Khanduri Sachin, Khan Mazhar, Shukla Anvisha, Khan Shahla, Ali Iffat, Ahmad Zahid S, Hamza Minal, Imam Tariq
Radiology, Era's Lucknow Medical College and Hospital, Lucknow, IND.
Cureus. 2019 Jun 20;11(6):e4954. doi: 10.7759/cureus.4954.
Objective The goal of this study was to evaluate the diagnostic yield of B-mode ultrasound and ultrasound elastography used alone and in combination for differentiating breast lesions into benign and malignant. Materials and methods Eighty-five patients were investigated with B-mode ultrasonography and elastography and provided a Breast Imaging Reporting, and Data System (BI-RADS) score based on ultrasonography, strain ratio, and elastography score (ES) based on elastography. Each lesion was then evaluated by a combination method, combining BI-RADS with strain ratio and BI-RADS with elastography score. Each modality was assessed for the successful detection and characterization of the lesion and whether combining ultrasonography B-mode imaging with strain elastography improves diagnosis and is reliable enough to replace invasive procedures such as biopsy that have been the mainstay of diagnosis. Results Of 85 lesions, 23 lesions (27%) were found to be malignant, and 62 lesions (72.9%) were benign. When used alone, BI-RADS had 100.0% sensitivity, 13% specificity, 50% and 100% positive and negative predictive values (respectively), and 72.9% accuracy. BI-RADS results were then combined with strain ratio (SR) and ES. BI-RADS with SR had 91.3% sensitivity, 95.2% specificity, 87.5% and 96.7% positive and negative predictive values (respectively), and 94.1% accuracy. Similarly, BI-RADS with ES had 91.3% sensitivity, 93.5% specificity, 84.0% and 96.7% positive and negative predictive values, and 92.9% accuracy. Conclusions The combination method performs better at diagnosing breast lesions than BI-RADS alone and can be used as an early and preliminary basis for diagnosis and in settings where invasive procedures cannot be performed. Combining strain elastography and BI-RADS also help characterize which lesions are better suited for biopsy, leading to a decline in unnecessary invasive procedures.
目的 本研究的目的是评估单独及联合使用B超和超声弹性成像将乳腺病变区分为良性和恶性的诊断效能。材料与方法 对85例患者进行B超和弹性成像检查，并根据超声检查结果给出乳腺影像报告和数据系统（BI-RADS）评分，根据弹性成像结果给出应变率和弹性成像评分（ES）。然后采用将BI-RADS与应变率相结合以及将BI-RADS与弹性成像评分相结合的联合方法对每个病变进行评估。评估每种检查方式对病变的成功检测和特征描述情况，以及B超成像与应变弹性成像联合使用是否能改善诊断，是否足够可靠以取代作为主要诊断手段的活检等侵入性检查。结果 在85个病变中，发现23个病变（27%）为恶性，62个病变（72.9%）为良性。单独使用时，BI-RADS的敏感性为100.0%，特异性为13%，阳性预测值和阴性预测值分别为50%和100%，准确率为72.9%。然后将BI-RADS结果与应变率（SR）和ES相结合。BI-RADS与SR联合使用时，敏感性为91.3%，特异性为95.2%，阳性预测值和阴性预测值分别为87.5%和96.7%，准确率为94.1%。同样，BI-RADS与ES联合使用时，敏感性为91.3%，特异性为93.5%，阳性预测值和阴性预测值分别为84.0%和96.7%，准确率为92.9%。结论 联合方法在诊断乳腺病变方面比单独使用BI-RADS表现更好，可作为早期和初步诊断的依据，以及在无法进行侵入性检查的情况下使用。将应变弹性成像和BI-RADS相结合还有助于确定哪些病变更适合活检，从而减少不必要的侵入性检查。
