Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123, Naples, Italy.
Radiology Unit, Maddaloni Hospital, Maddaloni, CE, Italy.
J Ultrasound. 2024 Sep;27(3):589-598. doi: 10.1007/s40477-024-00893-w. Epub 2024 Jul 25.
The purpose of this study is to evaluate elastography in a wide spectrum of soft tissue superficial lesions by correlating the elastographic characteristics of these lesions with the elastographic score (ES) system established by Asteria.
Forty patients with different superficial lesions of the soft tissues were studied, including lipomas, schwannomas, neuromas, epidermal inclusion cysts, "in transit" melanoma metastasis, arterio-venous malformation, and giant-cell tumor. An ultrasound examination was performed combined with color-Doppler and elastographic module. The B-mode criteria were echogenicity, margins, and structural homogeneity of the lesion. The color-Doppler criterion was irregular and mainly intra-nodular vascularization. ES 1-4 was attributed, in relation with the increasing tissue stiffness, according to the classification of Asteria adapted for soft tissues. Subsequently, we added to each single B-mode and color-Doppler criterion the ES 3 and 4, thus crossing two parameters of malignancy. All the presumptive diagnoses formulated were confirmed with the clinical data or with the histopathological result.
The hypoechoic appearance had the best diagnostic performance. Sensitivity was 87%, specificity 71%, positive predictive value (PPV) 80%, negative predictive value (NPV) 80%, and diagnostic accuracy 80%. There was a good correlation with the clinical and biopsy data, the irregularity of margins the worst performance, the inhomogeneity an intermediate. Color-Doppler had sensitivity 74%, specificity 82%, PPV 85%, NPV 70% and diagnostic accuracy 77.5%. Elastography had sensitivity 87%, specificity 94%, PPV 95%, NPV 84%, and diagnostic accuracy 90%. The combination hypoechoic appearance + ES3/ES4 showed sensitivity 83%, specificity 100%, PPV 100%, NPV 81%,and diagnostic accuracy of 90%. The combination of irregularity of margins + ES3/ES4 showed sensitivity 43%, specificity 100%, PPV 100%, NPV 59%, and diagnostic accuracy of 67.5%. The combination of inhomogeneity of the lesion + ES3/ES4 showed sensitivity 65%, specificity 94%, PPV 94%, NPV 68%, and diagnostic accuracy of 78%. The combination of the color-Doppler with the ES3/ES4 showed sensitivity 69.5%, specificity 100%, PPV 100%, NPV 71%, and diagnostic accuracy of 82.5%.In the combined evaluation, there was a significant increase in specificity, allowing healthy subjects to be categorized as correctly negative, with a reduction in false positives which also translates into an increase in PPV.
Elastography alone is not sufficient for a correct diagnostic classification and must be considered as an additional parameter in the study of soft-tissue lesions. Although there was a good agreement between B-mode malignancy criteria and ES3/ES4, there is no significant improvement in sensitivity. Ultrasound assessment, especially of superficial lesions, cannot be separated from an integrated approach that foresees the additional and routine use of the elastographic examination.
本研究旨在通过将这些病变的弹性特征与 Asteria 建立的弹性评分（ES）系统相关联，评估广泛的软组织浅表病变的弹性成像。
对 40 例不同软组织浅表病变的患者进行研究，包括脂肪瘤、神经鞘瘤、神经瘤、表皮包涵囊肿、“转移中”黑色素瘤转移、动静脉畸形和巨细胞瘤。联合彩色多普勒和弹性模块进行超声检查。B 模式标准为病变的回声、边缘和结构均匀性。彩色多普勒标准为不规则和主要是结节内血管化。根据 Asteria 为软组织改编的分类，将组织硬度增加的 ES 1-4 归因于 ES 1-4。随后，我们将 ES 3 和 4 添加到每个单独的 B 模式和彩色多普勒标准中，从而交叉两个恶性参数。所有的假定诊断均通过临床数据或组织病理学结果得到证实。
低回声表现具有最佳的诊断性能。敏感性为 87%，特异性为 71%，阳性预测值（PPV）为 80%，阴性预测值（NPV）为 80%，诊断准确率为 80%。与临床和活检数据相关性良好，边缘不规则表现最差，不均匀性表现居中。彩色多普勒敏感性为 74%，特异性为 82%，PPV 为 85%，NPV 为 70%，诊断准确率为 77.5%。弹性成像敏感性为 87%，特异性为 94%，PPV 为 95%，NPV 为 84%，诊断准确率为 90%。联合低回声表现+ES3/ES4 显示敏感性为 83%，特异性为 100%，PPV 为 100%，NPV 为 81%，诊断准确率为 90%。联合边缘不规则+ES3/ES4 显示敏感性为 43%，特异性为 100%，PPV 为 100%，NPV 为 59%，诊断准确率为 67.5%。联合病变不均匀+ES3/ES4 显示敏感性为 65%，特异性为 94%，PPV 为 94%，NPV 为 68%，诊断准确率为 78%。联合彩色多普勒+ES3/ES4 显示敏感性为 69.5%，特异性为 100%，PPV 为 100%，NPV 为 71%，诊断准确率为 82.5%。在联合评估中，特异性显著提高，允许健康受试者正确地归类为阴性，减少假阳性，这也转化为提高 PPV。
单独的弹性成像不足以进行正确的诊断分类，必须被视为软组织病变研究的附加参数。尽管 B 模式恶性标准与 ES3/ES4 之间存在良好的一致性，但敏感性并没有显著提高。超声评估，尤其是对浅表病变的评估，不能脱离综合方法，该方法需要额外且常规使用弹性检查。
