Wei Qi, Yan Yu-Jing, Wu Ge-Ge, Ye Xi-Rong, Jiang Fan, Liu Jie, Wang Gang, Wang Yi, Wang Yu, Pan Zhi-Ping, Hu Jin-Hua, Song Juan, Dietrich Christoph F, Cui Xin-Wu
Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Medical Ultrasound, The Central Hospital of EDong Healthcare, Huangshi, China.
Front Oncol. 2021 Nov 9;11:779612. doi: 10.3389/fonc.2021.779612. eCollection 2021.
This study aimed to explore the value of elasticity score (ES) and strain ratio (SR) combined with conventional ultrasound in distinguishing benign and malignant breast masses and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.
This prospective, multicenter study included 910 patients from nine different hospitals. The acquisition and analysis of conventional ultrasound and strain elastography (SE) were obtained by radiologists with more than 5 years of experience in breast ultrasound imaging. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of conventional ultrasound alone and combined tests with ES and/or SR were calculated and compared.
The optimal cutoff value of SR for differentiating benign from malignant masses was 2.27, with a sensitivity of 60.2% and a specificity of 84.8%. When combined with ES and SR, the AUC of the new BI-RADS classification increased from 0.733 to 0.824 ( < 0.001); the specificity increased from 48.1% to 68.5% ( < 0.001) without a decrease in the sensitivity (98.5% . 96.4%, = 0.065); and the PPV increased from 52.2% to 63.7% ( < 0.001) without a loss in the NPV (98.2% . 97.1%, = 0.327). All three combinations of conventional ultrasound, ES, and SR could reduce the biopsy rate of category 4a lesions without reducing the malignant rate of biopsy (from 100% to 68.3%, 34.9%, and 50.4%, respectively, all < 0.001).
SE can be used as a useful and non-invasive additional method to improve the diagnostic performance of conventional ultrasound by increasing AUC and specificity and reducing the unnecessary biopsy of BI-RADS 4a lesions.
本研究旨在探讨弹性评分（ES）和应变率（SR）联合传统超声在鉴别乳腺良恶性肿块以及减少乳腺影像报告和数据系统（BI-RADS）4a类病变活检方面的价值。
这项前瞻性多中心研究纳入了来自9家不同医院的910例患者。由具有5年以上乳腺超声成像经验的放射科医生进行传统超声和应变弹性成像（SE）的采集与分析。计算并比较单独使用传统超声以及联合ES和/或SR检查的诊断敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。
区分良恶性肿块的SR最佳截断值为2.27，敏感性为60.2%，特异性为84.8%。当与ES和SR联合时，新的BI-RADS分类的AUC从0.733增加到0.824（P<0.001）；特异性从48.1%增加到68.5%（P<0.001），而敏感性未降低（98.5%对96.4%，P=0.065）；PPV从52.2%增加到63.7%（P<0.001），NPV未降低（98.2%对97.1%，P=0.327）。传统超声、ES和SR的所有三种组合均可降低4a类病变的活检率，且不降低活检的恶性率（分别从100%降至68.3%、34.9%和50.4%，均P<0.001）。
SE可作为一种有用的非侵入性辅助方法，通过增加AUC和特异性以及减少BI-RADS 4a类病变的不必要活检来提高传统超声的诊断性能。
