剪切波弹性成像提高了乳腺超声的特异性：BE1 多国研究 939 个肿块。
Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses.
机构信息
Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket St, Pittsburgh, PA 15213, USA.
出版信息
Radiology. 2012 Feb;262(2):435-49. doi: 10.1148/radiol.11110640.
PURPOSE
To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses.
MATERIALS AND METHODS
From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined.
RESULTS
Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962 (P=.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC.
CONCLUSION
Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.
目的
确定在超声（US）评估乳腺肿块时添加剪切波（SW）弹性特征是否能提高准确性。
材料和方法
本前瞻性多中心机构审查委员会批准、符合 HIPAA 规定的协议于 2008 年 9 月至 2010 年 9 月进行，958 名女性同意重复标准乳房 US 检查并补充定量 SW 弹性检查。记录 B 型乳腺成像报告和数据系统（BI-RADS）特征和评估。进行 SW 弹性评估（肿块最硬部分和周围组织的平均、最大和最小弹性；病变与脂肪的弹性比；SW 弹性与 B 型病变直径或面积的比值；SW 弹性病变形状和均匀性）。独立评估 SW 弹性的定性彩色硬度。可分析 939 个肿块；102 个 BI-RADS 类别 2 肿块被假定为良性；837 个类别 3 或更高病变有参考标准。将 BI-RADS 类别 4a 或更高视为恶性的阳性结果，确定 SW 弹性特征对重新分类为 3 类和 4a 类病变后的接收者操作特征曲线（ROC）曲线下面积（AUC）、敏感性和特异性的影响。
结果
中位参与者年龄为 50 岁；939 个肿块中有 289 个（30.8%）为恶性（中位数肿块大小为 12mm）。B 型 BI-RADS AUC 为 0.950；303 个 BI-RADS 类别 3 肿块中有 8 个（2.6%）、193 个类别 4a 病变中有 18 个（9.3%）、97 个类别 4b 病变中有 41 个（42%）、57 个类别 4c 病变中有 42 个（74%）和 187 个类别 5 病变中有 180 个（96.3%）为恶性。通过使用视觉彩色硬度选择性升级类别 3 并降低类别 4a 肿块的硬度，特异性从 61.1%（397/650）提高到 78.5%（510/650）（P<.001）；AUC 增加到 0.962（P=.005）。SW 弹性图像上的椭圆形形状和定量最大弹性 80kPa（5.2m/sec）或更低可提高特异性（69.4%[451/650]和 77.4%[503/650]，两者均<.001），而敏感性或 AUC 无明显改善。
结论
在 BI-RADS 特征分析中添加 SW 弹性特征可提高乳腺 US 肿块评估的特异性，而不降低敏感性。
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