Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 100-744, Korea.
AJR Am J Roentgenol. 2013 Aug;201(2):W347-56. doi: 10.2214/AJR.12.10416.
The purpose of this article is to compare the diagnostic performances of shearwave and strain elastography for the differentiation of benign and malignant breast lesions.
B-mode ultrasound and shear-wave and strain elastography were performed in 150 breast lesions; 71 were malignant. BI-RADS final assessment, elasticity values in kilopascals, and elasticity scores on a 5-point scale were assessed before biopsy. The results were compared using the area under the receiver operating characteristic curve (AUC).
The AUC for shear-wave elastography was similar to that of strain elastography (0.928 vs 0.943). The combined use of B-mode ultrasound and either elastography technique improved diagnostic performance in the differentiation of benign and malignant breast lesions compared with the use of B-mode ultrasound alone (B-mode alone, AUC = 0.851; B-mode plus shear-wave elastography, AUC = 0.964; B-mode plus strain elastography, AUC = 0.965; p < 0.001). With the best cutoff points of 80 kPa on shear-wave elastography and a score between 3 and 4 on strain elastography, the sensitivity was higher in shear-wave elastography, and specificity was higher in strain elastography (95.8% vs 81.7%, p = 0.002; 93.7% vs 84.8%, p = 0.016). In cases of infiltrating ductal carcinoma, mean elasticity scores were lower in grade 3 than in grade 1 and 2 cancers (p = 0.017) with strain elastography causing false-negative findings.
The diagnostic performance of shear-wave and strain elastography was similar. Either elastography technique can improve overall diagnostic performance in the differentiation of benign and malignant lesions when combined with B-mode ultrasound. However, the sensitivity and specificity of shear-wave and strain elastography were different according to lesion histologic profile, tumor grade, and breast thickness.
本文旨在比较剪切波弹性成像和应变弹性成像在鉴别乳腺良恶性病变中的诊断性能。
对 150 个乳腺病变进行了 B 型超声和剪切波弹性成像和应变弹性成像检查；其中 71 个为恶性病变。在活检前评估 BI-RADS 最终评估、千帕斯卡的弹性值和 5 分制的弹性评分。使用受试者工作特征曲线下的面积（AUC）进行比较。
剪切波弹性成像的 AUC 与应变弹性成像相似（0.928 对 0.943）。与单独使用 B 型超声相比，联合使用 B 型超声和任何一种弹性成像技术均可提高乳腺良恶性病变的鉴别诊断性能（单独 B 型超声，AUC=0.851；B 型超声加剪切波弹性成像，AUC=0.964；B 型超声加应变弹性成像，AUC=0.965；p<0.001）。在剪切波弹性成像的最佳截断值为 80kPa，应变弹性成像的评分在 3 到 4 之间时，剪切波弹性成像的敏感性较高，应变弹性成像的特异性较高（95.8%对 81.7%，p=0.002；93.7%对 84.8%，p=0.016）。在浸润性导管癌中，3 级的平均弹性评分低于 1 级和 2 级癌症（p=0.017），应变弹性成像出现假阴性结果。
剪切波和应变弹性成像的诊断性能相似。当与 B 型超声联合使用时，任何一种弹性成像技术都可以提高良恶性病变的整体诊断性能。然而，根据病变的组织学特征、肿瘤分级和乳房厚度，剪切波和应变弹性成像的敏感性和特异性有所不同。
