| 摘要: |
| 目的：评估剪切波弹性成像在乳腺影像报告和数据系统 （BI-RADS）4A类病灶中的诊断价值。
方法：回顾性分析131位乳腺疾病患者，共133个病灶。所有病灶均接受常规超声及剪切波弹性成像检查，且所有病灶均为BI-RADS 4A类。获取每个病灶的剪切波速度最大值（SWVmax）、剪切波速度最小值（SWVmin）、剪切波速度差值（△SWV）及弹性彩色模式，以病理结果为金标准，构建操作者工作特征曲线，计算曲线下面积（AUC）。将剪切波弹性成像各参数与临床资料、常规超声特征联合构建Logistic回归模型，计算该模式的诊断效能，并与剪切波弹性成像各参数进行比较。
结果：133个病灶中，良性病灶110个，恶性病灶23个。患者年龄、Adler血流分级、SWVmax、SWVmin、△SWV及弹性彩色模式在良恶性病灶间有显著差异（P值均<0.05）。SWVmax、SWVmin、△SWV及弹性彩色模式的AUC值分别为0.767、0.643、0.755及0.780，敏感性分别为65.2%、60.9%、69.6%及69.6%，特异性分别为90.0%、60.9%、86.4%及86.4%。SWVmax、△SWV及弹性彩色模式的AUC值差异无统计学意义（P值均>0.05），但均高于SWVmin的AUC值（P值均<0.05）。通过二分类非条件Logistic回归分析显示，共有患者年龄、病灶的Adler血流分级与弹性彩色模式纳入方程，该模型的AUC值、敏感性及特异性分别为0.864、78.3%及为90.9%，诊断效能明显大于剪切波弹性成像的任一参数（P值均<0.05）。
结论：剪切波弹性成像在乳腺BI-RADS 4A类病灶的鉴别诊断中有一定的诊断价值，尤其是SWVmax、△SWV及弹性彩色模式的诊断性能较高。多因素Logistic回归显示弹性彩色模式与年龄、Alder血流分级的结合可最大限度提高BI-RADS 4A类恶性病灶的检出率，并降低不必要的穿刺活检率。 |
| 关键词: 剪切波弹性成像 乳腺病灶 超声 BI-RADS |
| DOI： |
| 投稿时间：2020-04-28修订日期：2021-03-01 |
| 基金项目: |
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| The value of shear wave elastography in the differential diagnosis of breast BI-RADS category 4A lesions |
| Zhang Yidan,Kong Wentao,Wang Ying,Wu Min |
| (Department of Ultrasound,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing Medical School) |
| Abstract: |
| Objective:To evaluate the diagnostic value of shear wave elastography(SWE) in Breast Imaging Reporting and Data System(BI-RADS) category 4A lesions.
Methods:Data from 131 patients with a total of 133 breast lesions were analyzed retrospectively.Every patient underwent conventional ultrasound and SWE, and all lesions were classified as BI-RADS category 4A.Obtain the maximum shear wave velocity (SWVmax), minimum shear wave velocity (SWVmin), shear wave velocity difference (△SWV) and elastic color pattern of each lesion.Using pathological results as the gold standard, the operator's working characteristic curve(ROC) was drawn, and the area under the curve (AUC) of each method was achieved.The parameters of SWE were combined with clinical data and conventional ultrasound features to construct a logistic regression model. The diagnostic performance of this model was obtained and compared with the parameters of SWE.
Results:Of 133 lesions,110 were benign and 23 were malignant.There were statistically significant difference in patient's age, the Adler stratifications of vascularity,SWVmax,
SWVmin,△SWV and color pattern between benign and malignant lesions.The AUCs of SWVmax,SWVmin,△SWV and color pattern were 0.767,0.643,0.755 and 0.780,the sensitivity were 65.2%,60.9%,69.6%and 69.6%,the specificity were 90.0%,60.9%,86.4% and 86.4%,respectively.The AUCs of SWVmax,△SWV and color pattern were similar(all P>0.05),but all higher than that of SWVmin(all P<0.05).The analysis of Logistic regression showed that patient's age,the Adler stratifications of vascularity and elastic color pattern were included in the equation.The AUC,sensitivity and specificity of the model were 0.864,78.3% and 90.9%,respectively, and were higher than each parameters of SWE alone.
Conclusions:SWE had a certain diagnostic value in differential diagnosis of breast BI-RADS category 4A lesions, especially SWVmax,△SWV and color pattern showed high diagnostic performance.Logistic regression analysis revealed that the combination of color pattern with patient's age and the Adler stratifications of vascularity could detection more malignant lesions and reduce the unnecessary biopsies. |
| Key words: Shear wave elastography Breast lesion Ultrasound BI-RADS. |
