乳腺病变超声弹性成像的临床应用及调整遵循了世界超声医学与生物学联合会（WFUMB）在现实世界中的指南和建议。
Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world.
作者信息
Tang Lei, Wang Yuqun, Chen Pingping, Chen Man, Jiang Lixin
机构信息
Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Ultrasound Medicine, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Front Oncol. 2022 Nov 24;12:1022917. doi: 10.3389/fonc.2022.1022917. eCollection 2022.
OBJECTIVE
This study aimed to explore the value of strain elastography (SE) and shear wave elastography (SWE) following the World Federation of Ultrasound in Medicine and Biology (WFUMB) guidelines and recommendations in the real world in distinguishing benign and malignant breast lesions and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.
METHODS
This prospective study included 274 breast lesions. The elastography score (ES) by the Tsukuba score, the strain ratio (SR) for SE, and Emax for SWE of the lesion(A) and the regions(A') included the lesion and the margin (0.5-5 mm) surrounding the lesion were measured. The sensitivity, specificity, and AUC were calculated and compared by the cutoff values recommended by WFUMB guidelines.
RESULTS
When scores of 1 to 3 were classified as probably benign by WFUMB recommendation, the ES was significantly higher in malignant lesions compared to benign lesions (p < 0.05) in all lesions. For the cohort by size >20 mm, the sensitivity was 100%, and the specificity was 45.5%. ES had the highest AUC: 0.79(95% CI 0.72-0.86) with a sensitivity of 96.2%, and a specificity of 61.8% for the cohort by size ≤20 mm. For the Emax-A'-S2.5mm, when the high stiffness would be considered with Emax above 80 kPa in SWE, the malignant lesions were diagnosed with a sensitivity of 95.8%, a specificity of 43.3% for all lesions, a sensitivity of 88.5% for lesions with size ≤20 mm, and sensitivity of 100.0% for lesions with size >20 mm. In 84 lesions of BI-RADS category 4a, if category 4a lesions with ES of 1-3 points or Emax-A'-S2.5 less than 80 kPa could be downgraded to category 3, 52 (61.9%) lesions could be no biopsy, including two malignancies. If category 4a lesions with ES of 1-3 points and Emax-A'-S2.5 less than 80kPa could be downgraded to category 3, 23 (27.4%) lesions could be no biopsy, with no malignancy.
CONCLUSIONS
The elastography score for SE and Emax-A' for SWE after our modification were beneficial in the diagnosis of breast cancer. The combination of SWE and SE could effectively reduce the biopsy rate of BI-RADS category 4a lesions.
目的
本研究旨在探讨按照世界医学超声与生物学联合会（WFUMB）的指南和建议，在实际应用中应变弹性成像（SE）和剪切波弹性成像（SWE）在鉴别乳腺良恶性病变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。
方法
本前瞻性研究纳入了274例乳腺病变。测量病变（A）以及包含病变及其边缘（0.5 - 5毫米）的区域（A'）的筑波评分法弹性成像评分（ES）、SE的应变率（SR）以及SWE的Emax。按照WFUMB指南推荐的临界值计算并比较敏感性、特异性和曲线下面积（AUC）。
结果
当按照WFUMB建议将1至3分归类为可能为良性时，在所有病变中，恶性病变的ES显著高于良性病变（p < 0.05）。对于直径>20毫米的病变队列，敏感性为100%，特异性为45.5%。对于直径≤20毫米的病变队列，ES的AUC最高：0.79（95%可信区间0.72 - 0.86），敏感性为96.2%，特异性为61.8%。对于Emax - A' - S2.5mm，当在SWE中Emax高于80 kPa被视为高硬度时，所有病变中诊断恶性病变的敏感性为95.8%，特异性为43.3%；直径≤20毫米的病变敏感性为88.5%；直径>20毫米的病变敏感性为100.0%。在BI-RADS 4a类的84个病变中，如果ES为1 - 3分或Emax - A' - S2.5小于80 kPa的4a类病变可降级为3类，则52个（61.9%）病变可不进行活检，其中包括2个恶性病变。如果ES为1 - 3分且Emax - A' - S2.5小于80kPa的4a类病变可降级为3类，则23个（27.4%）病变可不进行活检，且无恶性病变。
结论
我们改良后的SE弹性成像评分和SWE的Emax - A'对乳腺癌诊断有益。SWE和SE联合可有效降低BI-RADS 4a类病变的活检率。
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