Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
J Ultrasound Med. 2010 Apr;29(4):551-63. doi: 10.7863/jum.2010.29.4.551.
The purpose of this study was to prospectively assess the performance of real-time tissue elastography (RTE) in the evaluation of breast masses and correlate RTE and American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) assessments with pathologic findings.
Informed consent was obtained from all patients for this Health Insurance Portability and Accountability Act-compliant, Institutional Review Board-approved study. Patients with sonographically visible breast lesions for which a biopsy was recommended were considered potential study participants. Between October 2006 and February 2008, 186 consecutive women with 200 lesions were enrolled. Twelve lesions in 11 patients were excluded, resulting in a study population of 188 lesions in 175 women. After routine B-mode sonographic examination, RTE was performed using a manual free-hand compression technique. Study lesions were assigned elasticity scores (ES) based on the system proposed by Itoh et al (Radiology 2006; 239:341-350), where 1 is normal and 5 represents abnormal strain. The lesion size on RTE and B-mode imaging was compared. Results were correlated with BI-RADS assessment and pathologic findings.
Pathologic examination revealed 61 of 188 malignancies (32.4%) and 127 of 188 benign lesions (67.6%). Of the malignant lesions, 84% had ES of 5 and 4, whereas 76% of benign lesions had ES of 1 and 2. The sensitivity of RTE was 92.7%, and specificity was 85.8%, with 4 false-negative and 16 false-positive results. Of the biopsy-proven benign BI-RADS 4A lesions, 63 of 76 (82.9%) had ES of 1 and 2, consistent with normal tissue.
Real-time tissue elastography may provide additional characterization of breast lesions, improving specificity, particularly for low-suspicion lesions.
本研究旨在前瞻性评估实时组织弹性成像（RTE）在评估乳腺肿块中的性能，并将 RTE 和美国放射学院乳腺成像报告和数据系统（BI-RADS）评估与病理结果相关联。
本符合《健康保险流通与责任法案》和机构审查委员会批准的研究获得了所有患者的知情同意。对于推荐活检的超声可见乳腺病变的患者，被认为是潜在的研究参与者。在 2006 年 10 月至 2008 年 2 月期间，共有 186 名连续女性患者的 200 个病变被纳入研究。11 名患者的 12 个病变被排除在外，最终有 175 名女性的 188 个病变纳入研究。在常规 B 型超声检查后，使用手动自由手压缩技术进行 RTE。根据 Itoh 等人提出的系统（Radiology 2006; 239:341-350）对研究病变进行弹性评分（ES），其中 1 表示正常，5 表示异常应变。比较 RTE 和 B 型成像上的病变大小。结果与 BI-RADS 评估和病理结果相关联。
病理检查显示 188 个病变中有 61 个为恶性肿瘤（32.4%），127 个为良性病变（67.6%）。在恶性病变中，84%的 ES 为 5 和 4，而 76%的良性病变的 ES 为 1 和 2。RTE 的灵敏度为 92.7%，特异性为 85.8%，有 4 个假阴性和 16 个假阳性结果。在经活检证实的良性 BI-RADS 4A 病变中，76 个中的 63 个（82.9%）的 ES 为 1 和 2，与正常组织一致。
实时组织弹性成像可能为乳腺病变提供额外的特征描述，提高特异性，特别是对低可疑病变。
