剪切波弹性成像与应变式弹性成像技术对乳腺良、恶性肿块鉴别诊断的对比研究
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摘要
目的比较剪切波弹性成像(SWE)技术与应变式弹性成像技术在乳腺良、恶性肿块鉴别诊断中的应用价值。方法将2017年7-12月在滨州医学院附属医院超声医学科检查发现乳腺肿块的90例患者纳入研究,共92枚乳腺肿块。术前均行SWE与应变式弹性成像检查。采用SWE技术测定92枚乳腺肿块的弹性模量最大值(Emax),并得出Emax的诊断临界值进行诊断,之后采用应变式弹性成像技术并以5分评分法进行鉴别诊断。以病理结果作为"金标准",分别计算SWE技术与应变式弹性成像技术鉴别诊断乳腺良、恶性肿块的敏感性、特异性、准确性。结果 SWE技术诊断乳腺良、恶性肿块的临界值为61.45kPa,SWE和应变式弹性成像诊断乳腺良、恶性肿块的敏感性、特异性、准确性分别为84.85%、94.92%、91.30%和87.88%、86.44%、86.96%。SWE及应变式弹性成像技术诊断乳腺肿块良、恶性的诊断效能比较,差异有统计学意义(P<0.05)。结论 SWE及应变式弹性成像对乳腺良、恶性肿块的鉴别诊断均有一定的临床应用价值,其中SWE的鉴别诊断效能要优于应变式弹性成像,但2种技术各具优势,应灵活应用。
Objective To compare the application value of shear wave elastic imaging(SWE)and strain elastography imaging in differential diagnosis of benign and malignant breast masses.Methods The study included 90 cases of breast masses found by ultrasound examination in the Affiliated Hospital of Binzhou Medical Universityfrom July to December 2017,there were 92 breast masses.SWE technology and strain elastography technology were performed before surgery.The Emaxvalue of 92 breast masses was measured by SWE,and the diagnostic threshold of Emaxvalue was obtained for diagnosis.After,strain elastography was used and the diagnosis was made by 5 points.Histopathologic result after surgery was adopted as diagnostic reference.Compared with pathological results,the sensitivity,specificity and accuracy of SWE and strain elastography technology were calculated.ResultsThe optimal cut-off value was 61.45 kPa to distinguish malignant breast solid lesions from benign for SWE.Generally,the sensitivity,specificity and accuracy were 84.85%,94.92% and 91.30%for SWE,and 87.88%,86.44% and 86.96%for strain elastography,respectively.The difference in diagnosis efficiency among SWE and strain elastography in differential diagnosis of benign and malignant breast tumors was statistically significant(P<0.05).Conclusion SWE and strain elastography are all useful for the differential diagnosis of benign and malignant breast tumors.But the diagnosis efficiency of SWE is superior to strain elastography.Each approach has respective advantages,it should be used flexible.
Objective To compare the application value of shear wave elastic imaging(SWE)and strain elastography imaging in differential diagnosis of benign and malignant breast masses.Methods The study included 90 cases of breast masses found by ultrasound examination in the Affiliated Hospital of Binzhou Medical Universityfrom July to December 2017,there were 92 breast masses.SWE technology and strain elastography technology were performed before surgery.The Emaxvalue of 92 breast masses was measured by SWE,and the diagnostic threshold of Emaxvalue was obtained for diagnosis.After,strain elastography was used and the diagnosis was made by 5 points.Histopathologic result after surgery was adopted as diagnostic reference.Compared with pathological results,the sensitivity,specificity and accuracy of SWE and strain elastography technology were calculated.ResultsThe optimal cut-off value was 61.45 kPa to distinguish malignant breast solid lesions from benign for SWE.Generally,the sensitivity,specificity and accuracy were 84.85%,94.92% and 91.30%for SWE,and 87.88%,86.44% and 86.96%for strain elastography,respectively.The difference in diagnosis efficiency among SWE and strain elastography in differential diagnosis of benign and malignant breast tumors was statistically significant(P<0.05).Conclusion SWE and strain elastography are all useful for the differential diagnosis of benign and malignant breast tumors.But the diagnosis efficiency of SWE is superior to strain elastography.Each approach has respective advantages,it should be used flexible.
引文
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[11]李奥,栗翠英,巩海燕,等.实时剪切波弹性成像评估乳腺良性结节微波消融效果的价值探讨[J].临床超声医学杂志,2016,18(12):798-800.
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[14]陈玲,沈嫱,张建兴,等.剪切波弹性定量技术及“硬边”征鉴别诊断乳腺实性肿块[J].中国医学影像技术,2015,31(2):263-267.
[15]BAE JS,CHANG JM,LEE SH,et al.Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ[J].Eur Radiol,2017,27(1):7-15.
[16]MORI M,TSUNODA H,KAWAUCHI N,et al.Elastographic evaluation of mucinous carcinoma of the breast[J].Breast Cancer,2012,19(1):60-63.
[17]KOJIMA Y,TSUNODA H.Mammography and ultrasound features of triple-negative breast cancer[J].Breast Cancer,2011,18(3):146-151.
[18]陈雅玲,高毅,王芬,等.乳腺剪切波弹性成像的各向异性与组织病理学的相关性[J].中华超声影像学杂志,2017,26(3):254-258.
[2]潘群艳,马苏亚,薛尧,等.Logistic回归模型评价剪切波弹性成像技术鉴别乳腺病灶良恶性的价值[J/CD].中华医学超声杂志:电子版,2013,10(8):669-673.
[3]ITOH A,UENO E,TOHNO E,et al.Breast disease:clinical application of US elastography for diagnosis[J].Radiology,2006,239(2):341-350.
[4]李娟,吴佳颖,冯齐齐,等.浸润性乳腺癌超声弹性成像与病理的相关性研究[J].医学综述,2015,21(23):4361-4363.
[5] BARR RG.Elastography in clinical practice[J].Radiol Clin North Am,2014,52(6):1145-1162.
[6]赵巧玲,李芬,张华,等.比较超声弹性成像与CDFI鉴别诊断良恶性乳腺病[J].中国医学影像技术,2013,29(1):75-78.
[7]纪晓辉,岳秀红.超声光散射成像联合实时剪切波弹性成像技术在乳腺良恶性肿物中的诊断价值[J].临床超声医学杂志,2016,18(2):127-129.
[8]付玉玉,崔广和,杨智,等.剪切波弹性成像在乳腺良恶性肿块鉴别诊断中的应用价值[J].中国医疗设备,2016,31(3):63-66.
[9]冯清华,罗良平,余江秀.实时组织弹性成像对乳腺良、恶性肿块诊断价值的Meta分析[J].中国医学影像技术,2011,27(2):321-325.
[10]杨洁,张学兰.不同超声成像技术在乳腺良恶性肿瘤鉴别诊断中的应用价值[J/CD].中华医学超声杂志:电子版,2016,13(8):633-635.
[11]李奥,栗翠英,巩海燕,等.实时剪切波弹性成像评估乳腺良性结节微波消融效果的价值探讨[J].临床超声医学杂志,2016,18(12):798-800.
[12]EVANS A,WHELEHAN P,THOMSON K,et al.Quantitative shear wave ultrasound elastography:initial experience in solid breast masses[J].Breast Cancer Res,2010,12(6):R104.
[13]ZHOU J,ZHAN W,CHANG C,et al.Breast lesions:Evaluation with shear wave elastography,with special emphasis on the“stiff rim”sign[J].Radiology,2014,272(1):63-72.
[14]陈玲,沈嫱,张建兴,等.剪切波弹性定量技术及“硬边”征鉴别诊断乳腺实性肿块[J].中国医学影像技术,2015,31(2):263-267.
[15]BAE JS,CHANG JM,LEE SH,et al.Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ[J].Eur Radiol,2017,27(1):7-15.
[16]MORI M,TSUNODA H,KAWAUCHI N,et al.Elastographic evaluation of mucinous carcinoma of the breast[J].Breast Cancer,2012,19(1):60-63.
[17]KOJIMA Y,TSUNODA H.Mammography and ultrasound features of triple-negative breast cancer[J].Breast Cancer,2011,18(3):146-151.
[18]陈雅玲,高毅,王芬,等.乳腺剪切波弹性成像的各向异性与组织病理学的相关性[J].中华超声影像学杂志,2017,26(3):254-258.