Dept of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Eur Respir J. 2021 Mar 25;57(3). doi: 10.1183/13993003.02347-2020. Print 2021 Mar.
Tissue stiffness information may help in the diagnosis of lung lesions. This study aimed to investigate and validate the application of transthoracic two-dimensional shear-wave ultrasound elastography in differentiating malignant from benign subpleural lung lesions.
This study involved one retrospective observational derivation cohort from January 2016 to December 2017 and one prospective observational validation cohort from December 2017 to December 2019. The inclusion criterion was radiographic evidence of pulmonary lesions. The patients were categorised into air bronchogram and hypoechoic groups based on B-mode grayscale images. The elasticity of subpleural lung lesions with acceptable shear-wave propagation was measured. Diagnoses were made on the basis of pathology, microbiological studies or following up the clinical course for at least 6 months.
A total of 354 patients were included. Among the 121 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 65 kPa with a Youden index of 0.60 and an accuracy of 84.3%. Among the 233 patients in the validation cohort, the diagnostic performance was maintained, with a Youden index of 0.65 and an accuracy of 86.7%. Upon applying the cut-off point to the air bronchogram group, the Youden index was 0.70 and the accuracy was 85.0%.
This study validated the application of transthoracic shear-wave ultrasound elastography for assessing lung malignancy. A cut-off point of 65 kPa is suggested for predicting lung malignancy. Furthermore, for pulmonary air bronchogram lesions with high elasticity, tissue proofing should be considered because of the high possibility of malignancy.
组织硬度信息可能有助于肺部病变的诊断。本研究旨在探讨和验证经胸二维剪切波超声弹性成像在区分良恶性胸膜下肺部病变中的应用。
本研究包括 2016 年 1 月至 2017 年 12 月的回顾性观察性推导队列和 2017 年 12 月至 2019 年 12 月的前瞻性观察性验证队列。纳入标准为影像学证实的肺部病变。根据 B 型灰阶图像将患者分为空气支气管征和低回声组。测量胸膜下肺部病变的弹性，要求具有可接受的剪切波传播。诊断基于病理学、微生物学研究或至少 6 个月的临床随访。
共纳入 354 例患者。在推导队列的 121 例患者中，构建了受试者工作特征曲线，区分良恶性病变的最佳截断点为 65kPa，Youden 指数为 0.60，准确率为 84.3%。在验证队列的 233 例患者中，诊断性能得以维持，Youden 指数为 0.65，准确率为 86.7%。在空气支气管征组中应用该截断点时，Youden 指数为 0.70，准确率为 85.0%。
本研究验证了经胸剪切波超声弹性成像在评估肺部恶性肿瘤中的应用。建议使用 65kPa 的截断点来预测肺癌。此外，对于弹性较高的肺部空气支气管征病变，由于恶性肿瘤的可能性较高，应考虑组织学检查。
