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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2019, Vol. 16 ›› Issue (08) : 586 -591. doi: 10.3877/cma.j.issn.1672-6448.2019.08.007

所属专题： 乳腺超声； 文献；

浅表器官超声影像学

三维剪切波弹性成像技术在鉴别诊断乳腺良恶性结节中的应用价值
田洁1, 刘千琪1, 王希1, 吴长君1,†()   
  1. 1. 150000　哈尔滨医科大学附属第一医院超声科
  • 收稿日期:2017-08-26 出版日期:2019-08-01
  • 通信作者: 吴长君
  • 基金资助:
    哈尔滨医科大学创新科学研究资助项目(31041180064); 哈尔滨医科大学附属第一医院科研创新基金项目(2019B20)

Application of three-dimensional quantitative elastography in differentiating benign and malignant breast masses

Jie Tian1, Qianqi Liu1, Xi Wang1, Changjun Wu1,†()   

  1. 1. Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150000, China
  • Received:2017-08-26 Published:2019-08-01
  • Corresponding author: Changjun Wu
  • About author:
    Corresponding author: Wu Changjun, Email:
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田洁, 刘千琪, 王希, 吴长君. 三维剪切波弹性成像技术在鉴别诊断乳腺良恶性结节中的应用价值[J]. 中华医学超声杂志（电子版）, 2019, 16(08): 586-591.

Jie Tian, Qianqi Liu, Xi Wang, Changjun Wu. Application of three-dimensional quantitative elastography in differentiating benign and malignant breast masses[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(08): 586-591.

目的

探讨三维剪切波弹性成像（SWE）技术在乳腺良恶性结节鉴别诊断中的应用价值。

方法

对2015年8月至2016年6月哈尔滨医科大学附属第一医院收治的128例乳腺占位性病变女性患者149个乳腺结节行常规超声、二维及三维SWE检查。所有病例均经病理证实。绘制SWE定量参数以及常规二维超声及常规二维超声联合SWE鉴别诊断乳腺良恶性结节的受试者操作特征（ROC）曲线，得出曲线下面积（AUC）并采用Z检验进行比较，得出相应的敏感度、特异度并采用McNemar比较。

结果

三维SWE中，灰阶图像上测量的标准差（ESDU）和弹性图像上测量的标准差（ESDE）鉴别诊断乳腺良恶性结节的AUC分别为0.887和0.909，差异无统计学意义（P>0.05）。三维SWE的ESDE鉴别诊断乳腺良恶性结节的特异度高于ESDU（90.2% vs 82.6%），且差异有统计学意义（P=0.023）。二维SWE的ESDE鉴别诊断乳腺良恶性结节的AUC大于ESDU（0.933 vs 0.908），且差异有统计学意义（P=0.04）。二维SWE的ESDE、ESDU与三维SWE的ESDE、ESDU鉴别诊断乳腺良恶性结节的AUC差异均无统计学意义。常规二维超声联合二维、三维SWE鉴别诊断乳腺良恶性结节的AUC均高于常规二维超声，且差异均有统计学意义（P<0.05）；除了三维SWE的ESDU，其余常规二维超声联合二维、三维SWE鉴别诊断乳腺良恶性结节的特异度均高于常规二维超声，且差异均有统计学意义（P均<0.05）。

结论

三维SWE在乳腺良恶性结节的鉴别中显示了良好的诊断效能，其中ESDE较ESDU具有更高的临床应用价值。

关键词: 乳腺疾病, 超声检查, 弹性成像技术
Objective

To evaluate the application value of three-dimensional (3D) shear wave elastography (SWE) in differentiating benign and malignant breast masses, and compare it with two-dimensional (2D) SWE.

Methods

One hundred and forty-nine breast masses in 128 female patients admitted to the First Affiliated Hospital of Harbin Medical University from August 2015 to June 2016 were examined by B-mode ultrasound (US), 2D and 3D SWE. All cases were confirmed by pathology. The diagnostic performance of SWE quantitative parameters, conventional 2D ultrasound, and conventional 2D ultrasound combined with SWE in diagnosing benign and malignant breast masses was assessed by receiver operating characteristic (ROC) curve analysis. The calculated areas under the curves (AUCs) were compared using the Z-test, and sensitivities and specificities were calculated and compared using the McNemar test.

Results

In 3D SWE, the AUC of the standard deviation (ESDU) measured on the grayscale image and the standard deviation (ESDE) measured on the elastic image for diagnosing benign and malignant breast masses were 0.887 and 0.909, respectively, which had no significant difference (P>0.05). In 3D SWE, the specificity of ESDE for diagnosing benign and malignant breast masses was significantly higher than that of ESDU (90.2% vs 82.6%, P=0.023). In 2D SWE, the AUC of ESDE in diagnosing benign and malignant breast masses was significantly higher than that of ESDU (0.933 vs 0.908, P=0.04). In comparison of 2D and 3D SWE data, no significant differences were found in AUCs for either ESDE or ESDU. The AUCs of conventional 2D ultrasound combined with 2D and 3D SWE in diagnosing benign and malignant breast masses were significantly higher than that of conventional 2D ultrasound (P<0.05). Except for the ESDU in 3D SWE, the specificities of other conventional 2D ultrasound data combined with 2D and 3D SWE in diagnosing benign and malignant breast masses were significantly higher than that of conventional 2D ultrasound (P<0.05).

Conclusion

3D SWE has good diagnostic performance in differentiating benign and malignant breast masses, and the measurement of ESDE has better clinical value than ESDU.

Key words: Breast diseases, Ultrasonography, Elasticity imaging techniques
图1 剪切波弹性成像图记录弹性参数。图a为二维剪切波弹性成像图，小的圆形感兴趣区尽可能包含灰阶勾勒出病变区域，且不超过病变的轮廓，测得的标准差记录为ESDE，大的圆形感兴趣区尽可能包含弹性勾勒出的病变区域边缘，测得的标准差记录为ESDU，上图为剪切波弹性成像图，下图为对应的灰阶图；图b为三维剪切波弹性成像图。左上图为断层示意图，其余图为对应的断层切面弹性图
表1 乳腺良恶性结节二维和三维SWE弹性值比较［kPa，M（QR）］
乳腺结节 ESDU ESDE Emax
二维SWE 三维SWE P值 二维SWE 三维SWE P值 二维SWE 三维SWE P值
恶性 17.8（12.3，25.2） 17.1（12.0，26.1） 0.651 22.8（16.2，30.8）a 20.6（16.53，28.6）a 0.479 148.9（102，208.4） 191.9（168.5，230.3） <0.001
良性 6.4（4.5，8.5） 7.18（5.4，8.8） 0.0307 7.07（5.2，9.8）a 7.9（6.3，10.7）a 0.0235 42.9（30.5，57.2） 85.4（65.9，121.2） <0.001
P值 <0.001 <0.001 ? <0.001 <0.001 ? <0.001 <0.001 ?
图2 二维和三维剪切波弹性成像定量参数诊断乳腺良恶性结节的受试者操作特征曲线
表2 二维和三维SWE定量参数鉴别诊断乳腺良恶性结节的效能比较
参数 阈值（kPa） AUC 敏感度（%） 特异度（%）
二维SWE 三维SWE 二维SWE 三维SWE P值 二维SWE 三维SWE P值 二维SWE 三维SWE P值
ESDU 10.6 9.8 0.908 0.887 0.369 82.4 87.7 0.248 89.1 82.6 0.041
ESDE 13.7 13.1 0.933a 0.909 0.154 84.2 80.7 0.479 93.4 90.2a 0.248
Emax 79.4 154.0 0.943b 0.904 0.010 85.9 82.4 0.479 95.6 90.2 0.074
图3 常规二维超声及常规二维超声联合剪切波弹性成像定量参数诊断乳腺良恶性结节的受试者操作特性曲线
表3 常规二维超声与常规二维超声联合SWE鉴别诊断乳腺良恶性结节的效能比较
方法 AUC 敏感度（%） 特异度（%）
常规二维超声BI-RADS分类 0.883 91.2 78.3
常规二维超声联合二维SWE ? ? ?
? ESDU 0.941a 84.2 93.5a
? ESDE 0.948a 87.7 94.6a
? Emax 0.956a 86.0 94.6a
常规二维超声联合三维SWE ? ? ?
? ESDU 0.935a 91.2 81.5
? ESDE 0.938a 82.5 93.5a
? Emax 0.936a 80.7 96.7a
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