剪切波弹性成像及自动乳腺全容积成像在乳腺肿块鉴别诊断中的价值  

The value of shear wave elastography combined with automated breast volume scanning in the differential diagnosis of breast masses

作　　者：王惠[1] 郭顺林[2] 马苏美[1] 雷军强[2] 李金桥 李沛 WANG Hui;GUO Shunlin;MA Sumei;LEI Junqiang;LI Jinqiao;LI Pei(Department of Ultrasound Medical,The First Hospital of Lanzhou University,Lanzhou 730000,P.R.China;Department of Radiology Medical,The First Hospital of Lanzhou University,Lanzhou 730000,P.R.China)

机构地区：[1]兰州大学第一医院超声医学科,甘肃兰州730000 [2]兰州大学第一医院放射医学科,甘肃兰州730000

出　　处：《医学影像学杂志》2021年第7期1189-1192,1224,共5页Journal of Medical Imaging

基　　金：兰州大学第一医院2019年度院内基金项目(编号:ldyyyn2019-65)。

摘　　要：目的探讨剪切波弹性成像(SWE)联合自动乳腺全容积成像(ABVS)在鉴别乳腺良恶性肿块中的价值。方法选取我院乳腺中心就诊的患者94例,共115个肿块,采用SWE与ABVS技术对乳腺肿块进行检测,获取肿块内剪切波弹性模量最大值Emax、剪切波弹性模量平均值Emean、肿块与周围脂肪组织弹性模量比值Eratio(单位为kPa)及ABVS冠状面图像,比较良恶性肿块的剪切波弹性模量值,判断冠状面超声征象。以穿刺组织学和手术病理为金标准,绘制受试者工作特征(ROC)曲线,确定诊断价值最高的一组弹性模量值,获得最佳诊断截点。结果乳腺恶性病灶的ABVS冠状面“汇聚征”出现率高于良性病灶,差异有统计学意义(χ^(2)=53274,P<0.05);恶性病灶组的Emax、Emean、Eratio均高于乳腺良性病灶组,差异均有统计学意义(P<0.05),乳腺肿块Emax、Emean、Eratio对应ROC曲线下面积分别为0.972、0.961及0.908,其中,肿块内Emax的诊断价值最高,其诊断截点为57.5kPa。ABVS冠状面“汇聚征”、肿块内Emax及两者联合诊断乳腺肿块良恶性的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为91.9%、90.9%、92.7%,76.9%、96.6%、98.3%,81.7%、93.9%、95.6%,65.4%、96.2%、98.1%,95.2%、92.1%、93.6%。结论ABVS冠状面“汇聚征”及SWE技术联合应用能提高鉴别诊断的敏感度、特异度、阳性预测值及准确性。Objective To evaluate the value of shear wave elastography(SWE)combined with automated breast volume scanning(ABVS)in differentiating benign and malignant breast masses.Methods From October 2019 to May 2020,94 patients with a total of 115 masses were detected using SWE and ABVS technology in our breast center.Emax,Emean,Eratio(in kPa)and ABVS coronal plane imaging for each mass were acquired before operation or core needle biopsy.According to pathological results,the ROC curves were performed to evaluate the diagnostic value of SWE alone,ABVS alone(convergence sign on coronal plane)and their combination in the diagnosis of breast masses.Results The rate of convergence sign on coronal plane in malignant masses was significantly higher than that in benign masses(χ^(2)=53274,P=<0.05).Emax,Emean and Eratio of the malignant masses were all higher than those in the benign breast masses,with statistically significant differences(P<0.05).The AUC of breast masses for Emax,Emean and Eratio were 0.972,0.961 and 0.908,respectively.With cut-off point of 57.5 kPa,Emax showed the best diagnostic value.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of convergence sign on coronal plane,Emax and their combination in diagnosing breast masses were(91.9%,90.9%,92.7%),(76.9%,96.6%,98.3%),(81.7%,93.9%,95.6%),(65.4%,96.2%,98.1%),(95.2%,92.1%,93.6%).Conclusion Both the convergence sign on coronal plane of ABVS and SWE have high diagnostic value and combining of two methods can improve the differential diagnostic value for breast masses.

关 键 词：乳腺肿瘤 超声检查 

分 类 号：R739.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]