Sinha Dimpi, Kundaragi Nischal G, Sharma Sukrity, Kale Sudhir K
Department of Radiology, Aster CMI Hospital, Bangalore, Karnataka, India.
Department of Interventional Radiology, Aster CMI Hospital, Bangalore, Karnataka, India.
Indian J Radiol Imaging. 2020 Oct-Dec;30(4):493-499. doi: 10.4103/ijri.IJRI_425_19. Epub 2021 Jan 13.
To evaluate the role of strain elastography (SE) in reclassification of indeterminate breast lesions placed under BIRADS 3 and 4 categories by conventional ultrasound (US) parameters so as to recourse biopsy only for suspicious stiffer lesions.
113 breast lesions in 100 women assigned as BIRADS category 3 and 4 on US parameters were prospectively evaluated by SE followed by histo-pathological examination. Strain ratio (SR) and Elastography Score (ES) were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality and diagnostic performance were compared. The best cut-off point was calculated for each of the elastography parameter using the receiver operator curve analysis (ROC).
Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). A statistically significant difference was observed in the AUC for ES and conventional US: 0.98 vs 0.90 (Difference = 0.08, = 0.02). Elastography parameters were more specific as compared to US (ES-94.5 & SR-93.2% vs 63%, < 0.05) with high NPV. SE performed better in BIRADS 4 category lesions. On the basis of elastography parameters, 85% of BIRADS 4 category lesions were correctly predicted as benign with overall sensitivity, specificity and diagnostic accuracy of elastography being 97%, 84.6% and 91.9%. Among BIRADS 3 category lesions, 97% were correctly predicted as benign and 50% lesions were correctly predicted as malignant with a sensitivity of 50%, specificity of 97.8% and diagnostic accuracy of 94%.
Strain elastography is a useful adjunct to conventional ultrasonography for the assessment of indeterminate breast lesions and may help in avoiding unnecessary follow ups and biopsies. Elastography score is a better parameter as compared to strain ratio.
评估应变弹性成像（SE）在对常规超声（US）参数判定为BIRADS 3类和4类的乳腺不确定病变进行重新分类中的作用，以便仅对可疑的较硬病变进行活检。
对100名女性的113个乳腺病变进行前瞻性评估，这些病变根据US参数被归类为BIRADS 3类和4类，随后进行组织病理学检查。测定每个病变的应变比（SR）和弹性成像评分（ES）。计算每种检查方法的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV），并比较诊断性能。使用受试者操作特征曲线分析（ROC）计算每个弹性成像参数的最佳截断点。
113个病变中，40个为恶性（35.4%），73个为良性（64.6%）。ES和传统US的曲线下面积（AUC）存在统计学显著差异：0.98对0.90（差异 = 0.08，P = 0.02）。与US相比，弹性成像参数更具特异性（ES - 94.5%和SR - 93.2%对63%，P < 0.05），NPV较高。SE在BIRADS 4类病变中表现更好。根据弹性成像参数，85%的BIRADS 4类病变被正确预测为良性，弹性成像的总体敏感性、特异性和诊断准确性分别为97%、84.6%和91.9%。在BIRADS 3类病变中，97%被正确预测为良性，50%的病变被正确预测为恶性，敏感性为50%，特异性为97.8%，诊断准确性为94%。
应变弹性成像对于评估乳腺不确定病变是常规超声的有用辅助手段，可能有助于避免不必要的随访和活检。与应变比相比，弹性成像评分是更好的参数。
