Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R, China.
Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai 201199, P.R, China.
Int J Med Sci. 2021 Aug 28;18(15):3615-3623. doi: 10.7150/ijms.64243. eCollection 2021.
Because the halo around the tumor in shear wave elastography (SWE) is defined as the "stiff rim" sign, the diagnosis of breast lesions with the stiff rim sign is popular. However, only a few studies have described the stiff rim sign quantitatively. This study aimed to investigate the usefulness of the stiff rim sign in the diagnosis and tumor, node, metastasis stage of breast cancer. Two hundred and ten breast lesions were analyzed retrospectively. The maximum, mean, minimum Young's modulus (YM), and the YM standard deviation in the lesion, the peritumoral stiffness (shell), and the region containing lesion and shell were obtained. The suspicious SWE feature with the best diagnostic performance was chosen to downgrade or upgrade the Breast Imaging Reporting and Data System (BI-RADS) classification. The coincidence rates of SWE and B-mode ultrasound in T staging and their positive predictive value (PPV) for T staging were compared. The presence of "stiff rim" sign was selected to upgrade or downgrade the BI-RADS classification because of its best performance. In pathological benign lesions, 18.9% (25 of 132) of lesions should undergo biopsy if BI-RADS combined with the stiff rim sign were referred while it was 57.6% (76 of 132) if BI-RADS alone was referred. The coincidence rate of T2 staging evaluated by SWE was significantly higher than B-mode ultrasound (about 30% increase, < 0.001). The PPVs of SWE for T1 and T2 staging were higher than B-mode ultrasound ( < 0.05). BI-RADS combined with "stiff rim" sign is expected to improve the diagnostic performance of breast lesions to avoid unnecessary biopsy. The maximum diameter of the lesion measured in SWE is more accurate than B-mode ultrasound in the estimation of T staging, which is beneficial to the treatment and prognosis of breast cancer.
由于剪切波弹性成像（SWE）中的肿瘤周围晕环被定义为“硬边”征象，因此诊断具有硬边征象的乳腺病变较为流行。然而，仅有少数研究对硬边征象进行了定量描述。本研究旨在探讨硬边征象在乳腺癌诊断和肿瘤、淋巴结、转移分期中的作用。回顾性分析 210 个乳腺病变。获得病变的最大、平均、最小杨氏模量（YM）和 YM 标准差，病变周围硬度（壳）以及包含病变和壳的区域。选择具有最佳诊断性能的可疑 SWE 特征来降低或升级乳腺影像报告和数据系统（BI-RADS）分类。比较 SWE 和 B 型超声在 T 分期中的符合率及其 T 分期的阳性预测值（PPV）。由于其最佳性能，选择“硬边”征象的存在来升级或降级 BI-RADS 分类。在病理良性病变中，如果 BI-RADS 结合硬边征象，则有 18.9%（132 例中的 25 例）的病变需要进行活检，而如果仅使用 BI-RADS 则有 57.6%（132 例中的 76 例）的病变需要进行活检。SWE 评估的 T2 分期的符合率显著高于 B 型超声（约增加 30%，<0.001）。SWE 对 T1 和 T2 分期的 PPV 均高于 B 型超声（<0.05）。BI-RADS 结合“硬边”征象有望提高乳腺病变的诊断性能，避免不必要的活检。SWE 测量的病变最大直径在 T 分期的评估中比 B 型超声更准确，这有利于乳腺癌的治疗和预后。
