Division of Imaging and Technology, Medical Research Institute, Ninewells Hospital Medical School, University of Dundee, Mailbox 4, Dundee, DD1 9SY, UK,
Eur Radiol. 2014 Apr;24(4):921-6. doi: 10.1007/s00330-013-3079-4. Epub 2013 Dec 11.
Shear wave elastography (SWE) is a promising adjunct to greyscale ultrasound in differentiating benign from malignant breast masses. The purpose of this study was to characterise breast cancers which are not stiff on quantitative SWE, to elucidate potential sources of error in clinical application of SWE to evaluation of breast masses.
Three hundred and two consecutive patients examined by SWE who underwent immediate surgery for breast cancer were included. Characteristics of 280 lesions with suspicious SWE values (mean stiffness >50 kPa) were compared with 22 lesions with benign SWE values (<50 kPa). Statistical significance of the differences was assessed using non-parametric goodness-of-fit tests.
Pure ductal carcinoma in situ (DCIS) masses were more often soft on SWE than masses representing invasive breast cancer. Invasive cancers that were soft were more frequently: histological grade 1, tubular subtype, ≤10 mm invasive size and detected at screening mammography. No significant differences were found with respect to the presence of invasive lobular cancer, vascular invasion, hormone and HER-2 receptor status. Lymph node positivity was less common in soft cancers.
Malignant breast masses classified as benign by quantitative SWE tend to have better prognostic features than those correctly classified as malignant.
• Over 90 % of cancers assessable with ultrasound have a mean stiffness >50 kPa. • 'Soft' invasive cancers are frequently small (≤10 mm), low grade and screen-detected. • Pure DCIS masses are more often soft than invasive cancers (>40 %). • Large symptomatic masses are better evaluated with SWE than small clinically occult lesions. • When assessing small lesions, 'softness' should not raise the threshold for biopsy.
剪切波弹性成像（SWE）是灰阶超声的一种有前途的辅助手段，可用于区分良性和恶性乳腺肿块。本研究的目的是描述在定量 SWE 上不硬的乳腺癌，阐明 SWE 在评估乳腺肿块中的临床应用中潜在的误差源。
纳入了 302 例连续接受 SWE 检查并立即因乳腺癌接受手术的患者。比较了 280 个可疑 SWE 值（平均硬度>50kPa）病变的特征与 22 个良性 SWE 值（<50kPa）病变的特征。使用非参数拟合优度检验评估差异的统计学意义。
纯导管原位癌（DCIS）肿块在 SWE 上比代表浸润性乳腺癌的肿块更软。柔软的浸润性癌更常为：组织学分级 1 级、管状亚型、浸润性大小≤10mm 和在筛查性乳房 X 线摄影中发现。在浸润性小叶癌、血管浸润、激素和 HER-2 受体状态方面未发现显著差异。在柔软的癌症中，淋巴结阳性的情况较少。
通过定量 SWE 分类为良性的恶性乳腺肿块比正确分类为恶性的肿块具有更好的预后特征。
超过 90%的可通过超声评估的癌症的平均硬度>50kPa。
“柔软”的浸润性癌常较小（≤10mm）、低级别且在筛查中发现。
纯 DCIS 肿块比浸润性癌（>40%）更常柔软。
大的有症状的肿块比小的临床隐匿性病变更适合用 SWE 评估。
在评估小病变时，“柔软度”不应提高活检的阈值。
