Wang Huiyan, Lu Longying, Zhang Heqing, Wan Xue, He Yushuang, Luo Honghao, Peng Yulan, Ma Lin, Zhao Haina
（ 610041） Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2024 Sep 20;55(5):1240-1246. doi: 10.12182/20240960206.
This study is focused on ultrasound multimodality examination, which refers to the combined use of three ultrasound examination modalities, ultrasound (US), acoustic radiation force impulse (ARFI) imaging, and contrast-enhanced ultrasound (CEUS). The purpose of this study is to analyze the value of applying ultrasound multimodality examination in the differential diagnosis of benign and malignant breast non-mass-like lesions (NMLs).
Cases of breast NMLs were analyzed retrospectively, and the nature of all the lesions was verified by pathological examination. Based on the gray-scale ultrasound image characteristics, the cases were classified into types Ⅰ to Ⅴ, and type Ⅰ and type Ⅱ were further classified into 4 subtypes, Ⅰa, Ⅰb, Ⅱa, and Ⅱb, according to whether there was also calcification, and the proportion of malignant cases in each subtype was statistically analyzed. Logistic regression models of US, US+ARFI, US+CEUS, and US+ARFI+CEUS for the diagnosis of malignant cases were established, ROC curves were drawn, the area under the curve (AUC) was calculated, and comparisons were made accordingly. The detection rate of malignant NMLs without calcification (atypical malignant NMLs) by the combination examination of US, ARFI, and CEUS was analyzed.
A total of 407 cases were included in the study. All subjects were female, aged 22 to 81 years, with the average age being (47.0±11.0) years. There were 220 benign cases and 187 malignant cases. Ranked from the highest to the lowest, the malignancy proportion of the different types was Ⅰb>Ⅱb>Ⅲ>Ⅴ>Ⅰa>Ⅱa>Ⅳ. The malignant proportion of the low echo area with calcification was significantly higher than that of the lesions without calcification. The AUC (95% confidence interval [CI]) for diagnosing malignant cases with the logistic regression models of US, US+ARFI, US+CEUS, and US+ARFI+CEUS were 0.895 (0.862-0.927), 0.908 (0.878-0.937), 0.921 (0.893-0.948), and 0.927 (0.902-0.952), respectively. Comparison of the AUC of the 4 regression models showed significant differences (<0.001). The detection rate of US for NMLs without calcification was 80.7%. When US was used in combination with ARFI and CEUS, 86.4% of the malignant NMLs lesions without calcification could be detected if the lesion CEUS score was 4 or 5 points or if shear-wave velocity (SWV)≥4.28 m/s.
Breast NMLs with calcification show high risks of malignancy, and a pathological examination is always recommended for a conclusive diagnosis. Ultrasound multimodality examination can improve the diagnostic accuracy of breast NML without calcification.
本研究聚焦于超声多模态检查，即联合使用超声（US）、声辐射力脉冲（ARFI）成像及超声造影（CEUS）这三种超声检查方式。本研究旨在分析应用超声多模态检查在乳腺非肿块样病变（NMLs）良恶性鉴别诊断中的价值。
回顾性分析乳腺NMLs病例，所有病变性质均经病理检查证实。根据灰阶超声图像特征，将病例分为Ⅰ至Ⅴ型，其中Ⅰ型和Ⅱ型根据有无钙化进一步分为4个亚型，即Ⅰa、Ⅰb、Ⅱa和Ⅱb，并对各亚型恶性病例比例进行统计学分析。建立US、US + ARFI、US + CEUS及US + ARFI + CEUS诊断恶性病例的Logistic回归模型，绘制ROC曲线，计算曲线下面积（AUC）并进行比较。分析US、ARFI及CEUS联合检查对无钙化恶性NMLs（非典型恶性NMLs）的检出率。
本研究共纳入407例病例。所有受试者均为女性，年龄22至81岁，平均年龄为（47.0±11.0）岁。良性病例220例，恶性病例187例。不同类型恶性比例由高到低依次为Ⅰb>Ⅱb>Ⅲ>Ⅴ>Ⅰa>Ⅱa>Ⅳ。有钙化低回声区的恶性比例显著高于无钙化病变。US、US + ARFI、US + CEUS及US + ARFI + CEUS诊断恶性病例的Logistic回归模型的AUC（95%置信区间[CI]）分别为0.895（0.862 - 0.927）、0.908（0.878 - 0.937）、0.921（0.893 - 0.948）和0.927（0.902 - 0.952）。4种回归模型AUC比较差异有统计学意义（<0.001）。US对无钙化NMLs的检出率为80.7%。当US与ARFI及CEUS联合使用时，若病变CEUS评分达4或5分或剪切波速度（SWV）≥4.28 m/s，则可检出86.4%的无钙化恶性NMLs病变。
有钙化的乳腺NMLs恶性风险高，确诊建议行病理检查。超声多模态检查可提高无钙化乳腺NMLs的诊断准确性。
