Blank Molly A B, Antaki James F
Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
Ultrasound Med Biol. 2017 Feb;43(2):387-397. doi: 10.1016/j.ultrasmedbio.2016.09.002. Epub 2016 Oct 14.
In this systematic review and meta-analysis, we report measured elasticities of benign and malignant breast pathologies from shear wave elastography (SWE), quantitatively confirm the effect of the selected region of interest (ROI) on these measures and test the hypothesis that a metric of heterogeneity based on the mean and maximum elasticity can improve specificity of diagnosis. The elasticities of benign, malignant and specific pathologic states are reported from 22 publications encompassing 2989 patients, identified from a structured search of the literature from May to September 2015. Twelve articles were included in a meta-analysis that grouped results by the method of ROI selection to discriminate between different pathologies. We observe a significant correlation between the method of selection of ROI for malignant mean (p < 0.001) and maximum (p = 0.027) elasticities, but no correlation with benign measures. We define a quantitative heterogeneity parameter, the "stiffness gradient," computed from the mean and maximum measured elasticities. The stiffness gradient out-performed the current standard maximum elasticity metric in stratifying malignancy risk by a margin of 15% for the partial ROI, and 42% for the maximized ROI. An anecdotal example of improved differentiation using the stiffness gradient on pathology-specific lesions is also provided. These results quantitatively indicate that the method of ROI selection in SWE not only has a significant impact on the resulting mean reported elasticity of a lesion, but may provide some insight into lesion heterogeneity. Our results suggest that further exploration of quantitative heterogeneity is warranted to improve the specificity of diagnosis.
在本系统评价和荟萃分析中，我们报告了通过剪切波弹性成像（SWE）测量的良性和恶性乳腺病变的弹性，定量确认了所选感兴趣区域（ROI）对这些测量值的影响，并检验了基于平均弹性和最大弹性的异质性指标可提高诊断特异性的假设。从2015年5月至9月对文献进行结构化检索，确定了22篇包含2989例患者的出版物，报告了良性、恶性和特定病理状态的弹性。12篇文章纳入荟萃分析，根据ROI选择方法对结果进行分组，以区分不同的病理情况。我们观察到，对于恶性平均弹性（p < 0.001）和最大弹性（p = 0.027），ROI选择方法之间存在显著相关性，但与良性测量值无相关性。我们定义了一个定量异质性参数“硬度梯度”，它由测量的平均弹性和最大弹性计算得出。在对恶性风险进行分层时，对于部分ROI，硬度梯度比当前标准的最大弹性指标的表现高出15%，对于最大化ROI则高出42%。还提供了一个在特定病理病变上使用硬度梯度改善鉴别诊断的实例。这些结果定量表明，SWE中ROI选择方法不仅对病变报告的平均弹性有显著影响，还可能为病变异质性提供一些见解。我们的结果表明，有必要进一步探索定量异质性以提高诊断特异性。
