Xiao Y, Yu Y, Niu L, Qian M, Deng Z, Qiu W, Zheng H
Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
Department of Department of Electronic Engineering, City University of Hong Kong, Hong Kong, China.
Clin Radiol. 2016 Sep;71(9):896-904. doi: 10.1016/j.crad.2016.06.104. Epub 2016 Jun 24.
To evaluate the diagnostic performance of the quantitative measurement of peripheral tissue elasticity using shear-wave elastography (SWE) in differentiating between benign and malignant breast lesions detected by ultrasonography (US).
This study was approved by institutional review board; informed consent was signed from all patients. From June 2012 to April 2014, conventional B-mode US and SWE were performed in 205 breast lesions (78 malignant, 127 benign) of 205 consecutive women (mean age, 41.9±12.3 years; age range, 18-76 years). For each lesion, a rim around its contour was constructed by using a computer-aided tool, including adequate adjacent peripheral tissue. Quantitative elastographic features of the rim (elasticity mean, maximum, standard deviation, and elasticity ratio) as well as Breast Imaging Reporting and Data System (BI-RADS) categories were assessed according to the final histopathological results. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curve analysis were performed to evaluate the diagnostic performances for the three data sets (conventional B-mode US alone, SWE features alone, and combined B-mode US and SWE features).
SWE features of the peripheral tissue differed significantly between benign and malignant breast lesions (mean±standard deviation [SD]: elasticity mean, 16.1±6.6 versus 43.6±17.8; maximum, 55.4±31.4 versus 150.3±44.6; SD, 8.1±4.1 versus 30±13.8 and elasticity ratio, 1.1±0.2 versus 2±0.7, respectively, all p<0.001), and enabled significantly higher specificities compared with conventional B-mode US alone (92.9%, 84.3%, 94.5%, and 93.7% versus 44.1%, respectively, all p<0.001). The combinations of SWE assessment (including individual features and the logistic regression model of all four features) and conventional B-mode US for BI-RADS 3 and 4a lesions significantly improved the diagnostic performance compared with B-mode US alone, with significantly increased specificity (85%, 82.7%, 81.9%, 86.6%, and 85% versus 44.1%; all p<0.001) and AUC (0.942, 0.940, 0.940, 0.935, and 0.953 versus 0.916, all p<0.05).
Quantitative evaluation of the elastic properties of the peripheral tissue exhibited good discriminatory ability in differentiating US-detected breast lesions and could be used to further stratify low-suspicion lesions within BI-RADS category 3 and 4a to avoid unnecessary biopsy.
评估使用剪切波弹性成像（SWE）定量测量外周组织弹性在鉴别超声（US）检测出的乳腺良恶性病变中的诊断性能。
本研究经机构审查委员会批准；所有患者均签署了知情同意书。2012年6月至2014年4月，对205名连续女性（平均年龄41.9±12.3岁；年龄范围18 - 76岁）的205个乳腺病变（78个恶性，127个良性）进行了常规B超和SWE检查。对于每个病变，使用计算机辅助工具在其轮廓周围构建一个边缘，包括足够的相邻外周组织。根据最终的组织病理学结果评估边缘的定量弹性特征（弹性均值、最大值、标准差和弹性比）以及乳腺影像报告和数据系统（BI - RADS）分类。进行敏感性、特异性、阳性和阴性预测值以及受试者操作特征（ROC）曲线分析，以评估三个数据集（单独的常规B超、单独的SWE特征以及联合的B超和SWE特征）的诊断性能。
乳腺良恶性病变外周组织的SWE特征存在显著差异（均值±标准差[SD]：弹性均值，16.1±6.6对43.6±17.8；最大值，55.4±31.4对150.3±44.6；标准差，8.1±4.1对30±13.8；弹性比，1.1±0.2对2±0.7，所有p<0.001），与单独的常规B超相比，特异性显著更高（分别为92.9%、84.3%、94.5%和93.7%对44.1%，所有p<0.001）。对于BI - RADS 3和4a类病变，SWE评估（包括个体特征和所有四个特征的逻辑回归模型）与常规B超的联合使用相比单独的B超显著提高了诊断性能，特异性显著增加（85%、82.7%、81.9%、86.6%和85%对44.1%；所有p<0.001），曲线下面积（AUC）增加（0.942、0.940、0.940、0.935和0.953对0.916，所有p<(0.05)）。
外周组织弹性特性的定量评估在鉴别US检测出的乳腺病变中表现出良好的鉴别能力，可用于进一步对BI - RADS 3类和4a类低可疑病变进行分层，以避免不必要的活检。
