二维及三维剪切波弹性成像技术对标准乳腺超声检查的评估：一项前瞻性、多中心研究。
Evaluation of standard breast ultrasonography by adding two-dimensional and three-dimensional shear wave elastography: a prospective, multicenter trial.
机构信息
Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China.
Department of Ultrasound Medicine & Laboratory of Translational Research in Ultrasound Theranostics, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Eur Radiol. 2024 Feb;34(2):945-956. doi: 10.1007/s00330-023-10057-9. Epub 2023 Aug 30.
OBJECTIVE
To reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4-5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions.
METHODS
A total of 897 breast lesions, categorized as BI-RADS 3-5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment.
RESULTS
After standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4-5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268).
CONCLUSION
Combining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4-5 lesions without sacrificing sensitivity unacceptably.
CLINICAL RELEVANCE STATEMENT
Combining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4-5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions.
TRIAL REGISTRATION
ChiCTR1900026556 KEY POINTS: • Reduce benign biopsy is necessary in breast lesions with BI-RADS 4-5 category. • A reduction of 54.1% on benign biopsies in BI-RADS 4-5 lesions was achieved using 2D + 3D SWE reclassification. • Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).
目的
通过联合二维和三维剪切波弹性成像（2D+3D SWE）与标准乳腺超声（US）对 BI-RADS 评估乳腺病变，减少 BI-RADS 4-5 分类的良性乳腺病变活检数量。
方法
对 897 个 BI-RADS 3-5 级的乳腺病变进行标准乳腺 US 检查，并补充二维 SWE 检查和 2D+3D SWE 分析。基于 BI-RADS 3 恶性率小于 2%，对标准乳腺 US 评估的病变进行 SWE 评估重新分类。
结果
标准乳腺 US 评估后，268 例（46.1%）BI-RADS 4-5 病变患者行良性活检。通过在 2D+3D SWE 重新分类中分别使用 120 kPa 为 BI-RADS 3 升级和 90 kPa 为 BI-RADS 4a 降级的单独截断值，123 例（21.2%）患者行良性活检，良性活检减少 54.1%（123 例比 268 例）。
结论
联合 2D+3D SWE 和标准乳腺 US 对 BI-RADS 病变进行重新分类，在不显著降低敏感性的情况下，可能会减少 BI-RADS 4-5 病变的良性活检。
临床意义
联合 2D+3D SWE 和 US 可有效减少 BI-RADS 4-5 级乳腺病变的良性活检，从而提高 BI-RADS 评估对乳腺病变患者的诊断准确性。
试验注册
ChiCTR1900026556
关键点
在 BI-RADS 4-5 类别中，减少良性活检是必要的。
通过 2D+3D SWE 重新分类，BI-RADS 4-5 病变的良性活检减少了 54.1%。
在标准乳腺 US 中添加 2D+3D SWE 提高了 BI-RADS 评估对乳腺病变的诊断性能：特异性从 54%增加到 79%，PPV 从 54%增加到 71%，敏感性（97.2%比 98.7%）和 NPV（98.1%比 98.7%）略有下降。
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