超声剪切波弹性成像对优化乳腺肿物BI-RADS分类中的临床价值研究

Clinical Value of Ultrasound Shear Wave Elastography in Optimizing the BI-RADS Classification of Breast Masses

摘要: 目的：研究超声剪切波弹性成像(SWE)在优化乳腺肿物BI-RADS分类中的临床价值。方法：以本院2016年1月~2018年4月就诊的100例(106个)乳腺肿物患者为研究对象，均经病理证实，先行常规超声扫描，行常规BI-RADS分类，再行SWE检测，获取定量参数。以病理结果为金标准，比较分析常规BI-RADS分类、SWE参数弹性最大值(E_max)、E_max优化BI-RADS分类后诊断乳腺恶性病变的敏感度、特异度、准确度。结果：病理证实恶性病变42个，良性病变64个；乳腺恶性病变Emax、弹性最小值(E_min)、平均值(E_mean)、方差(SD)、弹性比值(E_ratio)均显著高于良性病变(P < 0.05)；以病理结果为金标准，常规BI-RASD分类诊断乳腺恶性病变敏感度、特异度、准确度分别为92.86%、57.81%、71.70%；受试者工作特征(ROC)曲线分析E_max、E_min、E_mean、SD、E_ratio曲线下面积(AUC)分别为0.94、0.55、0.88、0.90、0.85；约登指数最大时E_max临界值为61.00 kPa，E_max诊断敏感度、特异度、准确度分别为78.57%、93.75%、87.74%；E_max优化BI-RADS分类调整后诊断乳腺恶性病变敏感度为92.86%、96.87%、94.34%。结论：SWE弹性最大值E_max优化BI-RADS分类能提高乳腺肿物恶性病变诊断特异度及准确度。

Abstract: Objective: To study the clinical value of ultrasound shear wave elastography (SWE) in optimizing the BI-RADS classification of breast masses. Methods: A total of 100 patients with 106 breast masses treated in the hospital from January 2016 to April 2018 were enrolled in the study. All masses were confirmed by pathology. The routine ultrasound scan was performed firstly, the conventional BI-RADS classification was performed secondly, and then SWE was performed to get quantitative parameters. With pathological results as the golden standard, the sensitivities, speci-ficities and accuracy areas of the conventional BI-RADS classification, the maximum SWE parameter elasticity (E_max) and E_max optimized BI-RADS classification for the diagnosis of malignant breast lesions were comparatively analyzed. Results: Pathologically 42 malignant lesions and 64 benign lesions were confirmed. The E_max, the minimum elasticity (E_min), mean elasticity (E_mean), square de-viation (SD) and elasticity ratio (E_ratio) of malignant breast lesions were significantly higher than those of benign lesions (P < 0.05). With pathological results as the golden standard, the sensitivity, specificity and accuracy of conventional BI-RASD classification for diagnosis of malignant breast lesions were 92.86%, 57.81% and 71.70%, respectively. The receiver operating characteristic (ROC) curve analysis showed that areas under curves (AUC) of E_max, E_min, E_mean, SD and E_ratio were 0.94, 0.55, 0.88, 0.90 and 0.85, respectively. When the Jordan index was maximum, the cut-off value of E_max was 61.00 kPa. The diagnostic sensitivity, specificity and accuracy of E_max were 78.57%, 93.75% and 87.74%. The sensitivities after adjustment of E_max optimized BI-RADS classification for the diagnosis of malignant breast lesions were 92.86%, 96.87% and 94.34%. Conclusion: The SWE maximum elasticity E_max optimized BI-RADS classification can improve the diagnostic specificity and accuracy of malignant breast lesions.