H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
Cancer Control. 2010 Jul;17(3):156-61. doi: 10.1177/107327481001700303.
While breast biopsy remains the gold standard for diagnosis of suspicious lesions, a large proportion of biopsy specimens reveal a benign result. Therefore, a noninvasive and reliable method to identify low-risk lesions would be a valuable tool.
We assessed the application and diagnostic performance of elastography for the characterization of breast lesions in patients referred for biopsy. Subjects referred for ultrasound-guided biopsy of sonographically apparent breast lesions were included in this study. The Hitachi Hi-Vision 900 ultrasound was used to generate index test results for elastography scoring (ES) and for strain ratio (SR) measurement. Sensitivity, specificity, and positive and negative predictive values were determined using pathologic results from 14-gauge core needle biopsy as the reference standard.
A total of 310 lesions in 288 patients were included in this series. Of these 310 lesions, 223 (72%) were benign and 87 (28%) were malignant. Sensitivity was 0.76 for ES and 0.79 for SR. Specificity was 0.81 for ES and 0.76 for SR. Positive predictive value was 0.60 for ES and 0.57 for SR. Negative predictive value was 0.90 for ES and 0.90 for SR. SR values for malignant lesions were significantly higher (median ratios 10.5 and 2.7, respectively, P < .001).
While the initial clinical performance of elastography imaging shows potential to reduce biopsy of low-risk lesions, a large-scale trial addressing appropriate patient selection, diagnostic parameters, and practical application of this technique is necessary prior to widespread clinical use.
虽然乳腺活检仍然是诊断可疑病变的金标准,但很大一部分活检标本显示为良性结果。因此,一种非侵入性且可靠的方法来识别低风险病变将是一种有价值的工具。
我们评估了弹性成像在超声引导活检患者中对乳腺病变的应用和诊断性能。本研究纳入了因超声表现明显的乳腺病变而接受超声引导活检的患者。使用日立 Hi-Vision 900 超声仪生成弹性成像评分(ES)和应变比(SR)测量的指数试验结果。使用 14 号活检针的病理结果作为参考标准,确定敏感性、特异性、阳性预测值和阴性预测值。
本系列共纳入 288 例患者的 310 个病变。其中,223 个(72%)病变为良性,87 个(28%)为恶性。ES 的敏感性为 0.76,SR 的敏感性为 0.79。ES 的特异性为 0.81,SR 的特异性为 0.76。ES 的阳性预测值为 0.60,SR 的阳性预测值为 0.57。ES 的阴性预测值为 0.90,SR 的阴性预测值为 0.90。恶性病变的 SR 值明显较高(中位数比值分别为 10.5 和 2.7,P <.001)。
虽然弹性成像成像的初步临床性能显示出减少低风险病变活检的潜力,但在广泛临床应用之前,需要进行大规模试验,以确定合适的患者选择、诊断参数和该技术的实际应用。