Department of Obstetrics and Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Acad Radiol. 2010 May;17(5):558-63. doi: 10.1016/j.acra.2009.12.006. Epub 2010 Feb 20.
Initial data suggest that elastography can improve the specificity of ultrasound in differentiating benign and malignant breast lesions. The aim of this study was to compare elastography and B-mode ultrasound to determine whether the calculation of strain ratios (SRs) can further improve the differentiation of focal breast lesions.
A total of 227 women with histologically proven focal breast lesions (113 benign, 114 malignant) were included at two German breast centers. The women underwent a standardized ultrasound procedure using a high-end ultrasound system with a 9-MHz broadband linear transducer. B-mode scans and sonoelastograms were analyzed by two experienced readers using the Breast Imaging Reporting and Data System criteria. SRs were calculated from a tumor-adjusted region of interest (mean color pixel density) and a comparable region of interest placed in the lateral fatty tissue. Sensitivity, specificity, and cutoff values were calculated for SRs (receiver-operating characteristic analysis).
The women had a mean age of 54 years (range, 19-87 years). The mean lesion diameter was 1.6 +/- 0.9 cm. Sensitivity and specificity were 96% and 56% for B-mode scanning, 81% and 89% for elastography, and 90% and 89% for SRs. An SR cutoff value of 2.45 (area under the curve, 0.949) allowed significant differentiation (P < .001) of malignant (mean, 5.1 +/- 4.2) and benign (mean, 1.6 +/- 1.0) lesions. The quantitative method of SR calculation was superior to subjective interpretation of sonoelastograms and B-mode scans, with a positive predictive value of 89% compared to 68% and 84% for the other two methods.
Calculation of SRs contributes to the standardization of sonoelastography with high sensitivity and allows significant differentiation of benign and malignant breast lesions with higher specificity compared to B-mode ultrasound but not elastography.
初步数据表明，弹性成像技术可以提高超声在鉴别乳腺良恶性病变中的特异性。本研究旨在比较弹性成像和 B 超，以确定应变比（SR）的计算是否可以进一步提高对乳腺局灶性病变的鉴别能力。
在德国两家乳腺中心，共纳入了 227 名经组织学证实的乳腺局灶性病变（113 例良性，114 例恶性）的女性。这些女性在使用具有 9MHz 宽带线性探头的高端超声系统进行标准化超声检查时接受了检查。两位经验丰富的阅片者使用乳腺影像报告和数据系统标准对 B 超扫描和超声弹性图进行分析。SRs 是从肿瘤调整的感兴趣区域（平均彩色像素密度）和放置在外侧脂肪组织中的可比感兴趣区域计算得出的。计算了 SRs 的灵敏度、特异性和临界值（接受者操作特征分析）。
这些女性的平均年龄为 54 岁（范围，19-87 岁）。病变平均直径为 1.6±0.9cm。B 超扫描的灵敏度和特异性分别为 96%和 56%，弹性成像为 81%和 89%，SRs 为 90%和 89%。SRs 的截断值为 2.45（曲线下面积，0.949）可以显著区分恶性（平均 5.1±4.2）和良性（平均 1.6±1.0）病变（P<.001）。SR 计算的定量方法优于超声弹性图和 B 超扫描的主观解读，阳性预测值为 89%，而另外两种方法分别为 68%和 84%。
SRs 的计算有助于提高超声弹性成像的标准化，具有较高的灵敏度，并能显著区分良性和恶性乳腺病变，特异性高于 B 超但不如弹性成像。
