超声造影与剪切波弹性成像同步在乳腺良恶性病变鉴别诊断中的诊断准确性：一项诊断试验
Diagnostic accuracy of contrast-enhanced ultrasound synchronized with shear wave elastography in the differential diagnosis of benign and malignant breast lesions: a diagnostic test.
作者信息
He Huiling, Wu Xiaojin, Jiang Meijuan, Xu Zhikang, Zhang Xuanxuan, Pan Jianlian, Fu Xinyu, Luo Yunkai, Chen Jian
机构信息
Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China.
Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Gland Surg. 2023 Jan 1;12(1):54-66. doi: 10.21037/gs-22-684. Epub 2023 Jan 13.
BACKGROUND
Breast cancer (BC) is one of the most common malignancies affecting women. Timely and accurate diagnosis is crucial for treatment and prognosis. Some studies have found that elastography combined with microperfusion characteristics, which are mostly described by contrast-enhanced ultrasound (CEUS), could help in the diagnosis of breast lesions. This study aimed to assess the diagnostic performance of CEUS synchronized with shear wave elastography (SWE) in discriminating between benign and malignant breast lesions by using real-time contrast elastography images to analyze shell elasticity and contrast intensity.
METHODS
A total of 26 pathologically confirmed breast lesions in 26 patients were retrospectively reviewed. Each patient underwent conventional B-mode ultrasound, CEUS, and then SWE data was obtained from a frame of image that was almost identical to the B-mode and CEUS images when acquiring time to peak (TTP). Breast lesions were evaluated based on the Breast Imaging Reporting and Data System (BI-RADS) and quantitative characteristics that describe the stiffness and intensity of contrast of the 1.0-3.0 mm shell region. Quantitative aspects of the inner lesions and shell on the elastogram included the maximum (Emax), mean (Emean), and minimum (Emin) Young's moduli. Quantitative enhanced features included maximum (Imax) and mean (Imean) intensity. We took postoperative pathological results as the gold standard. Receiver operating characteristic (ROC) curves were used to compare the diagnostic efficacy of the 2 examination modalities, either alone or in combination.
RESULTS
The age of the patients ranged from 23 to 76 years, with a 42.5-year average age. In all breast lesions, 19 were benign and 7 were malignant. SWE synchronized with CEUS can effectively improve the diagnostic performance of breast lesions, and Emean + Imean and Emax + Emean + Imean of shell at 1.0 mm both had the highest area under the curve (AUC) of 0.86 [95% confidence interval (CI): 0.67, 0.96], with the sensitivity and specificity of 71.43% and 89.47%, respectively.
CONCLUSIONS
The combination of CEUS and SWE has a better diagnostic value in differentiating benign and malignant breast lesions compared to separate techniques.
背景
乳腺癌（BC）是影响女性的最常见恶性肿瘤之一。及时准确的诊断对于治疗和预后至关重要。一些研究发现，弹性成像结合微灌注特征（大多通过超声造影（CEUS）描述）有助于乳腺病变的诊断。本研究旨在通过使用实时弹性成像图像分析包膜弹性和造影剂强度，评估CEUS与剪切波弹性成像（SWE）同步在鉴别乳腺良恶性病变中的诊断性能。
方法
回顾性分析26例患者的26个经病理证实的乳腺病变。每位患者均接受常规B超、CEUS检查，然后在获取达峰时间（TTP）时，从与B超和CEUS图像几乎相同的一帧图像中获取SWE数据。根据乳腺影像报告和数据系统（BI-RADS）以及描述1.0 - 3.0 mm包膜区域硬度和造影剂强度的定量特征对乳腺病变进行评估。弹性图上内部病变和包膜的定量参数包括最大（Emax）、平均（Emean）和最小（Emin）杨氏模量。定量增强特征包括最大（Imax）和平均（Imean）强度。我们将术后病理结果作为金标准。采用受试者操作特征（ROC）曲线比较两种检查方式单独及联合应用的诊断效能。
结果
患者年龄范围为23至76岁，平均年龄4２.5岁。所有乳腺病变中，19例为良性，7例为恶性。CEUS与SWE同步可有效提高乳腺病变的诊断性能，1.0 mm包膜处的Emean + Imean以及Emax + Emean + Imean的曲线下面积（AUC）最高，均为0.86 [95%置信区间（CI）：0.67, 0.96]，敏感性和特异性分别为71.43%和89.47%。
结论
与单独技术相比，CEUS和SWE联合应用在鉴别乳腺良恶性病变方面具有更好的诊断价值。
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