Thomas A, Fischer T, Frey H, Ohlinger R, Grunwald S, Blohmer J-U, Winzer K-J, Weber S, Kristiansen G, Ebert B, Kümmel S
Department of Obstetrics and Gynecology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
Ultrasound Obstet Gynecol. 2006 Sep;28(3):335-40. doi: 10.1002/uog.2823.
To evaluate whether real-time elastography, a new, non-invasive method for the diagnosis of breast cancer, improves the differentiation and characterization of benign and malignant breast lesions.
Real-time elastography was carried out in 108 potential breast tumor patients with cytologically or histologically confirmed focal breast lesions (59 benign, 49 malignant; median age, 53.9 years; range, 16-84 years). Tumor and healthy tissue were differentiated by measurement of elasticity based on the correlation between tissue properties and elasticity modulus. Evaluation was performed using the three-dimensional (3D) finite element method, in which the information is color-coded and superimposed on the B-mode ultrasound image. A second observer evaluated the elastography images, in order to improve the objectivity of the method. The results of B-mode scan and elastography were compared with those of histology and previous sonographic findings. Sensitivities and specificities were calculated, taking histology as the gold standard.
B-mode ultrasound had a sensitivity of 91.8% and a specificity of 78%, compared with sensitivities of 77.6% and 79.6% and specificities of 91.5% and 84.7%, respectively, for the two observers evaluating elastography. Agreement between B-mode ultrasound and elastography was good, yielding a weighted kappa of 0.67.
Our initial clinical results suggest that real-time elastography improves the specificity of breast lesion diagnosis and is a promising new approach for the diagnosis of breast cancer. Elastography provides additional information for differentiating malignant BI-RADS (breast imaging reporting and data system) category IV lesions.
评估实时弹性成像这一诊断乳腺癌的新型非侵入性方法是否能改善对乳腺良恶性病变的鉴别与特征描述。
对108例有细胞学或组织学确诊的局灶性乳腺病变的潜在乳腺癌患者（59例良性，49例恶性；中位年龄53.9岁；范围16 - 84岁）进行实时弹性成像检查。基于组织特性与弹性模量之间的相关性，通过测量弹性来区分肿瘤组织和健康组织。采用三维（3D）有限元方法进行评估，其中信息以彩色编码并叠加在B超图像上。由另一位观察者对弹性成像图像进行评估，以提高该方法的客观性。将B超扫描和弹性成像的结果与组织学结果及既往超声检查结果进行比较。以组织学为金标准计算敏感性和特异性。
B超的敏感性为91.8%，特异性为78%，而两位评估弹性成像的观察者的敏感性分别为77.6%和79.6%，特异性分别为91.5%和84.7%。B超与弹性成像之间的一致性良好，加权kappa值为0.67。
我们的初步临床结果表明，实时弹性成像提高了乳腺病变诊断的特异性，是一种有前景的乳腺癌诊断新方法。弹性成像为鉴别恶性乳腺影像报告和数据系统（BI - RADS）IV类病变提供了额外信息。
