Carlsen Jonathan Frederik, Ewertsen Caroline, Sletting Susanne, Talman Maj-Lis, Vejborg Ilse, Bachmann Nielsen Michael
Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark.
Center for Fast Ultrasound imaging (CFU), Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark.
PLoS One. 2017 Oct 26;12(10):e0186230. doi: 10.1371/journal.pone.0186230. eCollection 2017.
To assess whether strain histograms are equal to strain ratios in predicting breast tumour malignancy and to see if either could be used to upgrade Breast Imaging Reporting and Data System (BI-RADS) 3 tumours for immediate biopsy.
Ninety-nine breast tumours were examined using B-mode BI-RADS scorings and strain elastography. Strain histograms and ratios were assessed, and areas- under-the-receiver-operating-characteristic-curve (AUROC) for each method calculated. In BI-RADS 3 tumours cut-offs for strain histogram and ratio values were calculated to see if some tumours could be upgraded for immediate biopsy. Linear regression was performed to evaluate the effect of tumour depth and size, and breast density on strain elastography.
Forty-four of 99 (44.4%) tumours were malignant. AUROC of BI-RADS, strain histograms and strain ratios were 0.949, 0.830 and 0.794 respectively. There was no significant difference between AUROCs of strain histograms and strain ratios (P = 0.405), while they were both inferior to BI-RADS scoring (P<0.001, P = 0.008). Four out of 26 BI-RADS 3 tumours were malignant. When cut-offs of 189 for strain histograms and 1.44 for strain ratios were used to upgrade BI-RADS 3 tumours, AUROCS were 0.961 (Strain histograms and BI-RADS) and 0.941 (Strain ratios and BI-RADS). None of them was significantly different from BI-RADS scoring alone (P = 0.249 and P = 0.414). Tumour size and depth, and breast density influenced neither strain histograms (P = 0.196, P = 0.115 and P = 0.321) nor strain ratios (P = 0.411, P = 0.596 and P = 0.321).
Strain histogram analyses are reliable and easy to do in breast cancer diagnosis and perform comparably to strain ratio analyses. No significant difference in AUROCs between BI-RADS scoring and elastography combined with BI-RADS scoring was found in this study.
评估应变直方图在预测乳腺肿瘤恶性程度方面是否等同于应变比，以及二者是否可用于将乳腺影像报告和数据系统（BI-RADS）3类肿瘤升级为立即活检。
采用B模式BI-RADS评分和应变弹性成像对99例乳腺肿瘤进行检查。评估应变直方图和应变比，并计算每种方法的受试者操作特征曲线下面积（AUROC）。对于BI-RADS 3类肿瘤，计算应变直方图和比值的临界值，以确定是否可将部分肿瘤升级为立即活检。进行线性回归以评估肿瘤深度、大小和乳腺密度对应变弹性成像的影响。
99例肿瘤中有44例（44.4%）为恶性。BI-RADS、应变直方图和应变比的AUROC分别为0.949、0.830和0.794。应变直方图和应变比的AUROC之间无显著差异（P = 0.405），但二者均低于BI-RADS评分（P<0.001，P = 0.008）。26例BI-RADS 3类肿瘤中有4例为恶性。当使用应变直方图临界值189和应变比临界值1.44来升级BI-RADS 3类肿瘤时，AUROC分别为0.961（应变直方图与BI-RADS）和0.941（应变比与BI-RADS）。二者与单独的BI-RADS评分均无显著差异（P = 0.249和P = 0.414）。肿瘤大小、深度和乳腺密度对应变直方图（P = 0.196、P = 0.115和P = 0.321）和应变比（P = 0.411、P = 0.596和P = 0.321）均无影响。
应变直方图分析在乳腺癌诊断中可靠且易于操作，与应变比分析效果相当。本研究未发现BI-RADS评分与弹性成像联合BI-RADS评分的AUROC有显著差异。
