超声剪切波弹性成像在乳腺病变中的应用：各向异性与临床及组织病理学发现的相关性。
Ultrasound shear wave elastography of breast lesions: correlation of anisotropy with clinical and histopathological findings.
机构信息
Department of Ultrasound, Fudan University Shanghai Cancer Center, No. 270 Dong-An Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong-An Road, Shanghai, 200032, China.
出版信息
Cancer Imaging. 2018 Apr 5;18(1):11. doi: 10.1186/s40644-018-0144-x.
BACKGROUND
Ultrasound shear-wave elastography (SWE) may increase specificity of breast lesion assessment with ultrasound, but elasticity measurements may change with transducer orientation, defined as anisotropy. In this study, we aimed to observe the anisotropy of SWE of breast lesions, and its correlation with clinical and histopathological findings.
METHODS
This retrospective study was approved by institutional review board. From June 2014 to June 2015, a total of 276 women (mean age, 48.75 ± 12.12 years) with 276 breast lesions (174 malignant, 102 benign) were enrolled for conventional ultrasound and SWE before surgical excision. Elasticity modulus in the longest diameter and orthogonal diameter were recorded, including maximum elasticity (Emax), mean elasticity (Emean), standard deviation (Esd) and ratio between mean elasticity of lesion and normal fatty tissue (Eratio). Anisotropy coefficients including anisotropic difference (AD) and anisotropy factors (AF) were calculated, and correlations with malignancy, tumor size, palpability, movability, lesion location and histopathology were analyzed.
RESULTS
The average Emax, Emean, Esd and Eratio of the longest diameter were significantly higher than orthogonal diameter (P < 0.05). AUCs of ADs and AFs were inferior to quantitative parameters (P < 0.001), with AUCs of AFs superior to ADs (P < 0.001). ADs showed no significant correlation with malignancy, palpability, movability, distance from nipple and skin, and histopathological patterns. ADmean was significantly higher in inner half than outer half of the breast (P = 0.034). Higher AFs were significantly correlated with larger lesion size (P = 0.042), palpability (P < 0.05), shorter distance from nipple and skin (P < 0.05) and higher suspicion for malignancy (P < 0.001). AFs were significantly higher in IDC than DCIS (P < 0.05), higher in Grade II/III than Grade I IDC (P < 0.001), and correlated with ER/PR(+) (P < 0.05).
CONCLUSIONS
AF of SWE was an indicator for malignancy and more aggressive breast cancer.
背景
超声剪切波弹性成像（SWE）可能会提高超声对乳腺病变评估的特异性，但弹性测量可能会随探头方向改变，即各向异性。本研究旨在观察 SWE 对乳腺病变的各向异性及其与临床和组织病理学发现的相关性。
方法
本回顾性研究经机构审查委员会批准。2014 年 6 月至 2015 年 6 月，共纳入 276 例行手术切除前常规超声和 SWE 检查的 276 例女性（平均年龄 48.75±12.12 岁）患者，共 276 个乳腺病变（174 个恶性，102 个良性）。记录最长直径和正交直径的弹性模量，包括最大弹性（Emax）、平均弹性（Emean）、标准偏差（Esd）和病变与正常脂肪组织平均弹性的比值（Eratio）。计算各向异性系数，包括各向异性差（AD）和各向异性因子（AF），并分析与恶性、肿瘤大小、触诊、可移动性、病变位置和组织病理学的相关性。
结果
最长直径的平均 Emax、Emean、Esd 和 Eratio 明显高于正交直径（P<0.05）。ADs 和 AFs 的 AUC 均劣于定量参数（P<0.001），AFs 的 AUC 优于 ADs（P<0.001）。ADs 与恶性、触诊、可移动性、距乳头和皮肤的距离以及组织病理学模式无显著相关性。ADmean 在乳腺内半部分明显高于外半部分（P=0.034）。较高的 AFs 与较大的病变大小显著相关（P=0.042）、触诊（P<0.05）、距乳头和皮肤的距离更短（P<0.05）以及恶性程度更高（P<0.001）。IDC 中的 AFs 明显高于 DCIS（P<0.05），在 II/III 级 IDC 中明显高于 I 级 IDC（P<0.001），并与 ER/PR（+）相关（P<0.05）。
结论
SWE 的 AF 是恶性和侵袭性更强的乳腺癌的一个指标。
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