Department of Surgery, Kosin University Gospel Hospital, Busan, Korea.
Department of Radiology, Kosin University Gospel Hospital, Busan, Korea.
J Breast Cancer. 2014 Mar;17(1):76-82. doi: 10.4048/jbc.2014.17.1.76. Epub 2014 Mar 28.
The aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone.
ARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch™ tissue imaging (VTI) and Virtual Touch™ tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations.
Among the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7±1.0 vs. 1.6±0.8, p<0.01), SWV (4.23±1.09 m/sec vs. 2.22±0.88 m/sec, p<0.01), and SR (5.69±1.63 vs. 2.69±1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each).
ARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.
本研究旨在确定 B 型超声（BUS）、声辐射力脉冲（ARFI）弹性成像和应变比（SR）联合应用是否比单独使用 BUS 提供更好的乳腺病变鉴别诊断性能。
2013 年 6 月至 9 月，对 157 例经 BUS 诊断的乳腺病变患者进行 ARFI 弹性成像和 SR 评估。根据乳腺影像报告和数据系统（BI-RADS）对 BUS 图像进行分类。ARFI 弹性成像采用虚拟触诊组织成像（VTI）和虚拟触诊组织定量（VTQ）技术。在 VTI 模式下，我们评估了乳腺病变及周围组织的彩色映射模式。根据弹性评分将病变分为五类。在 VTQ 模式下，用剪切波速度（SWV）测量对每个病变进行评估。SR 由病变和可比的外侧脂肪组织计算得出。我们比较了单独使用 BUS 以及联合使用 BUS、ARFI 弹性成像和 SR 评估的诊断性能。
在 157 个病变中，40 个为恶性，117 个为良性。恶性病变的平均弹性评分（3.7±1.0 比 1.6±0.8，p<0.01）、SWV（4.23±1.09 m/sec 比 2.22±0.88 m/sec，p<0.01）和 SR（5.69±1.63 比 2.69±1.40，p<0.01）明显高于良性病变。BUS 联合 ARFI 弹性成像和 SR 值的诊断结果为 97.5%的敏感性、92.3%的特异性、93.6%的准确性、79.6%的阳性预测值（PPV）和 99.1%的阴性预测值。与单独使用 BUS 相比，这 3 种影像学检查的联合应用具有更高的特异性、准确性和 PPV（p<0.01）。
ARFI 弹性成像和 SR 值对良性和恶性病变的平均值有明显差异。此外，这两种方法补充了 BUS，并提高了乳腺病变检测的诊断性能。因此，ARFI 弹性成像和 SR 值可以作为互补方法，以做出更准确的乳腺病变诊断。
