Farooq Faryal, Mubarak Syed, Shaukat Shaista, Khan Noman, Jafar Kahkashan, Mahmood Tariq, Saeed Muhammad Arif
Diagnostic Radiology, Jinnah Post Graduate Medical Centre, Karachi, PAK.
Diagnostic Radiology, Karachi Medical and Dental College, Karachi, PAK.
Cureus. 2019 Oct 8;11(10):e5861. doi: 10.7759/cureus.5861.
Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions. Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.
The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical Centre, Karachi. All consecutive patients undergoing breast biopsy and elastography of breast lesions were enlisted; 2 x 2 tables were used to measure the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of breast ultrasound elastography for differentiation of benign from malignant breast masses.
A total of 155 female patients were included with a mean age of 45.41 ± 14.24 years (range 20-70 years). On histological evaluation, 115 (74.2%) lesions were malignant and 40 (25.8%) were benign. The overall average mean elastography value was 108.45 kPa ± 52.75. The mean elastography (E) value for benign breast lesions was 48.96 kPa ± 42.32 and 132.78 kPa ± 42.32 for malignant lesions. The difference in mean elastography values of benign and malignant breast lesions was statistically significant (48.96 kPa ± 42.32 vs 32.78 kPa ± 42.32, P <0.001). The area under the curve (AUC) was 0.952, optimal cutoff E value of 72 kPa and higher likelihood ratio was 9.41. A cutoff mean elastography (E) value of ≤ 72 kilopascal (kPa) for benign lesions had sensitivity 92.17%, specificity 90.4%, PPV 96.36%, NPV 80.0% and diagnostic accuracy 91.61%. Conclusion: Ultrasound elastography was found to have high sensitivity and specificity and diagnostic accuracy for differentiating benign from malignant breast lesions. Use of shear-wave elastography may increase malignancy detection rate by reducing the need for biopsy in benign breast lesions.
乳腺癌是发达国家和发展中国家女性中最常见的癌症。巴基斯坦是亚洲乳腺癌发病率最高的国家。指南建议采用乳腺X线摄影和超声检查进行乳腺癌筛查。剪切波弹性成像（SWE）是一种较新的技术，可辅助对乳腺病变进行进一步特征描述。目的：本研究旨在以组织学诊断为金标准，确定乳腺超声弹性成像在鉴别乳腺良恶性病变中的诊断准确性。
本研究在卡拉奇的阿巴西·谢赫德医院和真纳研究生医学中心进行。纳入所有接受乳腺活检和乳腺病变弹性成像检查的连续患者；使用2×2列联表来测量乳腺超声弹性成像在鉴别乳腺良恶性肿块方面的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性。
共纳入155例女性患者，平均年龄45.41±14.24岁（范围20 - 70岁）。组织学评估显示，115例（74.2%）病变为恶性，40例（25.8%）为良性。弹性成像总体平均数值为108.45 kPa±52.75。乳腺良性病变的平均弹性成像（E）值为48.96 kPa±42.32，恶性病变为132.78 kPa±42.32。乳腺良恶性病变的平均弹性成像值差异具有统计学意义（48.96 kPa±42.32 vs 132.78 kPa±42.32，P<0.001）。曲线下面积（AUC）为0.952，最佳截断E值为72 kPa，似然比为9.41。良性病变的截断平均弹性成像（E）值≤72千帕（kPa）时，敏感性为92.17%，特异性为90.4%，PPV为96.36%，NPV为80.0%，诊断准确性为91.61%。结论：超声弹性成像在鉴别乳腺良恶性病变方面具有较高的敏感性、特异性和诊断准确性。使用剪切波弹性成像可能通过减少良性乳腺病变的活检需求来提高恶性肿瘤的检出率。
