emax,Emean,Emin and Esd in the ultrasound gel pad group were lower than those in the coupler group,the differences were statistically significant(all P<0.001).The consistency of Emax,Emean and Esd in the ultrasound gel pad group was very good(ICC=0.886,0.825,0.774,all P<0.001),and the consistency of Emin was good(ICC=0.613,P<0.001).The consistency of Emax,Emean,Emin and Esd in the coupling agent group was good(ICC=0.733,0.405,0.578,0.728,all P<0.001).The Emax,Emean and Esd of malignant lesions were higher than those of benign lesions in the coupling agent group and ultrasound gel pad group,and Emin of malignant lesions were lower than that of benign lesions,the differences were statistically significant(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of Emax in differentiating benign and malignant breast lesions was the highest in the coupling agent group(0.774),and the sensitivity and specificity were 82.14%and 68.13%,respectively.The AUC of Emax in differentiating benign and malignant breast lesions was the highest in ultrasound gel pad group(0.910),and the sensitivity and specificity were 87.50%and 86.81%,respectively.The AUC,sensitivity and specificity of Emax in differentiating benign and malignant breast lesions were higher in the ultrasound gel pad group than those in the coupling agent group,the differences were statistically significant(all P<0.05).The diagnostic results of Emax in differentiating benign and malignant breast lesions were consistent with pathological results in the ultrasound gel pad group(Kappa=0.717,P<0.05),while the diagnostic results of Emax in differentiating benign and malignant breast lesions were consistent with pathological results in the coupling agent group(Kappa=0.460,P<0.05).Conclusion The application of ultrasound gel pad can improve the stability of SWE measurement,and it has a certain clinical application value in the differential diagnosis of benign and malignant breast lesions.