Koh Jieun, Kim Eun-Kyung, Kim Min Jung, Yoon Jung Hyun, Park Vivian Youngjean, Moon Hee Jung
1 Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea.
2 Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Acta Radiol. 2019 Mar;60(3):278-285. doi: 10.1177/0284185118780901. Epub 2018 Jun 11.
Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions.
To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women.
Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors.
Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography ( P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography ( P = 0.390).
In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.
弹性成像已作为超声检查（US）的一种辅助诊断工具引入，有助于临床医生决定是否对超声检测到的病变进行活检。
根据无症状女性患乳腺癌的个人风险因素，评估应变弹性成像在降低乳腺影像报告和数据系统（BI-RADS）4a类乳腺病变分级中的作用。
对总共255个无症状的4a类病变的应变弹性成像特征分为软和非软（中等和硬）两类。通过手术或活检确诊恶性病变，通过手术或活检确诊良性病变，且超声检查至少六个月无变化。根据风险因素的存在情况计算弹性成像为软和非软的病变的恶性率。
255个病变中，25个（9.8%）为恶性，230个（90.2%）为良性。在平均风险女性的195个病变中，弹性成像为软的病变的恶性率为1.5%（1/68），显著低于弹性成像为非软的病变的14.2%（18/127）（P = 0.004）。在高风险女性的60个病变中，弹性成像为软的病变的恶性率为15.0%（3/20），与弹性成像为非软的病变的7.5%（3/40）无显著差异（P = 0.390）。
在平均风险女性中，弹性成像为软的4a类病变由于恶性率低至1.5%，可通过超声进行随访。
