From the Department of Radiology (S.H.L., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea (J.C., E.S.C.); Department of Radiology, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Korea (H.Y.C.); Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea (S.H.C., S.H.K.); Department of Radiology, Dongnam Institute of Radiological and Medical Science, Busan, Korea (E.B.R.); Department of Radiology, Bungdang CHA Hospital, Seongnam, Gyeonggi-do, Korea (K.H.K.); Department of Radiology, Hanyang University Hospital, Seoul, Korea (H.R.K., J.S.P.); Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea (A.Y.); Department of Radiology, Gangnam Severance Hospital, Seoul, Korea (J.H.Y., E.J.S.); and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.).
Radiology. 2017 Nov;285(2):660-669. doi: 10.1148/radiol.2017162424. Epub 2017 Jun 21.
Purpose To investigate the value of the combined use of elastography and color Doppler ultrasonography (US) with B-mode US for evaluation of screening US-detected breast masses in women with dense breasts. Materials and Methods This prospective, multicenter study included asymptomatic women with dense breasts who were referred for screening US between November 2013 and December 2014. Eligible women had a newly detected breast mass at conventional B-mode US screening, for which elastography and color Doppler US were performed. The following outcome measures were compared between B-mode US and the combination of B-mode US, elastography, and color Doppler US: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and the number of false-positive findings at screening US. Results Among 1021 breast masses (mean size, 1.0 cm; range, 0.3-3.0 cm) in 1021 women (median age, 45 years), 68 were malignant (56 invasive). Addition of elastography and color Doppler US to B-mode US increased the AUC from 0.87 (95% confidence interval [CI]: 0.82, 0.91) to 0.96 (95% CI: 0.95, 0.98; P < .001); specificity from 27.0% (95% CI: 24.2%, 29.9%) to 76.4% (95% CI: 73.6%, 79.1%; P < .001) without loss in sensitivity (95% CI: -1.5%, 1.5%; P > .999); and PPV from 8.9% (95% CI: 7.0%, 11.2%) to 23.2% (95% CI: 18.5%, 28.5%; P < .001), while avoiding 67.7% (471 of 696) of unnecessary biopsies for nonmalignant lesions. Conclusion Addition of elastography and color Doppler US to B-mode US can increase the PPV of screening US in women with dense breasts while reducing the number of false-positive findings without missing cancers. RSNA, 2017 Online supplemental material is available for this article.
目的 旨在探究超声弹性成像与彩色多普勒超声联合常规超声用于评估致密型乳腺中超声检出乳腺肿块的应用价值。
材料与方法 本前瞻性多中心研究纳入了 2013 年 11 月至 2014 年 12 月期间因常规超声筛查检出新的乳腺肿块而转诊的无症状致密型乳腺女性。符合条件的女性在常规 B 型超声筛查中检测到新的乳腺肿块，对其进行超声弹性成像和彩色多普勒超声检查。比较了 B 型超声与 B 型超声、弹性成像和彩色多普勒超声联合诊断的以下结果：受试者工作特征曲线下面积（AUC）、敏感性、特异性、阳性预测值（PPV）和筛查超声中假阳性发现的数量。
结果 在 1021 名女性（中位年龄 45 岁）的 1021 个乳腺肿块（平均大小 1.0 cm；范围 0.3-3.0 cm）中，有 68 个为恶性肿瘤（56 个为浸润性癌）。在 B 型超声的基础上增加弹性成像和彩色多普勒超声检查，AUC 从 0.87（95%置信区间：0.82，0.91）增加到 0.96（95%置信区间：0.95，0.98；P<0.001）；特异性从 27.0%（95%置信区间：24.2%，29.9%）增加到 76.4%（95%置信区间：73.6%，79.1%；P<0.001），而敏感性无损失（95%置信区间：-1.5%，1.5%；P>0.999）；PPV 从 8.9%（95%置信区间：7.0%，11.2%）增加到 23.2%（95%置信区间：18.5%，28.5%；P<0.001），同时避免了对 67.7%（471/696）非恶性病变进行不必要的活检。
结论 在 B 型超声的基础上增加超声弹性成像和彩色多普勒超声检查可提高致密型乳腺超声筛查的 PPV，同时减少假阳性发现数量，而不会遗漏癌症。
