Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Eur J Radiol. 2013 Nov;82(11):e680-5. doi: 10.1016/j.ejrad.2013.08.004. Epub 2013 Aug 14.
To evaluate the interobserver agreement and the diagnostic performance of various qualitative features in shear-wave elastography (SWE) for breast masses.
A total of 153 breast lesions in 152 women who underwent B-mode ultrasound and SWE before biopsy were included. Qualitative analysis in SWE was performed using two different classifications: E values (Ecol; 6-point color score, Ehomo; homogeneity score and Esha; shape score) and a four-color pattern classification. Two radiologists reviewed five data sets: B-mode ultrasound, SWE, and combination of both for E values and four-color pattern. The BI-RADS categories were assessed B-mode and combined sets. Interobserver agreement was assessed using weighted κ statistics. Areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were analyzed.
Interobserver agreement was substantial for Ecol (κ=0.79), Ehomo (κ=0.77) and four-color pattern (κ=0.64), and moderate for Esha (κ=0.56). Better-performing qualitative features were Ecol and four-color pattern (AUCs, 0.932 and 0.925) compared with Ehomo and Esha (AUCs, 0.857 and 0.864; P<0.05). The diagnostic performance of B-mode ultrasound (AUC, 0.950) was not significantly different from combined sets with E value and with four color pattern (AUCs, 0.962 and 0.954). When all qualitative values were negative, leading to downgrade the BI-RADS category, the specificity increased significantly from 16.5% to 56.1% (E value) and 57.0% (four-color pattern) (P<0.001) without improvement in sensitivity.
The qualitative SWE features were highly reproducible and showed good diagnostic performance in suspicious breast masses. Adding qualitative SWE to B-mode ultrasound increased specificity in decision making for biopsy recommendation.
评估剪切波弹性成像（SWE）中各种定性特征在乳腺肿块中的观察者间一致性和诊断性能。
共纳入 152 例女性 153 个乳腺病变，所有患者均行 B 超及 SWE 检查，且均在穿刺活检前行上述检查。SWE 的定性分析采用两种不同的分类方法：E 值（Ecol；6 分色评分、Ehomo；均匀性评分和 Esha；形状评分）和四色模式分类。两位放射科医生对五种数据进行了回顾：B 超、SWE 及两者结合的 E 值和四色模式。BI-RADS 类别分别在 B 超和结合组进行评估。采用加权 κ 统计评估观察者间一致性。分析受试者工作特征曲线（ROC）下面积（AUC）、敏感性和特异性。
Ecol（κ=0.79）、Ehomo（κ=0.77）和四色模式（κ=0.64）的观察者间一致性较好，Esha（κ=0.56）的观察者间一致性中等。Ecol 和四色模式（AUCs 为 0.932 和 0.925）的定性特征比 Ehomo 和 Esha（AUCs 为 0.857 和 0.864）表现更好（P<0.05）。B 超（AUC 为 0.950）的诊断性能与 E 值和四色模式的联合组（AUC 分别为 0.962 和 0.954）无显著差异。当所有定性值均为阴性时，BI-RADS 类别降级，E 值（特异性从 16.5%显著提高至 56.1%）和四色模式（特异性从 16.5%显著提高至 57.0%）（P<0.001），而敏感性无改善。
SWE 的定性特征具有高度可重复性，在可疑乳腺肿块中具有良好的诊断性能。在决定是否推荐活检时，将定性 SWE 添加到 B 超中可提高特异性。
