实时剪切波弹性成像和超声造影对BI-RADS 4类乳腺病变诊断效能的对比研究

摘要

Objective To compare the BI-RADS 4 category breast lesions diagnostic efficiency by shear-wave elastography(SWE) and contrast-enhanced ultrasound(CEUS).Methods Seventy patients with 72 lesions were examined by SWE and CEUS,respectively.Maximum elasticity(Emax) and CEUS 5-point scores were assessed.The results were compared using the area under the receiver operating characteristic(AUC) curve.Results The Emax and CEUS 5-point scores were 23.58 kPa and 2.56 ±0.64 respectively for benign masses and 61.45 kPa and 3.95 ±0.88 respectively for malignant masses,there were significant difference(both P<0 . 01). The AUC of Emax and CEUS 5-point scores were 0 . 840 , 0 . 754 , no significant difference was demonstrated.The accuracy of Emax(93.9%) was higher than that of CEUS 5-point scores(75.7%) in the diagnosis of BI-RADS 4A category lesions(P<0 . 05). There were no significant differences in accuracy between BI-RADS 4B and 4C category lesions . Conclusion Both SWE and CEUS are helpful for differential diagnosing the BI-RADS 4 category breast lesions,and SWE has better diagnostic efficiency in BI-RADS 4A category lesions.%目的 比较实时剪切波弹性成像(SWE)与超声造影对乳腺BI-RADS 4类病变的诊断价值.方法 对70例BI-RADS 4类乳腺病变患者(共72个乳腺病变)分别行SWE和超声造影检查,测量其最大弹性模量值(Emax),应用超声造影5分法对病灶进行评分.以手术及病理结果为金标准,构建受试者工作特征曲线,计算其曲线下面积(AUC)并比较两种方法的诊断效能.结果 41个乳腺良性病变的Emax值和超声造影评分分别为23.58 kPa、(2.56±0.64)分;31个恶性病变的Emax值和超声造影评分分别为61.45 kPa、(3.95±0.88)分,差异均有统计学意义(均P<0.01).Emax值和超声造影评分诊断BI-RADS 4类乳腺病变的AUC分别为0.840、0.754,差异无统计学意义.SWE对BI-RADS 4A类乳腺病变的诊断准确率为93.9%,高于超声造影(75.7%),差异有统计学意义(P<0.05);对于BI-RADS 4B和4C类乳腺病变,两种检查方法诊断准确率比较差异均无统计学意义.结论 SWE和超声造影在乳腺BI-RADS 4类病变的良恶性鉴别诊断中均有较高的诊断价值,SWE对于BI-RADS 4A类病变具有更好的诊断价值.