Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Department of Medical Ultrasound, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, China.
Clin Hemorheol Microcirc. 2018;69(3):355-370. doi: 10.3233/CH-170252.
To assess the performance of conventional high frequency ultrasound (US) and US elastography in diagnosis of complex cystic and solid breast lesions.
Ninety three lesions in 93 patients underwent conventional US and US elastography, including strain elastography, acoustic radiation force impulse (ARFI) imaging, and point shear wave speed (SWS) measurement.
Pathological examination revealed 31 (33.3%) of the 93 lesions were malignant and the remaining 62 (66.7%) were benign. Multivariate analysis showed that elder patient (OR: 25.301), internal vascularity (OR: 4.518), and not circumscribed margin (OR: 3.813) were independent predictors for malignancy, while predominately cystic lesions (OR: 0.178) was a predictor for benign lesions (all p < 0.05). Invalid SWS measurement was occurred in 19 of 31 (61.3%) malignant lesions and 16 of 62 (25.8%) benign lesions, respectively (p < 0.05). The mean SWS value for malignant lesions was significantly lower than that for benign ones, being 1.60±0.63 m/s (range, 0.68-2.70 m/s) versus 2.33±0.77 m/s (range, 0.67-3.97 m/s) (p < 0.05). Areas under the ROC curve (Azs) for Breast Imaging Reporting and Data System (BI-RADS) assessment, strain elasticity score, ARFI imaging and valid point SWS measurement were 0.844, 0.734, 0.763 and 0.778,respectively.
US BI-RADS category, strain elastography score, ARFI imaging patterns and point SWS measurement are useful for malignancy prediction of complex cystic and solid breast lesions. The result that SWS for malignant lesions is lower than benign one should be carefully interpreted since invalid SWS measurement is excluded for analysis. The true stiffness of malignant cystic and solid lesions should be further evaluated with a new generation of two-dimensional SWS imaging.
评估常规高频超声（US）及超声弹性成像在诊断复杂囊性及实性乳腺病变中的性能。
93 例患者的 93 个病灶行常规 US 及超声弹性成像检查，包括应变成像、声辐射力脉冲（ARFI）成像及单点剪切波速度（SWS）测量。
病理检查显示 93 个病灶中 31 个（33.3%）为恶性，62 个（66.7%）为良性。多因素分析显示，老年患者（OR：25.301）、内部血管（OR：4.518）及非边界清晰（OR：3.813）为恶性的独立预测因素，而以囊性为主的病变（OR：0.178）为良性病变的预测因素（均 P<0.05）。31 个恶性病灶中，19 个（61.3%）的 SWS 测量无效，62 个良性病灶中，16 个（25.8%）的 SWS 测量无效（P<0.05）。恶性病灶的平均 SWS 值显著低于良性病灶，分别为 1.60±0.63 m/s（范围，0.68-2.70 m/s）和 2.33±0.77 m/s（范围，0.67-3.97 m/s）（P<0.05）。乳腺影像报告和数据系统（BI-RADS）评估、应变弹性评分、ARFI 成像及有效单点 SWS 测量的 ROC 曲线下面积（Azs）分别为 0.844、0.734、0.763 和 0.778。
US BI-RADS 分类、应变弹性评分、ARFI 成像模式及单点 SWS 测量有助于预测复杂囊性及实性乳腺病变的恶性程度。由于排除了无效的 SWS 测量进行分析，因此应谨慎解释恶性病变 SWS 低于良性病变的结果。应进一步使用新一代二维 SWS 成像评估恶性囊性及实性病变的真实硬度。
