剪切波弹性成像在乳腺非肿块病变良恶性鉴别诊断中的作用

doi:10.13481/j.1671-587X.20230630

Abstract

Abstract:

Objective To discuss the effect of shear wave elastography （SWE） on the differential diagnosis of benign and malignant breast non-mass lesion （NML）， and to clarify its clinical significance. Methods A total of 158 patients with breast NML were selected and divided into benign lesion group （ n=83） and malignant lesion group（ n=75） according to the postoperative pathological type of the patients.The routine ultrasound and SWE examinations were conducted before operation， and the SWE parameters of the lesions， including the maximum （E_max）， average （E_mean），minimum （E_min）， standard deviation （E_sd） and whether the stiff rim sign presented or not at 1， 2 and 3 mm around the lesion were recorded. The SWE characteristics and differences in SWE parameters of the NML patients between two groups were analyzed， and the receiver operating characteristic curve（ROC） was plotted， and the area under curve （AUC）， specificity and sensitivity were calculated. Results There were statistically significant differences in age， lesion size， palpation， and whether menopause had crested of the NML patients between two groups（ P<0.01）. All the lesions of the patients in two groups appeared as hyperechoic and irregular in shape. Compared with benign lesion group， the percentage of the patients with non-parallel， calcification and posterior echo attenuation in malignant lesion group was significantly increased （ P<0.01）， and the percentage of the patients without blood supply was significantly decreased （ P<0.01）. Compared with benign lesion group， the E_max， E_mean， and E_sd of the NML patients in malignant lesion group were significantly increased （ P<0.01）， and the E_max， E_mean， and E_sd at 1， 2， and 3 mm around the lesion were all increased （ P<0.01）. The stiff rim sign manifested as a circular or semi-circular red region around the lesions of the patients in malignant lesion group. Compared with benign lesion group， the percentage of hard rim sign of the NML patients in malignant lesion group was significantly increased （ P<0.01）.Compared with inside the lesion，the E_min at 1，2 and 3 mm around the lesion of the NML patients in benign lesion group and malignant lesion group were decreased（ P<0.01）. The AUC of E_max at 1， 2 and 3 mm around the lesion were 0.872， 0.860， 0.873 and 0.866，respectively； the AUC of E_mean were 0.796， 0.822， 0.820 and 0.815，respectively； the AUC of E_sd were 0.832， 0.857， 0.859， and 0.842，respectively；the sensitivity and specificity of E_max inside the lesion were 85.33% and 83.13%，respectively；the sensitivity and specificity of E_max at 1 mm around the lesion were 82.67% and 80.72%，respectively； the sensitivity and specificity at 2 mm around the lesion were 78.67% and 87.95%，respectively； the sensitivity and specificity at 3 mm around the lesion were 80.00% and 86.75%，respectively； the specificity of E_sd at 2 mm around the lesion was highest （93.33%）. Conclusion The SWE parameters inside and around the lesion and the manifestation of stiff rim sign can provide the reference for the differential diagnosis of benign and malignant breast NML， and have good diagnostic performance.

Key words: Breast tumor, Non-mass lesions, Shear wave elastography, Stiff rim sign, Differential diagnosis

CLC Number:

R737.9

Zhirui CHUAN,Hongying YANG,Zhiyao LI,Dong CHEN,Huijing NI,Xiaokai LU,Haitao CHEN,Xiaomao LUO. Effect of shear wave elastography on differential diagnosis of benign and malignant breast non-mass lesions[J].Journal of Jilin University(Medicine Edition), 2023, 49(6): 1625-1634.

Figures/Tables 11

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References 24

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Group	n	Age (year)				Diameter of tumor ( l/mm)			Palpability[ n/( η/%)]
Group	n	Age (year)				Diameter of tumor ( l/mm)			Yes			No
Benign lesion	83	39.49±9.52			19.41±11.94				55（66.27）		28（33.73）
Malignant lesion	75	48.47±8.40			27.29±14.27				66（88.00）		9（12.00）
χ ²/t		－6.25			－3.78				10.38
P		<0.01			<0.01				0.001
Group	n	Pain[ n/( η/%)]						Nipple discharge[ n/( η/%)]		Menstrual history[ n/( η/%)]
Group	n	Yes		No				Yes	No	Menopause			Menopause
Benign lesion	83	16（19.28）	67（80.72）				13（15.66）		70（84.34）	7（8.43）			76（91.57）
Malignant lesion	75	13（17.33）	62（82.67）				8（10.67）		67（89.33）	24（32.00）			51（68.00）
χ ²/t		0.10					0.85			13.87
P		0.735					0.356			<0.01

Group	n	Orientation					Calcification
Group	n	Parallel		Not parallel			Yes		No
Benign lesion	83	80（96.39）		56（74.67）			3（3.61）		17（22.67）
Malignant lesion	75	3（3.61）		19（25.33）			80（96.39）		58（77.33）
χ ²/t		15.51					12.94
P		<0.01					<0.01
Group	n	Posterior acoustic feature				Vascularity
Group	n	No posterior acoustic feature	Enhancement		Shadowing	Absent		Internal vascularity		Vessels in rim
Benign lesion	83	72（86.75）	4（4.82）		7（8.43）	10（12.05）		60（72.29）		13（15.66）
Malignant lesion	75	52（69.33）	0（0）		23（30.67）	0（0）		56（74.67）		19（25.33）
χ ²/t		Fisher				10.89
P		<0.01				0.004

Group	n	Inside lesion
Group	n	E_max	E_mean	E_min	E_sd
Benign lesion	83	68.23±37.62	27.92±11.82	9.13±6.34	10.16±5.09
Malignant lesion	75	124.63±57.82	43.12±15.79	10.97±8.10	17.72±8.41
t		7.33	6.89	1.58	6.75
P		<0.01	<0.01	0.117	<0.01
	n	1 mm arround lesion
	n	E_max	E_mean	E_min	E_sd
Benign lesion	83	63.05±32.54	27.41±11.76	8.64±5.89	10.82±5.27
Malignant lesion	75	114.14±52.67	43.08±13.85	10.48±6.70	19.78±9.71
t		7.24	7.69	1.82	7.11
P		<0.01	<0.01	0.071	<0.01
Group	n	2 mm arround lesion
Group	n	E_max	E_mean	E_min	E_sd
Benign lesion	83	65.86±31.70	26.61±11.13	7.08±4.94	11.10±5.11
Malignant lesion	75	121.62±64.23	41.24±13.39	8.41±5.78	19.47±9.81
t		6.81	7.49	1.55	6.62
P		<0.01	<0.01	0.124	<0.01
Group	n	3 mm arround lesion
Group	n	E_max	E_mean	E_min	E_sd
Benign lesion	83	70.45±35.03	25.83±10.55	6.01±4.55	11.38±4.84
Malignant lesion	75	124.81±67.74	39.35±13.00	7.16±5.10	19.06±10.15
t		6.24	7.20	1.50	5.96
P		<0.01	<0.01	0.135	<0.01

Group	n	Stiff rim sign
Group	n	Yes	No
Benign lesion	83	14（16.87）	69（83.13）
Malignant lesion	75	57（76.00）	18（24.00）
χ2		55.68
P		<0.01

Lesion position	E_max	E_mean	E_min	E_sd
Inside lesion	68.23±37.62	27.92±11.82	9.13±6.34	10.16±5.09
1 mm around lesion	63.05±32.54	27.41±11.76	8.64±5.89 ^*	10.82±5.27
2 mm around lesion	65.86±31.70	26.61±11.13	7.08±4.94 ^*	11.10±5.11
3 mm around lesion	70.45±35.03	25.83±10.55	6.01±4.55 ^*	11.39±4.84
^*P<0.01 vs inside lesion.

Effect of shear wave elastography on differential diagnosis of benign and malignant breast non-mass lesions

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Variable	Cut-off point （kPa）	Sensitivity（ η/%）	Specificity（ η/%）	AUC(95% CI)
Inside　lesional
E_max	88.48	85.33	83.13	0.872（0.809－0.920）
E_mean	36.94	72.00	78.31	0.796（0.724－0.856）
E_sd	12.29	81.33	75.90	0.832（0.764－0.887）
1 mm arround lesion
E_max	80.24	82.67	80.72	0.860（0.796－0.910）
E_mean	27.67	90.67	62.65	0.822（0.753－0.878）
E_sd	13.81	78.67	81.93	0.857（0.792－0.907）
2 mm arround lesion
E_max	89.89	78.67	87.95	0.873（0.811－0.921）
E_mean	28.17	86.67	67.47	0.820（0.751－0.876）
E_sd	11.37	93.33	65.06	0.859（0.795－0.909）
3 mm arround lesion
E_max	89.89	80.00	86.75	0.866（0.802－0.915）
E_mean	26.85	85.33	68.67	0.815（0.745－0.872）
E_sd	12.59	86.67	69.88	0.842（0.776－0.896）

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