Ren Wei-Wei, Li Xiao-Long, He Ya-Ping, Li Dan-Dan, Wang Dan, Zhao Chong-Ke, Bo Xiao-Wan, Liu Bo-Ji, Yue Wen-Wen, Xu Hui-Xiong
Clin Hemorheol Microcirc. 2017;66(1):37-46. doi: 10.3233/CH-16243.
To evaluate the diagnostic performance of two different shear wave elastography (SWE) techniques in distinguishing malignant breast lesions from benign ones.
From March 2016 to May 2016, a total of 153 breast lesions (mean diameter, 16.8 mm±10.5; range 4.1-90.0 mm) in 153 patients (mean age, 46.4 years±15.1; age range 20-86 years) were separately performed by two different SWE techniques (i.e. T-SWE, Aplio500, Toshiba Medical System, Tochigi, Japan; and S-SWE, the Aixplorer US system, SuperSonic Imagine, Provence, France). The maximum (Emax), mean (Emean) and standard deviation (ESD) of elasticity modulus values in T-SWE and S-SWE were analyzed. All the lesions were confirmed by ultrasound (US)-guided core needle biopsy (n = 26), surgery (n = 122), or both (n = 5), with pathological results as the gold standard. The areas under the receiver operating characteristic curves (AUROCs) were calculated. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were calculated to assess the diagnostic performance between T-SWE and S-SWE. Operator consistency was also evaluated.
Among the 153 lesions, 41 (26.8%) were malignant and 112 (73.2%) were benign. Emax (T-SWE: 40.10±37.14 kPa vs. 118.78±34.41 kPa; S-SWE: 41.22±22.54 kPa vs. 134.77±60.51 kPa), Emean (T-SWE: 19.75±16.31 kPa vs. 52.93±25.75 kPa; S-SWE: 20.95±10.98 kPa vs. 55.95±22.42 kPa) and ESD (T-SWE: 9.00±8.55 kPa vs. 38.44±12.30 kPa; S-SWE: 8.17±6.14 kPa vs. 29.34±13.88 kPa) showed statistical differences in distinguishing malignant lesions from benign ones both in T-SWE and S-SWE (all p < 0.05). In T-SWE, the diagnostic performance of ESD was the highest (AUROC = 0.958), followed by Emax (AUROC = 0.909; p = 0.001 in comparison with ESD) and Emean (AUROC = 0.892; p < 0.001 in comparison with ESD), while in S-SWE, the diagnostic performance of Emax was the highest (AUROC = 0.967), followed by ESD (AUROC = 0.962, p > 0.05 in comparison with Emax) and Emean (AUROC = 0.930, p = 0.034 in comparison with Emax). AUROC-max (T-SWE: 0.909 vs.
S-SWE: 0.967), AUROC-mean (T-SWE: 0.892 vs.
S-SWE: 0.930) and AUROC-SD (T-SWE: 0.958 vs.
S-SWE: 0.962) showed no significant difference between T-SWE and S-SWE (all p > 0.05). The intra-class correlation coefficients (ICC) of the intra-operator consistency and inter-operator consistency respectively were 0.961 and 0.898 in T-SWE, while 0.954 and 0.897 in S-SWE.
T-SWE and S-SWE are equivalent for distinguishing the breast lesions. In T-SWE, ESD had the best diagnostic performance, while in S-SWE, Emax had the best diagnostic performance.
评估两种不同的剪切波弹性成像（SWE）技术在鉴别乳腺恶性病变与良性病变中的诊断性能。
2016年3月至2016年5月，对153例患者（平均年龄46.4岁±15.1；年龄范围20 - 86岁）的153个乳腺病变（平均直径16.8 mm±10.5；范围4.1 - 90.0 mm）分别采用两种不同的SWE技术（即T-SWE，Aplio500，东芝医疗系统，日本枥木；以及S-SWE，Aixplorer超声系统，Supersonic Imagine，法国普罗旺斯）进行检查。分析T-SWE和S-SWE中弹性模量值的最大值（Emax）、平均值（Emean）和标准差（ESD）。所有病变均通过超声（US）引导下的粗针活检（n = 26）、手术（n = 122）或两者（n = 5）确诊，病理结果作为金标准。计算受试者操作特征曲线下面积（AUROCs）。计算敏感性、特异性、准确性、阳性预测值（PPV）、阴性预测值（NPV）以评估T-SWE和S-SWE之间的诊断性能。还评估了操作者间的一致性。
在153个病变中，41个（26.8%）为恶性，112个（73.2%）为良性。Emax（T-SWE：40.10±37.14 kPa对118.78±34.41 kPa；S-SWE：41.22±22.54 kPa对134.77±60.51 kPa）、Emean（T-SWE：19.75±16.31 kPa对52.93±25.75 kPa；S-SWE：20.95±10.98 kPa对55.95±22.42 kPa）和ESD（T-SWE：9.00±8.55 kPa对38.44±12.30 kPa；S-SWE：8.17±6.14 kPa对29.34±13.88 kPa）在T-SWE和S-SWE中区分恶性病变与良性病变方面均显示出统计学差异（均p < 0.05）。在T-SWE中，ESD的诊断性能最高（AUROC = 0.958），其次是Emax（AUROC = 0.909；与ESD相比p = 0.001）和Emean（AUROC = 0.892；与ESD相比p < 0.001），而在S-SWE中，Emax的诊断性能最高（AUROC = 0.967），其次是ESD（AUROC = 0.962，与Emax相比p > 0.05）和Emean（AUROC = 0.930，与Emax相比p = 0.034）。AUROC-max（T-SWE：0.909对S-SWE：0.967）、AUROC-mean（T-SWE：0.892对S-SWE：0.930）和AUROC-SD（T-SWE：0.958对S-SWE：0.962）在T-SWE和S-SWE之间无显著差异（均p >
