From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 100-744, Korea.
Radiology. 2014 Oct;273(1):61-9. doi: 10.1148/radiol.14132443. Epub 2014 Jun 19.
To evaluate the additional value of shear-wave elastography (SWE) to B-mode ultrasonography (US) and to determine an appropriate guideline for the combined assessment of screening US-detected breast masses.
This study was conducted with institutional review board approval, and written informed consent was obtained. From March 2010 to February 2012, B-mode US and SWE were performed in 159 US-detected breast masses before biopsy. For each lesion, Breast Imaging Reporting and Data System (BI-RADS) category on B-mode US images and the maximum stiffness color and elasticity values on SWE images were assessed. A guideline for adding SWE data to B-mode US was developed with the retrospective cohort to improve diagnostic performance in sensitivity and specificity and was validated in a distinct prospective cohort of 207 women prior to biopsy.
Twenty-one of 159 masses in the development cohort and 12 of 207 breast masses in the validation cohort were malignant. In the development cohort, when BI-RADS category 4a masses showing a dark blue color or a maximum elasticity value of 30 kPa or less on SWE images were downgraded to category 3, specificity increased from 9.4% (13 of 138) to 59.4% (82 of 138) and 57.2% (79 of 138) (P < .001), respectively, without loss in sensitivity (100% [21 of 21]). In the validation cohort, specificity increased from 17.4% (34 of 195) to 62.1% (121 of 195) and 53.3% (104 of 195) (P < .001) respectively, without loss in sensitivity (91.7% [11 of 12]).
The addition of SWE to B-mode US improved diagnostic performance with increased specificity for screening US-detected breast masses. BI-RADS category 4a masses detected at US screening that showed a dark blue color or a maximum elasticity value of 30 kPa or less on SWE images can be safely followed up instead of performing biopsy.
评估剪切波弹性成像（SWE）对 B 型超声（US）的附加价值，并为筛查性 US 检测到的乳腺肿块的联合评估制定合适的指南。
本研究经机构审查委员会批准，并获得书面知情同意。2010 年 3 月至 2012 年 2 月，对 159 个经 US 检测到的乳腺肿块在活检前进行了 B 型 US 和 SWE 检查。对每个病变，评估 B 型 US 图像上的乳腺影像报告和数据系统（BI-RADS）分类以及 SWE 图像上的最大硬度彩色和弹性值。通过回顾性队列制定了将 SWE 数据添加到 B 型 US 的指南，以提高诊断性能的敏感性和特异性，并在活检前对 207 名女性的独立前瞻性队列进行了验证。
在开发队列的 159 个肿块中有 21 个，在验证队列的 207 个乳腺肿块中有 12 个是恶性的。在开发队列中，当 BI-RADS 类别 4a 肿块在 SWE 图像上显示深蓝色或最大弹性值为 30 kPa 或更低时，降级为类别 3，特异性从 9.4%（13/138）增加到 59.4%（82/138）和 57.2%（79/138）（P<0.001），而敏感性没有损失（100%[21/21]）。在验证队列中，特异性从 17.4%（34/195）增加到 62.1%（121/195）和 53.3%（104/195）（P<0.001），而敏感性没有损失（91.7%[11/12]）。
在 B 型 US 中添加 SWE 提高了筛查性 US 检测到的乳腺肿块的诊断性能，特异性增加。在 US 筛查中检测到的 BI-RADS 类别 4a 肿块，如果在 SWE 图像上显示深蓝色或最大弹性值为 30 kPa 或更低，则可以安全随访，而无需进行活检。
