Fischer T, Filimonow S, Hamm B, Slowinski T, Thomas A
Institut für Radiologie, Charité Universitätsmedizin Berlin.
Rofo. 2006 Dec;178(12):1224-34. doi: 10.1055/s-2006-927061.
The diagnostic value of 3D ultrasound (US) was evaluated in comparison to 2D US on the basis of a set of pre-defined criteria for breast lesions. The individual criteria were correlated with the histological findings and they were ranked according to their significance for lesion characterization in both 3D US and 2D US.
A total of 92 breast lesions were examined of which 61 were malignant and 31 were benign, as confirmed by histology of core biopsy specimens (Aplio 80, Toshiba, Otawara, Japan). The 2D and 3D data sets were stored digitally. The vascular tree was stored separately using 3D fusion. In addition, a power Doppler (PD) examination was performed. A total of 644 individual images were evaluated by two independent readers. The lesions were evaluated using established criteria (BI-RADS classification). For statistical evaluation, the individual US measurements were classified according to the following two groups: those suggesting malignant lesions and those suggestive of benign lesions. Pearsons's chi-square test was performed for both groups. The 2D and 3D techniques were compared directly using kappa (kappa) statistics. Odds ratios (OR) were determined for the purpose of weighting the individual criteria. The sensitivities and specificities of 2D and 3D US were calculated.
The diagnostic value of 3D US was comparable to that of 2D US, with only slight differences observed for specific measurements. Analysis of 2D US data indicated that there was a strong correlation between malignant tumor growth and two specific 2D criteria: lesion margin and effect of the lesion on adjacent breast tissue (r (2) = 0.632, p < 0.001). Analysis of 3D images indicated that the significant measurements for tumor malignancy were shape and lesion margin in sagittal, transverse (r (2) = 0741, p < 0.001), and frontal views (r (2) = 0.592, p < 0.001) as well as retraction and lesion demarcation in the frontal views (r (2) = 0.649, p < 0.001). The comparison of 2D and 3D yielded primarily moderate (kappa = 0.412) to good (kappa = 0.789) agreement between the individual criteria. Crucial criteria for lesion characterization were the effect of the lesion on adjacent breast tissue (OR 47.8 [16.0-143.3]) in 2D US and the lesion margin (OR 36.4 [15.3-86.6]) and the 3 additional criteria of the frontal plane (OR 21.9-32.9) in 3D US. The two US techniques had comparable sensitivities (2D/3D 95-97 %/92-95 %) and specificities (2D/3D 54-58 %/61-67 %). The reconstructed 3D view of the vascular tree was subjectively considered to be helpful by both readers. A higher degree of vascularization was observed with 3D US.
The diagnostic role of 3D ultrasound in the diagnostic evaluation of breast cancer is comparable to that of 2D US. Our findings illustrate the significance of the evaluation of frontal views in lesion characterization.
基于一组针对乳腺病变的预定义标准，将三维超声（US）与二维超声进行比较，评估其诊断价值。将各个标准与组织学结果相关联，并根据其在三维超声和二维超声中对病变特征描述的重要性进行排序。
共检查了92个乳腺病变，经芯针活检标本组织学证实（Aplio 80，东芝，大田原，日本），其中61个为恶性，31个为良性。二维和三维数据集以数字方式存储。使用三维融合技术单独存储血管树。此外，进行了能量多普勒（PD）检查。两位独立的阅片者共评估了644张个体图像。使用既定标准（BI-RADS分类）对病变进行评估。为进行统计学评估，将个体超声测量结果分为以下两组：提示恶性病变的和提示良性病变的。对两组均进行了Pearson卡方检验。使用kappa（κ）统计量直接比较二维和三维技术。为加权各个标准，确定了比值比（OR）。计算了二维和三维超声的敏感性和特异性。
三维超声的诊断价值与二维超声相当，仅在特定测量中观察到细微差异。二维超声数据分析表明，恶性肿瘤生长与两个特定的二维标准之间存在强相关性：病变边界以及病变对相邻乳腺组织的影响（r² = 0.632，p < 0.001）。三维图像分析表明，肿瘤恶性程度的重要测量指标为矢状面、横断面（r² = 0.741，p < 0.001）和额面视图中的形状和病变边界（r² = 0.592，p < 0.001）以及额面视图中的回缩和病变分界（r² = 0.649，p < 0.001）。二维和三维的比较主要显示各个标准之间具有中等（κ = 0.412）至良好（κ = 0.789）的一致性。病变特征描述的关键标准在二维超声中为病变对相邻乳腺组织的影响（OR 47.8 [16.0 - 143.3]），在三维超声中为病变边界（OR 36.4 [15.3 - 86.6]）以及额面的另外三个标准（OR 21.9 - 32.9）。两种超声技术具有相当的敏感性（二维/三维 95 - 97%/92 - 95%）和特异性（二维/三维 54 - 58%/61 - 67%）。两位阅片者主观上均认为血管树的三维重建视图有帮助。三维超声观察到更高程度的血管化。
三维超声在乳腺癌诊断评估中的诊断作用与二维超声相当。我们的研究结果说明了在病变特征描述中评估额面视图的重要性。
