Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy.
J Ultrasound. 2024 Dec;27(4):831-839. doi: 10.1007/s40477-024-00944-2. Epub 2024 Aug 5.
To evaluate the role of multiparametric ultrasound (mpUS) in the characterization of focal breast lesions (FBLs).
This prospective study enrolled patients undergoing multiparametric breast ultrasound for FBLs. An experienced breast radiologist evaluated the following ultrasound features: US BI-RADS category, vascularization pattern (internal, vessels in rim and combined) and presence of penetrating vessels with each Doppler method (Color-Doppler, Power-Doppler, Microvascular imaging), strain ratio (SR) and Tsukuba score (TS) with Strain Elastography (SE), E, E, E and E with 2D-shear wave elastography (2D-SWE). Core biopsy for all BI-RADS 4-5 FBLs and 24-month follow-up for all BI-RADS 2-3 FBLs were considered for standard of reference. The diagnostic performance was assessed with the area under curve (AUCs) and cut-off values were determined according to the Youden's index.
A total of 139 FBLs were included with 75/139 (53.9%) benign and 64/139 (46.1%) malignant FBLs. Internal vascularization patterns (p < 0.001), penetrating vessels (p < 0.001), TS 4-5 (p < 0.001) and all 2D-SWE parameters (p < 0.001) were significantly different between benign and malignant FBLs. The BI-RADS score provided an AUC of 0.876 (95% CI 0.810-0.926) for the diagnosis of malignant FBLs. Among the 2D-SWE measurements, an excellent diagnostic performance was observed for E with an AUC of 0.915 (95% CI 0.856-0.956) and E of 0.908 (95% CI 0.847-0.951). Optimal cutoff for the diagnosis of malignant FBLs were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, E > 82.6 kPa, E > 66.0 kPa, E > 54.4 kPa and E > 330.8. Multiparametric ultrasound, particularly SWE, can improve specificity in the characterization of FBLs.
评估多参数超声（mpUS）在局灶性乳腺病变（FBL）特征中的作用。
本前瞻性研究纳入了因 FBL 而行多参数乳腺超声检查的患者。一位经验丰富的乳腺放射科医生评估了以下超声特征：美国放射学会乳腺影像报告和数据系统（BI-RADS）类别、血管模式（内部、边缘血管和联合）以及每种多普勒方法（彩色多普勒、能量多普勒、微血管成像）、应变比（SR）和筑波评分（TS）的穿透血管，应变弹性成像（SE）的 E、E、E 和 E，二维剪切波弹性成像（2D-SWE）的 E。所有 BI-RADS 4-5 FBL 均行核心活检，所有 BI-RADS 2-3 FBL 行 24 个月随访作为标准参考。根据曲线下面积（AUCs）评估诊断性能，并根据 Youden 指数确定截断值。
共纳入 139 个 FBL，其中良性 75/139（53.9%）个，恶性 64/139（46.1%）个。良性和恶性 FBL 之间的内部血管模式（p<0.001）、穿透血管（p<0.001）、TS 4-5（p<0.001）和所有 2D-SWE 参数（p<0.001）均有显著差异。BI-RADS 评分对恶性 FBL 的诊断 AUC 为 0.876（95%CI 0.810-0.926）。在 2D-SWE 测量中，E 的诊断性能表现优异，AUC 为 0.915（95%CI 0.856-0.956），E 的 AUC 为 0.908（95%CI 0.847-0.951）。恶性 FBL 诊断的最佳截断值为 US BI-RADS>3、应变比>2.52、筑波评分>3、E>82.6kPa、E>66.0kPa、E>54.4kPa 和 E>330.8kPa。多参数超声，特别是 SWE，可提高 FBL 特征描述的特异性。
