超声综合评分法、弹性应变率比值法和钼钯X线对触诊阴性乳腺实性肿块的诊断价值研究
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摘要
背景
乳腺癌是女性最常见的恶性肿瘤,也是女性癌症致死的主要病因之一。随着乳腺癌筛查工作的开展以及影像技术的不断发展,越来越多的临床触诊阴性乳腺病灶(non-palpablebreast lesions, NPBL)被检出。乳腺钼靶x线摄影是乳腺影像学传统的检查方法,现仍广泛应用于临床诊断。美国放射学会提出的乳腺影像报告和数据系统(breast imaging report and Data system, BI-RADS)作为一种质控手段,有利于影像科医师与临床医师交流。
超声弹性成像是近几年发展起来的新技术,通过反映乳腺肿物的硬度来判断病灶的良恶性。以往弹性成像技术应用多采用评分法,有可能受限于医生主观因素而影响诊断效果,应变率比值测量技术采用半定量方法,可更加客观评价病灶的软硬程度。
本研究通过比较弹性应变率比值法和钼靶BI-RADS标准对触诊阴性乳腺病灶良恶性的评估结果,以期为临床提高乳腺疾病的正确诊断率提供更多帮助。
目的
探讨超声弹性应变率比值法与钼靶X线对触诊阴性乳腺实性肿块的诊断价值。
方法
对93例患者97个NPBL病灶进行钼靶X线BI-RADS分级,并于穿刺活检或手术切除前进行超声弹性应变率比值法测定。以病理诊断为金标准,构建受试者工作特征曲线(receiver operating characteristic curve, ROC),比较2种不同方法对NPBL的诊断价值。
结果
1.触诊阴性乳腺恶性病灶弹性应变率比值远大于良性病灶(分别为6.16±4.31和2.71±2.75),两者比较差异显著(P<0.01)。
2.根据ROC曲线确定弹性应变01率比值的最佳诊断临界点为3.27,对应的敏感性、特异性和准确性分别为89.3%、91.2%和90.6%
3.弹性病变率比值法与钼靶X线BI-RADS分级的曲线下面积(AUC)分别为0.898和0.783。两者比较差异有统计学意义(P<0.05)。
结论
1.弹性应变率比值法对NPBL的良恶性评估价值明显。
2.对于NPBL弹性应变率比值法作为一种无痛、无创,操作简便,可重复性强的新型成像技术其诊断效果好于钼靶BI-RADS分级标准。
背景
随着影像学的不断发展以及女性健康意识的不断提高,越来越多的触诊阴性乳腺病变(non-palpable breast lesions, NPBL)被检出。据报道触诊阴性乳腺癌与可触及肿物乳腺癌的生物学特性有较大差异,触诊阴性乳腺癌肿瘤细胞的异型性、转移潜能及生长活性均低于可触及肿物的乳腺癌。并且预后好于可触及性乳腺癌。
美国放射学会2003出版的乳腺影像报告及数据系统(breast imaging report and Data system, BI-RADS)新加入了超声诊断标准(BI-RADS-US),为规范化诊断提供了依据。乳腺恶性肿瘤是典型的血管依赖性病变,彩色多普勒超声在乳腺疾病的诊断中具有重要作用,高频超声可以较敏感的显示肿瘤周边及内部的血流情况。弹性应变率比值(strain ratio, SR)是实时超声弹性成像技术中估算组织硬度的新方法,使得避免判断病灶的主观性及测出病灶的硬度值成为可能。
随着BI-RADS-US分级在临床上的应用,显示出了良好的诊断效果,但是仍然存在一些问题,一方面血流方面淡化了多普勒超声的功用,仅列出病灶内、毗邻处及周围组织有无增加的弥漫性血流信号等情况,而未包括血流的形态和频谱分析等乳腺良恶性病变鉴别诊断的重要参数。另一方面随着弹性成像技术的发展,BI-RADS-US分级完善方面也期待加入超声弹性成像的指标。
本研究将判断乳腺肿块性质的常规超声的3种判断标准和新技术弹性应变率比值法相结合对NPBL的良恶性进行对比研究,将各单项诊断指标的诊断结果给予量化,各量化值相加便得到的综合分值,并提出采用超声综合评分法与各个单项标准进行分析比较,以期为临床提高诊断率提供更多的理论依据。
目的
研究超声综合评分法对NPBL良恶性的诊断价值
方法
采用日立HIVISION900型多功能彩色多普勒超声诊断仪,对98个触诊阴性乳腺实性病灶,于穿刺活检或手术切除前行高频多普勒超声及超声弹性应变率比值检查,其中恶性病灶22个,良性76个,并进行超声综合评分。超声评分参数包括BI-RADS-US分级、Adler血流分级、频谱多普勒动脉阻力指数(resistance index, RI)和弹性应变率比值测量,累计每个NPBL的总评分。以病理结果作为金标准,绘制4项超声参数与超声综合评分法鉴别NPBL良恶性的受试者工作特征曲线(receiver operating characteristic curve, ROC),Z检验对5条ROC曲线下面积进行比较,找出最佳曲线及诊断NPBL的最佳截断值和相应的敏感性、特异性和准确性。所有数据采用SPSS13.0和MedCalc12.1.3.0统计学软件进行统计学分析。
结果1.弹性应变率比值法、BI-RADS-US标准、Adler血流分级及频谱多普勒血流RI诊断的ROC曲线的AUC分别为0.871、0.859、0.693和0.690。弹性应变率比值法与BI-RADS-US标准比较,差异无统计学意义(Z=0.208,P=0.835),与Adler血流分级及频谱多普勒血流RI诊断标准比较,差异有统计学意义(P=0.016)和(P=0.020)。BI-RADS-US标准与Adler血流分级及频谱多普勒血流RI诊断标准比较,差异有统计学意义(P=0.008)和(P=0.020)。Adler血流分级和频谱多普勒血流RI诊断标准比较差异无统计学意义(P=0.976)。
2.超声综合评分范围0-6分,评分≤1分的均为良性,超声评分≥4分的均为恶性,评分为2和3的恶性病灶分别为7.0%(2/28)和40%(6/15)。超声评分越高恶性的比例越大。
3.超声综合评分法构建NPBLROC曲线的AUC为0.956,与弹性应变率比值法、BI-RADS-US标准、Adler血流分级及频谱多普勒血流RI诊断标准比较,差异均有统计学意义(P<0.05)。根据ROC曲线确定最佳的诊断截点≥3分,其对应的敏感性、特异性准确性分别为90.9%、88.2%和88.8%。
结论
超声综合评分法将BI-RADS-US分级、Adler血流分级、频谱多普勒动脉阻力指数RI和弹性应变率比值测量4种标准进行量化并综合分析,能有效的鉴别NPBL的良恶性,诊断效果好于各个单项标准。它简单实用,准确性高可重复性好,是评估NPBL良恶性的新方法,将提高NPBL恶性病灶的检出率,并使得需要活检以确定良恶性的患者数也大为减少,具有较高的临床应用价值。
1.本研究立足临床需要首次提出超声综合评分法对实性NPBL的良恶性进行评估。超声综合评分法将常规超声的3种判断标准和新技术弹性应变率比值法相结合,极大的提高了诊断的敏感性、特异性和准确性,具有较高的临床应用价值。
2.首次对NPBL用超声弹性应变率比值法和钼靶BI-RADS分级两种方法进行比较,结果显示弹性应变率比值法对于NPBL的诊断效果好于钼靶BI-RADS分级标准,为临床提高NPBL的诊断率提供了新的方法。
Background
Breast cancer is the most common female malignancy, is also one of the leading causes of cancer death in women. As the breast cancer screening work and the imaging technology development, more and more nonpalpable breast lesions (NPBL) were detected. Mammography is the traditional examination in breast, which is still widely used in clinical diagnosis. Breast imaging report and Data system (BI-RADS) as a means of quality control was used for standardization mammography reports, assessment of lesion, recommending the treatment measures.
Elastography as a new technology was developed in recent years, which through evaluated the hardness of breast masses to judge the benign and malignant of lesions. Previous elasticity imaging techniques using scoring method, it can be limited by the subjective factors and affect doctor's diagnosis. Strain ratio (SR) measurement techniques using semi quantitative method, can be more objective to evaluate the hard and soft degree of breast lesions. The purpose of this study was to evaluate the diagnostic of Mammography and strain ratio measure method for nonpalpable breast masses, and help the clinical to improve the diagnosis of breast disease.
Objective
Evaluation of sonoelastography strain ratio and mammography in nonpalpable breast lesions.
Methods
97nonpalpable breast masses in93women who had been scheduled for a sonographically guided core biopsy or operation were examined with mammography and sonoelastography. The pathologic diagnosis was as golden standard. The diagnostic performance of the two methods was evaluated with receiver operating characteristic curve (ROC)
Results
1. The results showed that there was a significant difference in the mean strain indices between nonpalpable benign and malignant breast masses:2.71±2.75for benign masses versus6.16±4.31for malignant masses (P<0.01)
2. According to the ROC, the best strain index cutoff point to achieve the maximal sum of the maximal sum of the sensitivity and specificity was3.27. The sensitivity, specificity and accuracy were89.3%、91.2%and90.6%, respectively.
3. Receiver operating characteristic curves for the elastographic strain index and mammograms. The Az walues(Z=2.265,P=0.026) were statistically different for the strain index0.898and mammograms0.783.
Conclusion
1. Sonoelastography strain ratio was found to have a diagnostic performance for differentiation of nonpalpable breast masses.
2. It is a simple, convenient operation, strong repeatability, non-invasive diagnostic examination that provides information about the stiffness of a mass, and have a good diagnostic performace than mammograms.
Background
With the continuous development of imaging and the improvement of awareness of women's health, more and more non-palpable breast lesions (NPBL) have been detected. It is reported in available literature non-palpable breast cancer and palpable tumor breast cancer are greatly distinguished in characters. Non-palpable breast tumor's cell atypia, metastatic potential and growth activity are lower than those of the palpable mass of breast cancer. In2003, Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology included new ultrasound diagnostic criteria (BI-RADS-US), and it provides the basis for standardized diagnosis. Malignant breast tumor is typical vascular dependent lesions. Color Doppler ultrasound has an important role in the diagnosis of breast disease. Sensitive high-frequency ultrasound can show the tumor periphery and the blood flow inside the case. Strain ratio (SR) is the real-time ultrasound elastic imaging technology in new method to estimate the tissue hardness, and that makes it possible to avoid subjective judgment of lesions and it can also measure hardness values of the lesions.
With the BI-RADS-US classification in clinical application, showing a good diagnosis effect, but there are still some problems, on one hand the blood dilution by Doppler ultrasound features, lists only within the lesion, adjacent to and surrounding tissues without increasing diffuse flow signal and so on, and did not include blood flow patterns and spectrum analysis and other benign and malignant breast lesions in the differential diagnosis of important parameters. On the other hand, along with the elastic imaging technology for the development of BI-RADS-US grade, perfect aspect also looking forward to joining ultrasound elasticity imaging index.
This essay is aimed at the study of the commonly used diagnostic criteria which can determine the nature of breast lumps NPBL, in other words, can help to find out whether these lumps are benign or malignant. The study will propose the analysis of using the ultrasonic score and comparison of each individual standard to provide more theoretical basis for clinical diagnosis.
Objective
To research the differential diagnosis value of nonpalpable breast lesions using ultrasound score.
Methods
Conventional US and elastographic images were obtained using a EUB-900scanner(Hitachi Medical, Tokyo). All of breast lesions were nonpalpable and detected by ultrasound or mammography before sonographically guided core biosy and operations. Of the98lesions,76benign and22were malignant, and cumulated ultrasound score. We measured and recorded four US parameters:BI-RADS-US, Adler flow grading, Doppler spectrum resistance index (resistance index, RI) and elastic strain ratio, and the total US score of each nonpalpable breast lesions, he pathologic diagnosis was as golden standard. Using receiver operating characteristic curves analysis, we researched weather the US score was more accurate than each parameter and which was the best cut-off value for differential diagnosis of nonpalpable breast lesions. All data analyses were conducted with SPSS13.0and MedCalc12.1.3.0statistic software.
Results
1. The area under the ROC cure values were0.871for the strain index,0.859for the BI-RADS-US,0.693for the Adler flow grade and0.690for the RI for differentiation of benign and malignant NPBL.
Receiver operating characteristic curves for the elastographic strain index and BI-RADS-US. The Az walues(Z=0.208, P=0.835) were no statistically different for the strain index0.871and0.859. There were statistically different for the strain index and Color Doppler flow imaging (P=0.016) or strain index and spectral Doppler resistance index((P=0.020). There were statistically different for BI-RADS-US and Color Doppler flow imaging (P=0.008) or BI-RADS-US and spectral Doppler resistance index (P=0.020). There were no statistically different for Color Doppler flow imaging and spectral Doppler resistance index(P=0.976).
2. Results shows ultrasound score≤1are benign, ultrasound score≥4points are malignant, a score of2and3of malignant lesions were7%(2/28) and40%(6/15). Ultrasound score were the higher the greater proportion of malignant.
3. The area under the ROC cure values were0.956for ultrasound score method to differentiate benign and malignant NPBL, There were statistically different between ultrasound score and strain index、BI-RADS-US、Color Doppler flow imaging or spectral Doppler resistance index (P<0.05). According to the ROC curve to determine the optimal diagnostic cutoff points was≥3, the sensitivity, specificity and accuracy were90.9%,88.2%and88.8%.
Conclusion
For clinically non-palpable breast lesions, ultrasound scoring method is helpful to determine the benign and malignant lesions, compared with single application of conventional ultrasound and elastography have greater clinical application value. It is simple and practical, accurate and highly reproducible, will raise the NPBL malignant lesion detection rates, and makes the need for biopsy to identify benign and malignant patients number has been greatly reduced, it has high value in clinical application. Main Innovative Points
1. Based on the clinical demand, this study first used US score to differential diagnosis nonpalpable breast lesions. It can greatly increase the diagnostic sensitivity and specificity of differentiation of benign and malignant nonpalpable breast lesions. So US score is a simple、practical and accurate new method which is worthwhile for clinical application.
2. We first study on the comparison between strain ratio and mammograms to differential diagnosis nonpalpable breast lesions. the results show the strain ratio method for the diagnosis of nonpalpable breast lesions is better than BI-RADS grading standard for mammography, It provides a new method for clinical to improve the diagnostic rate
乳腺癌是女性最常见的恶性肿瘤,也是女性癌症致死的主要病因之一。随着乳腺癌筛查工作的开展以及影像技术的不断发展,越来越多的临床触诊阴性乳腺病灶(non-palpablebreast lesions, NPBL)被检出。乳腺钼靶x线摄影是乳腺影像学传统的检查方法,现仍广泛应用于临床诊断。美国放射学会提出的乳腺影像报告和数据系统(breast imaging report and Data system, BI-RADS)作为一种质控手段,有利于影像科医师与临床医师交流。
超声弹性成像是近几年发展起来的新技术,通过反映乳腺肿物的硬度来判断病灶的良恶性。以往弹性成像技术应用多采用评分法,有可能受限于医生主观因素而影响诊断效果,应变率比值测量技术采用半定量方法,可更加客观评价病灶的软硬程度。
本研究通过比较弹性应变率比值法和钼靶BI-RADS标准对触诊阴性乳腺病灶良恶性的评估结果,以期为临床提高乳腺疾病的正确诊断率提供更多帮助。
目的
探讨超声弹性应变率比值法与钼靶X线对触诊阴性乳腺实性肿块的诊断价值。
方法
对93例患者97个NPBL病灶进行钼靶X线BI-RADS分级,并于穿刺活检或手术切除前进行超声弹性应变率比值法测定。以病理诊断为金标准,构建受试者工作特征曲线(receiver operating characteristic curve, ROC),比较2种不同方法对NPBL的诊断价值。
结果
1.触诊阴性乳腺恶性病灶弹性应变率比值远大于良性病灶(分别为6.16±4.31和2.71±2.75),两者比较差异显著(P<0.01)。
2.根据ROC曲线确定弹性应变01率比值的最佳诊断临界点为3.27,对应的敏感性、特异性和准确性分别为89.3%、91.2%和90.6%
3.弹性病变率比值法与钼靶X线BI-RADS分级的曲线下面积(AUC)分别为0.898和0.783。两者比较差异有统计学意义(P<0.05)。
结论
1.弹性应变率比值法对NPBL的良恶性评估价值明显。
2.对于NPBL弹性应变率比值法作为一种无痛、无创,操作简便,可重复性强的新型成像技术其诊断效果好于钼靶BI-RADS分级标准。
背景
随着影像学的不断发展以及女性健康意识的不断提高,越来越多的触诊阴性乳腺病变(non-palpable breast lesions, NPBL)被检出。据报道触诊阴性乳腺癌与可触及肿物乳腺癌的生物学特性有较大差异,触诊阴性乳腺癌肿瘤细胞的异型性、转移潜能及生长活性均低于可触及肿物的乳腺癌。并且预后好于可触及性乳腺癌。
美国放射学会2003出版的乳腺影像报告及数据系统(breast imaging report and Data system, BI-RADS)新加入了超声诊断标准(BI-RADS-US),为规范化诊断提供了依据。乳腺恶性肿瘤是典型的血管依赖性病变,彩色多普勒超声在乳腺疾病的诊断中具有重要作用,高频超声可以较敏感的显示肿瘤周边及内部的血流情况。弹性应变率比值(strain ratio, SR)是实时超声弹性成像技术中估算组织硬度的新方法,使得避免判断病灶的主观性及测出病灶的硬度值成为可能。
随着BI-RADS-US分级在临床上的应用,显示出了良好的诊断效果,但是仍然存在一些问题,一方面血流方面淡化了多普勒超声的功用,仅列出病灶内、毗邻处及周围组织有无增加的弥漫性血流信号等情况,而未包括血流的形态和频谱分析等乳腺良恶性病变鉴别诊断的重要参数。另一方面随着弹性成像技术的发展,BI-RADS-US分级完善方面也期待加入超声弹性成像的指标。
本研究将判断乳腺肿块性质的常规超声的3种判断标准和新技术弹性应变率比值法相结合对NPBL的良恶性进行对比研究,将各单项诊断指标的诊断结果给予量化,各量化值相加便得到的综合分值,并提出采用超声综合评分法与各个单项标准进行分析比较,以期为临床提高诊断率提供更多的理论依据。
目的
研究超声综合评分法对NPBL良恶性的诊断价值
方法
采用日立HIVISION900型多功能彩色多普勒超声诊断仪,对98个触诊阴性乳腺实性病灶,于穿刺活检或手术切除前行高频多普勒超声及超声弹性应变率比值检查,其中恶性病灶22个,良性76个,并进行超声综合评分。超声评分参数包括BI-RADS-US分级、Adler血流分级、频谱多普勒动脉阻力指数(resistance index, RI)和弹性应变率比值测量,累计每个NPBL的总评分。以病理结果作为金标准,绘制4项超声参数与超声综合评分法鉴别NPBL良恶性的受试者工作特征曲线(receiver operating characteristic curve, ROC),Z检验对5条ROC曲线下面积进行比较,找出最佳曲线及诊断NPBL的最佳截断值和相应的敏感性、特异性和准确性。所有数据采用SPSS13.0和MedCalc12.1.3.0统计学软件进行统计学分析。
结果1.弹性应变率比值法、BI-RADS-US标准、Adler血流分级及频谱多普勒血流RI诊断的ROC曲线的AUC分别为0.871、0.859、0.693和0.690。弹性应变率比值法与BI-RADS-US标准比较,差异无统计学意义(Z=0.208,P=0.835),与Adler血流分级及频谱多普勒血流RI诊断标准比较,差异有统计学意义(P=0.016)和(P=0.020)。BI-RADS-US标准与Adler血流分级及频谱多普勒血流RI诊断标准比较,差异有统计学意义(P=0.008)和(P=0.020)。Adler血流分级和频谱多普勒血流RI诊断标准比较差异无统计学意义(P=0.976)。
2.超声综合评分范围0-6分,评分≤1分的均为良性,超声评分≥4分的均为恶性,评分为2和3的恶性病灶分别为7.0%(2/28)和40%(6/15)。超声评分越高恶性的比例越大。
3.超声综合评分法构建NPBLROC曲线的AUC为0.956,与弹性应变率比值法、BI-RADS-US标准、Adler血流分级及频谱多普勒血流RI诊断标准比较,差异均有统计学意义(P<0.05)。根据ROC曲线确定最佳的诊断截点≥3分,其对应的敏感性、特异性准确性分别为90.9%、88.2%和88.8%。
结论
超声综合评分法将BI-RADS-US分级、Adler血流分级、频谱多普勒动脉阻力指数RI和弹性应变率比值测量4种标准进行量化并综合分析,能有效的鉴别NPBL的良恶性,诊断效果好于各个单项标准。它简单实用,准确性高可重复性好,是评估NPBL良恶性的新方法,将提高NPBL恶性病灶的检出率,并使得需要活检以确定良恶性的患者数也大为减少,具有较高的临床应用价值。
1.本研究立足临床需要首次提出超声综合评分法对实性NPBL的良恶性进行评估。超声综合评分法将常规超声的3种判断标准和新技术弹性应变率比值法相结合,极大的提高了诊断的敏感性、特异性和准确性,具有较高的临床应用价值。
2.首次对NPBL用超声弹性应变率比值法和钼靶BI-RADS分级两种方法进行比较,结果显示弹性应变率比值法对于NPBL的诊断效果好于钼靶BI-RADS分级标准,为临床提高NPBL的诊断率提供了新的方法。
Background
Breast cancer is the most common female malignancy, is also one of the leading causes of cancer death in women. As the breast cancer screening work and the imaging technology development, more and more nonpalpable breast lesions (NPBL) were detected. Mammography is the traditional examination in breast, which is still widely used in clinical diagnosis. Breast imaging report and Data system (BI-RADS) as a means of quality control was used for standardization mammography reports, assessment of lesion, recommending the treatment measures.
Elastography as a new technology was developed in recent years, which through evaluated the hardness of breast masses to judge the benign and malignant of lesions. Previous elasticity imaging techniques using scoring method, it can be limited by the subjective factors and affect doctor's diagnosis. Strain ratio (SR) measurement techniques using semi quantitative method, can be more objective to evaluate the hard and soft degree of breast lesions. The purpose of this study was to evaluate the diagnostic of Mammography and strain ratio measure method for nonpalpable breast masses, and help the clinical to improve the diagnosis of breast disease.
Objective
Evaluation of sonoelastography strain ratio and mammography in nonpalpable breast lesions.
Methods
97nonpalpable breast masses in93women who had been scheduled for a sonographically guided core biopsy or operation were examined with mammography and sonoelastography. The pathologic diagnosis was as golden standard. The diagnostic performance of the two methods was evaluated with receiver operating characteristic curve (ROC)
Results
1. The results showed that there was a significant difference in the mean strain indices between nonpalpable benign and malignant breast masses:2.71±2.75for benign masses versus6.16±4.31for malignant masses (P<0.01)
2. According to the ROC, the best strain index cutoff point to achieve the maximal sum of the maximal sum of the sensitivity and specificity was3.27. The sensitivity, specificity and accuracy were89.3%、91.2%and90.6%, respectively.
3. Receiver operating characteristic curves for the elastographic strain index and mammograms. The Az walues(Z=2.265,P=0.026) were statistically different for the strain index0.898and mammograms0.783.
Conclusion
1. Sonoelastography strain ratio was found to have a diagnostic performance for differentiation of nonpalpable breast masses.
2. It is a simple, convenient operation, strong repeatability, non-invasive diagnostic examination that provides information about the stiffness of a mass, and have a good diagnostic performace than mammograms.
Background
With the continuous development of imaging and the improvement of awareness of women's health, more and more non-palpable breast lesions (NPBL) have been detected. It is reported in available literature non-palpable breast cancer and palpable tumor breast cancer are greatly distinguished in characters. Non-palpable breast tumor's cell atypia, metastatic potential and growth activity are lower than those of the palpable mass of breast cancer. In2003, Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology included new ultrasound diagnostic criteria (BI-RADS-US), and it provides the basis for standardized diagnosis. Malignant breast tumor is typical vascular dependent lesions. Color Doppler ultrasound has an important role in the diagnosis of breast disease. Sensitive high-frequency ultrasound can show the tumor periphery and the blood flow inside the case. Strain ratio (SR) is the real-time ultrasound elastic imaging technology in new method to estimate the tissue hardness, and that makes it possible to avoid subjective judgment of lesions and it can also measure hardness values of the lesions.
With the BI-RADS-US classification in clinical application, showing a good diagnosis effect, but there are still some problems, on one hand the blood dilution by Doppler ultrasound features, lists only within the lesion, adjacent to and surrounding tissues without increasing diffuse flow signal and so on, and did not include blood flow patterns and spectrum analysis and other benign and malignant breast lesions in the differential diagnosis of important parameters. On the other hand, along with the elastic imaging technology for the development of BI-RADS-US grade, perfect aspect also looking forward to joining ultrasound elasticity imaging index.
This essay is aimed at the study of the commonly used diagnostic criteria which can determine the nature of breast lumps NPBL, in other words, can help to find out whether these lumps are benign or malignant. The study will propose the analysis of using the ultrasonic score and comparison of each individual standard to provide more theoretical basis for clinical diagnosis.
Objective
To research the differential diagnosis value of nonpalpable breast lesions using ultrasound score.
Methods
Conventional US and elastographic images were obtained using a EUB-900scanner(Hitachi Medical, Tokyo). All of breast lesions were nonpalpable and detected by ultrasound or mammography before sonographically guided core biosy and operations. Of the98lesions,76benign and22were malignant, and cumulated ultrasound score. We measured and recorded four US parameters:BI-RADS-US, Adler flow grading, Doppler spectrum resistance index (resistance index, RI) and elastic strain ratio, and the total US score of each nonpalpable breast lesions, he pathologic diagnosis was as golden standard. Using receiver operating characteristic curves analysis, we researched weather the US score was more accurate than each parameter and which was the best cut-off value for differential diagnosis of nonpalpable breast lesions. All data analyses were conducted with SPSS13.0and MedCalc12.1.3.0statistic software.
Results
1. The area under the ROC cure values were0.871for the strain index,0.859for the BI-RADS-US,0.693for the Adler flow grade and0.690for the RI for differentiation of benign and malignant NPBL.
Receiver operating characteristic curves for the elastographic strain index and BI-RADS-US. The Az walues(Z=0.208, P=0.835) were no statistically different for the strain index0.871and0.859. There were statistically different for the strain index and Color Doppler flow imaging (P=0.016) or strain index and spectral Doppler resistance index((P=0.020). There were statistically different for BI-RADS-US and Color Doppler flow imaging (P=0.008) or BI-RADS-US and spectral Doppler resistance index (P=0.020). There were no statistically different for Color Doppler flow imaging and spectral Doppler resistance index(P=0.976).
2. Results shows ultrasound score≤1are benign, ultrasound score≥4points are malignant, a score of2and3of malignant lesions were7%(2/28) and40%(6/15). Ultrasound score were the higher the greater proportion of malignant.
3. The area under the ROC cure values were0.956for ultrasound score method to differentiate benign and malignant NPBL, There were statistically different between ultrasound score and strain index、BI-RADS-US、Color Doppler flow imaging or spectral Doppler resistance index (P<0.05). According to the ROC curve to determine the optimal diagnostic cutoff points was≥3, the sensitivity, specificity and accuracy were90.9%,88.2%and88.8%.
Conclusion
For clinically non-palpable breast lesions, ultrasound scoring method is helpful to determine the benign and malignant lesions, compared with single application of conventional ultrasound and elastography have greater clinical application value. It is simple and practical, accurate and highly reproducible, will raise the NPBL malignant lesion detection rates, and makes the need for biopsy to identify benign and malignant patients number has been greatly reduced, it has high value in clinical application. Main Innovative Points
1. Based on the clinical demand, this study first used US score to differential diagnosis nonpalpable breast lesions. It can greatly increase the diagnostic sensitivity and specificity of differentiation of benign and malignant nonpalpable breast lesions. So US score is a simple、practical and accurate new method which is worthwhile for clinical application.
2. We first study on the comparison between strain ratio and mammograms to differential diagnosis nonpalpable breast lesions. the results show the strain ratio method for the diagnosis of nonpalpable breast lesions is better than BI-RADS grading standard for mammography, It provides a new method for clinical to improve the diagnostic rate
引文
1. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sci Am,1998,4(1):35
2. American College of Radiology. Breast imaging reporting and data system atlas (BI-RADS atlas).4ed. Reston:Am Coll Radiol,2003:1-257
3. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239:341-350
4. Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26 (2):61-66
5.罗葆明,曾婕,欧冰,等.乳腺超声弹性成像检查感兴趣区域大小对诊断结果影响.中国医学影像技术,2007,23(9)：1330-1332
6. Zhi H,Xiao XY,Yang HY, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol.2008,15(11):1347-1353
7. Suzuki T, Toi M, Saji S, et al. Early breast cancer. Int J Cli Oncol,2006,11 (2) 108-119
8. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann Surg Oncol,2001,8 (9):705-710
9. Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15 (6):668-670
10. Satake H, Nishio A, Ikeda M, et al. Predictive value for malignancy of suspicious breast masses of BI-RADS catrgories 4 and 5 using ultrasound elastography and MR diffusion-weighted imaging. AJR Am J Roentgenol,2011,196(1.202-209)
11. Raza S, Odulate A, Ong EM, et al. Using Real-time tissue elastography for breast lesion evaluation:our initial experience. Ultrasound Med,2010,29(4):551-563
12. Regini ES, Bagnera S, Tota D, et al. Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions. Radiol Med,2010, 115(4):551-562
13.智慧,肖晓云,杨海云,等.弹性应变率比值在乳腺实性肿物良恶性鉴别诊断中的价值初探.中国超声影像学杂志,2009,18(7)：589-591
14. Swets JA. Measuring the accuracy of diagnostic systems. Science,1988,240: 1285-1293
15. G. Hatzung, S.Grunwald, M. Zygmunt,et al. Sonoelastography in the diagnosis of malignant and benign breast lesions:initial clinical experiences. Ultraschall in Med,2010,31:596-603
16.安彦虹,叶兆祥,李弋,等.乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值.中华放射学杂志,2011,45(4)：353-357
17.何俊诗,吏瑞雪,姬智艳,等.乳腺钼靶BI-RADSⅣ级临床影像表现分析.中华临床医师杂志(电子版).2012,6(3)：584-588
1. Sickles EA. Quality assurance. How to audit your own mammographypractice. Radial Clin North Am,1992,30(1):265-275
2. Lovrics PJ, Comacchi SD, Farrokhyar F, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early breast cancer. Am J Surg,2008,197(6):740-746
3. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sei Am,1998,4(1):35-4
4. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann SurgOncol,2001,8(9):705-710
5. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Ultrasound.4th ed. Reston, VA:American College of Radiology,2003,77-79
6. Shiina T, Doyley MM, Bamber jc. Strain imaging using combined RF and envelope autocorrelation processing. In:Proceedings of the IEEE Ultrasonics Symposium. Savoy,Ⅲ:Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive,1996. 1331-1336
7. Waki K. Murayama N. Matsumura T, et al. Investigation of strain ratio using ultrasound elastography technique. In:Proceedings of ISICE:The First International Symposium on Information and Computer Elements,2007, Kitakyushu.449-452
8. Rim A, Chellman-Jeffers M. Trends in breast cacer screening and diagnosis. Cleve Clin J Med,2008,75(1):2-9
9. Hooley RJ, Andrejeva L, Scoutt LM. Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging. Ultrasound Q,2011,27(1):23-47
10. Adler DD, Carson PL, Robin JM, et al. Doppler ultrasound colour flow imaging in the study of breast cancer:preliminary findings. Ultrasound Med Bioi,1990, 16(6):553-559
11. Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram:differentiation between benign and malignant Breast masses. Clin Imaging,1999,23(5):284-288
12. Pakin DM, Bray F, Ferlay J, et al. Global cancer statistics,2002, CA Cancer J. Clin,2005,55(7):74-108
13. Parkin, Fernfindez LM. Use of statistics to assess the globe burden of breast cancer. Breast,2006,12 (Suppl 1):70-80
14. Agarwal G Pradeep PV,Aggarwal V, et al. Spectrum of breast cancer in Asian women. World J. Surg,2007,31(5):1031-1040
15. Al-Sobhi SS, Helvie MA, Pass HA, et al. Extent of lumpectomy for breast cancer after diagnosis by stereotactic core versus wire localization biopsy. Ann Surg Oncol,1999,6(4):330-335
16. Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15(6):668-670
17.陈曼,陈伟国,龚新环.彩色多普勒在乳腺疾病中的应用及相关因素.中国超声医学杂志,1999,15：(5)540-543
18. Ophir J, Cespedes El, Ponnekanti H, et al. Elastograpy:A quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging,1991,13 (2):111-134
19.徐智章,俞清.超声弹性成像原理及初步应用.上海医学影像,2005,14(1),3-5
20. Pickerell DM. Elastography:imaging of tomorrow? J Diagn Med.2010, 26(3):109-113
21.Bamber JC. Ultrasound elasticity imaging:definition and technology. Eur Radiol,1999,9(Suppl 3):327-330
22.李玉林.病理学.6版.北京：人民卫生出版社,2004,318-319
23.沈建红,罗葆明,欧冰,等.乳腺恶性病变超声诊断的Logistic回归模型.中 国医学影像技术,2007,23(1)：88-90
24. Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity. Radiology,2003,43(10):850-855
25.智慧,肖晓云,杨海云,等.超声弹性成像比值法与评分法在乳腺肿物诊断中的比较.中华超声影像学杂志,2010,19(2)：142-144
26. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239(2):341-350
27. Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26(2):61-66
28. Thomas A, Fischer T, Frey H, et al. Real-time elastography-an advanced method of ultrasound:First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol,2006,28(3):335-340
1. Rim A, Chellman-Jeffers M. Trends in breast cacer screening and diagnosis. Cleve Clin J Med,2008,75(1):2-9
2. Hooley RJ, Andrejeva L, Scoutt LM. Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging. Ultrasound Q,2011,27(1):23-47
3. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Ultrasound.4th ed. Reston, VA:American College of Radiology,2003
4. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), MIR.4th ed. Reston, VA:American College of Radiology,2003
5. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Mammographu.4th ed. Reston, VA:American College of Radiology,2003
6.万文博,李俊来,王知力等,乳腺病灶影像报告数据系统分级的超声诊断指标量化研究.中华医学超声杂志,2011,8(6)：1241-1249
7. Hong AS, Rosen EL, Soo MS, et al. BI-RADS for sonography:positive and negative predictive values of sonographic features. AJR Am JpRoentgenol,2005,184(4):1260-1265
8. Gokalp G, Topal U, Kizilkaya E. Power Doppler sonography:anything to add to BI-RADS US in solid breast masses? Eur J Radiol,2009.70(1):77-85
9. Moon HJ, Kim MJ, Kwak JY, et al.Probably benign breast lesions on ultrasonography:a retrospective review of ultrasonographic features and clinical factors affecting the BI-RADS categorization. Acta Radiol,2010,51(4):375-382
10. Park CS, Lee JH, Yim MB, Schepps B, et al.Observer agreement using the ACR Breast Imaging Reporing and Data System(BI_RADS)-ultrasound,First Edition(2003). Korean J Radiol,2007,8(5)397-402
11. Lazarus E, Mainiero MB, Schepps B,et al. BI-RADS lexicon for US and mammography:interobserver variability and positive predictive value. Radiology,2006,239(2):385-391
12.智文祥,陈亚青,李文英,等.不同年资医师运用BI-RADS判断乳腺病灶特征的一致性.中国医学影像技术,2009,25(8)：1384-1386
13.赖兴建,朱庆莉,姜玉新等.乳腺病变超声乳腺影像报告和数据系统(BI-RADS)诊断一致性评估.中华超声影像学杂志,2010,19(8)：701-704
14. Heinig J, Witteler R, Schmitz R, et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet Gynecol,2008,32(4):573-578
15. Tan YY, Wee SB, Tan MP, et al. Positive predictive value of BI-RADS categorization in an Asian population. Asian J Surg,2004,27(3):186-191
16.牛晓燕,房世保,李萍等.超声弹性应变率比值法对触诊阴性乳腺实性肿块的诊断价值研究.中国超声医学杂志,2012,28(8)：698-701
17. Leong LC, Sim LS, Lee YS, et al. A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol,2010,65(11):887-894
18. Schaefer FK, Heer I, Schaefer PJ, et al. Breast ultrasound elastography-Results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol,2011,77(3):450-456
19. Chan A. Antiangiogenic therapy for metastatic breast cancer:current status and future directions. Drugs,2009,69(2):167-181
20.韩增辉,王建宏,钱蕴秋,等.小乳腺癌的高频声像图及能量多普勒血流特征.中国超声医学杂志,2001,17(7)：499-502
21. Adler DD, Carson PL, Robin JM, et al. Doppler ultrasound colour flow imaging in the study of breast cancer:preliminary findings. Ultrasound Med Bioi,1990,16(6):553-559
22. Sehgal CM, Weinstein SP, Arger PH, et al. A review of breast ultrasound. J Mammary Gland Biol Neoplasia,2006,11(2):113-123.
23.李颖嘉,龚渭冰,吴凤林.能量多普勒超声检测乳腺癌血管生成活性及其与腋窝淋巴结转移的关系.中华超声影像学杂志,2001,10(4)：228-230
24.朱庆莉,姜玉新,孙强,等.乳腺癌的彩色多普勒血流分布特征与组织病理学对照研究.中国医学影像技术,2005,21(10)：1516-1518
25. Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram:differentiation between benign and malignant Breast masses. Clin Imaging,1999,23(5):284-288
26. Mansour GM, El-Lamie IK, El Sayed HM. Preoperative breast ultrasound and Doppler velocimetric findings in patients with breast cancer. Eur J Gynaecol Oncol,2006,27(2):165-167
27. Stuhrmann M, Ronius R, Schietzel M. Tumor vascularity of breast lesions: potentials and limits of contrast-enhanced Doppler sonogmphy. Am J Roentgenol,2000,175:1585-1589
28. Schroeder RJ, Bostanjoglo M, Rademaker J, et al. Role of power Doppler techniques and ultrasound contrast enhancement in the differential diagnosis of focal breast lesions. Eur Radiol,2003,13(1):68-79
29.肖晓云,智慧,杨海云,等.超声造影5分法诊断乳腺肿物的价值初探.中华超声影像学杂志,2012,21(4)：328-330
30. Lencioni R, Cioni D, Bartolozzi C. Tissue harmonic and contrast-specific imaging:back to gray scale in ultrasound. Eur Radiol,2002,12(1):151-165
31.罗慧,罗奕伦,姜燕,等.超声造影增强强度在乳腺肿块诊断中的价值.中国超声医学杂志,2007,23(2)：107-110
32. Caumo F, Carbognin G, Casarin A, et al. Angiosonography in suspicious breast lesions with non-diagnostic FNAC:comparison with Power Doppler US. Radiol med(Torino),2006,111(1):61-72
33.王小燕,韦海明,蓝春勇,等.乳腺导管乳头状瘤的超声图像与超声造影对照分析.中国超声医学杂志,2011,27(3)：213-216
34.钟丽瑶,曹泽民,周平,等.超声造影剂不同注射方法对乳腺腋窝淋巴结的显示情况比较.医学临床研究,2011,28(2)：266-268
35.Ophir J, Cespedes I, Ponnekanti H, et al. Elastography:a quantitative method for imaging the elasticity of biological tissues. Ultrasonic Imaging,1991, 13:131-134
36. krouskop TA, Wheeler TM, Kallel F, et al. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging,1998,20(4):260-274
37. Itoh A,Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology,2006,239(2):341-350
38.罗葆明,欧冰,智慧.等.改良超声弹性成像评分标准在乳腺肿块鉴别诊断中的价值.现代临床医学生物工程学杂志,2006,12：396-398
39. Shiina T, Doyley MM, Bamber jc. Strain imaging using combined RF and envelope autocorrelation processing. In:Proceedings of the IEEE Ultrasonics Symposium. Savoy, Ⅲ:Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive,1996. 1331-1336
40.智慧,肖晓云,杨海云,等.弹性应变率比值在乳腺实性肿物良恶性鉴别诊断中的价值初探.中华超声影像学杂志,2009,18(7)：589-591
41.智慧,肖晓云,杨海云,等.超声弹性成像比值法与评分法在乳腺肿物诊断中的比较.中华超声影像学杂志,2010,19(2)：142-144
42.陈俊英、徐栋、钱超文,等.超声引导下粗针穿刺活检在乳腺癌新辅助化疗中的应用价值.浙江医学,2011,33(6)：938-940
43. Staren ED. Ultrasound guided biopsy of nonpalpble breast masses by surgeons. Ann Surg Oncol,1996,3(5):476-479
44.李俊来,苏莉,于德江,等.超声引导经皮穿刺活检对乳腺占位性病变的诊断价值.中医学影像技术,2006,22(8)：1230-1232
45. Nakano S, Sakamoto H, Ohtsuka M, et al. Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy. Breast Cancer,2007, 14 (3):292-296
46. Cangiarella J, Waisman J, Symmans WF, et al. Mammotomecore biopsy for mammary microcalcifcation:analysis of 160 biopsies from 142 women with surgical and radiologic follow-up. Cancer,2001,91(1):173-177
1. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sci Am,1998,4(1):35
2. American College of Radiology. Breast imaging reporting and data system atlas (BI-RADS atlas).4ed. Reston:Am Coll Radiol,2003:1-257
3. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239:341-350
4. Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26 (2):61-66
5.罗葆明,曾婕,欧冰,等.乳腺超声弹性成像检查感兴趣区域大小对诊断结果影响.中国医学影像技术,2007,23(9)：1330-1332
6. Zhi H,Xiao XY,Yang HY, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol.2008,15(11):1347-1353
7. Suzuki T, Toi M, Saji S, et al. Early breast cancer. Int J Cli Oncol,2006,11(2) 108-119
8. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann Surg Oncol,2001,8 (9):705-710
9. Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15 (6):668-670
10. Bm RG. Real-time ultrasound elasticity of the breast:Initial clinical results. Ultrasound Q,2010,26(2):61-66
11. Raza S, Odulate A, Ong EM, et al. Using Real-time tissue elastography for breast lesion evaluation:our initial experience. Ultrasound Med,2010,29(4):551-563.
12. Regini ES, Bagnera S, Tota D, et al. Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions. Radiol Med,2010, 115(4):551-562
13.智慧,肖晓云,杨海云,等.弹性应变率比值在乳腺实性肿物良恶性鉴别诊 断中的价值初探.中国超声影像学杂志,2009,18(7)：589-591
14. Swets JA. Measuring the accuracy of diagnostic systems. Science,1988,240: 1285-1293
15. G. Hatzung, S.Grunwald, M. Zygmunt,et al. Sonoelastography in the diagnosis of malignant and benign breast lesions:initial clinical experiences. Ultraschall in Med,2010,31:596-603
16.安彦虹,叶兆祥,李弋,等.乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值.中华放射学杂志,2011,45(4)：353-357
17.何俊诗,吏瑞雪,姬智艳,等.乳腺钼靶BI-RADSⅣ级临床影像表现分析.中华临床医师杂志(电子版).2012,6(3)：584-588
1. Sickles EA. Quality assurance. How to audit your own mammographypractice. Radial Clin North Am,1992,30(1):265-275
2. Lovrics PJ, Comacchi SD, Farrokhyar F, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early breast cancer. Am J Surg,2008,197(6):740-746
3. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sei Am,1998,4 (1):35-4
4. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann SurgOncol,2001,8(9):705-710
5. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Ultrasound.4th ed. Reston, VA:American College of Radiology,2003,77-79
6. Shiina T, Doyley MM, Bamber jc Strain imaging using combined RF and envelope autocorrelation processing. In:Proceedings of the IEEE Ultrasonics Symposium. Savoy, III:Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive,1996. 1331-1336
7. Waki K. Murayama N. Matsumura T, et al. Investigation of strain ratio using ultrasound elastography technique. In:Proceedings of ISICE:The First International Symposium on Information and Computer Elements,2007, Kitakyushu.449-452
8. Rim A, Chellman-Jeffers M. Trends in breast cacer screening and diagnosis. Cleve Clin J Med,2008,75(1):2-9
9. Hooley RJ, Andrejeva L, Scoutt LM. Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging. Ultrasound Q,2011,27(1):23-47
10. Adler DD, Carson PL, Robin JM, et al. Doppler ultrasound colour flow imaging in the study of breast cancer:preliminary findings. Ultrasound Med Bioi,1990, 16(6):553-559
11. Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram:differentiation between benign and malignant Breast masses. Clin Imaging,1999,23(5):284-288
12. Pakin DM, Bray F, Ferlay J, et al. Global cancer statistics,2002, CA Cancer J. Clin,2005,55(7):74-108
13. Parkin, Fernfindez LM. Use of statistics to assess the globe burden of breast cancer. Breast,2006,12(Suppl 1):70-80
14 Agarwal G Pradeep PV,Aggarwal V, et al. Spectrum of breast cancer in Asian women. World J. Surg,2007,31(5):1031-1040
15 Al-Sobhi SS, Helvie MA, Pass HA, et al. Extent of lumpectomy for breast cancer after diagnosis by stereotactic core versus wire localization biopsy. Ann Surg Oncol,1999,6(4):330-335
16 Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15(6):668-670
17陈曼,陈伟国,龚新环.彩色多普勒在乳腺疾病中的应用及相关因素.中国超声医学杂志,1999,15：(5)540-543
18 Ophir J, Cespedes EI, Ponnekanti H, et al. Elastograpy:A quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging,1991,13(2):111-134
19徐智章,俞清.超声弹性成像原理及初步应用.上海医学影像,2005,14(1),3-5
20 Pickerell DM. Elastography:imaging of tomorrow? J Diagn Med.2010, 26(3):109-113
21 Bamber JC. Ultrasound elasticity imaging:definition and technology. Eur Radiol,1999,9(Suppl 3):327-330
22李玉林.病理学.6版.北京：人民卫生出版社,2004,318-319
23沈建红,罗葆明,欧冰,等.乳腺恶性病变超声诊断的Logistic回归模型.中国医学影像技术,2007,23(1)：88-90
24 Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity. Radiology,2003,43(10):850-855
25智慧,肖晓云,杨海云,等.超声弹性成像比值法与评分法在乳腺肿物诊断中的比较.中华超声影像学杂志,2010,19(2)：142-144
26 Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239(2):341-350
27 Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26(2):61-66
28 Thomas A, Fischer T, Frey H, et al. Real-time elastography-an advanced method of ultrasound:First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol,2006,28(3):335-340
2. American College of Radiology. Breast imaging reporting and data system atlas (BI-RADS atlas).4ed. Reston:Am Coll Radiol,2003:1-257
3. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239:341-350
4. Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26 (2):61-66
5.罗葆明,曾婕,欧冰,等.乳腺超声弹性成像检查感兴趣区域大小对诊断结果影响.中国医学影像技术,2007,23(9)：1330-1332
6. Zhi H,Xiao XY,Yang HY, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol.2008,15(11):1347-1353
7. Suzuki T, Toi M, Saji S, et al. Early breast cancer. Int J Cli Oncol,2006,11 (2) 108-119
8. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann Surg Oncol,2001,8 (9):705-710
9. Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15 (6):668-670
10. Satake H, Nishio A, Ikeda M, et al. Predictive value for malignancy of suspicious breast masses of BI-RADS catrgories 4 and 5 using ultrasound elastography and MR diffusion-weighted imaging. AJR Am J Roentgenol,2011,196(1.202-209)
11. Raza S, Odulate A, Ong EM, et al. Using Real-time tissue elastography for breast lesion evaluation:our initial experience. Ultrasound Med,2010,29(4):551-563
12. Regini ES, Bagnera S, Tota D, et al. Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions. Radiol Med,2010, 115(4):551-562
13.智慧,肖晓云,杨海云,等.弹性应变率比值在乳腺实性肿物良恶性鉴别诊断中的价值初探.中国超声影像学杂志,2009,18(7)：589-591
14. Swets JA. Measuring the accuracy of diagnostic systems. Science,1988,240: 1285-1293
15. G. Hatzung, S.Grunwald, M. Zygmunt,et al. Sonoelastography in the diagnosis of malignant and benign breast lesions:initial clinical experiences. Ultraschall in Med,2010,31:596-603
16.安彦虹,叶兆祥,李弋,等.乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值.中华放射学杂志,2011,45(4)：353-357
17.何俊诗,吏瑞雪,姬智艳,等.乳腺钼靶BI-RADSⅣ级临床影像表现分析.中华临床医师杂志(电子版).2012,6(3)：584-588
1. Sickles EA. Quality assurance. How to audit your own mammographypractice. Radial Clin North Am,1992,30(1):265-275
2. Lovrics PJ, Comacchi SD, Farrokhyar F, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early breast cancer. Am J Surg,2008,197(6):740-746
3. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sei Am,1998,4(1):35-4
4. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann SurgOncol,2001,8(9):705-710
5. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Ultrasound.4th ed. Reston, VA:American College of Radiology,2003,77-79
6. Shiina T, Doyley MM, Bamber jc. Strain imaging using combined RF and envelope autocorrelation processing. In:Proceedings of the IEEE Ultrasonics Symposium. Savoy,Ⅲ:Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive,1996. 1331-1336
7. Waki K. Murayama N. Matsumura T, et al. Investigation of strain ratio using ultrasound elastography technique. In:Proceedings of ISICE:The First International Symposium on Information and Computer Elements,2007, Kitakyushu.449-452
8. Rim A, Chellman-Jeffers M. Trends in breast cacer screening and diagnosis. Cleve Clin J Med,2008,75(1):2-9
9. Hooley RJ, Andrejeva L, Scoutt LM. Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging. Ultrasound Q,2011,27(1):23-47
10. Adler DD, Carson PL, Robin JM, et al. Doppler ultrasound colour flow imaging in the study of breast cancer:preliminary findings. Ultrasound Med Bioi,1990, 16(6):553-559
11. Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram:differentiation between benign and malignant Breast masses. Clin Imaging,1999,23(5):284-288
12. Pakin DM, Bray F, Ferlay J, et al. Global cancer statistics,2002, CA Cancer J. Clin,2005,55(7):74-108
13. Parkin, Fernfindez LM. Use of statistics to assess the globe burden of breast cancer. Breast,2006,12 (Suppl 1):70-80
14. Agarwal G Pradeep PV,Aggarwal V, et al. Spectrum of breast cancer in Asian women. World J. Surg,2007,31(5):1031-1040
15. Al-Sobhi SS, Helvie MA, Pass HA, et al. Extent of lumpectomy for breast cancer after diagnosis by stereotactic core versus wire localization biopsy. Ann Surg Oncol,1999,6(4):330-335
16. Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15(6):668-670
17.陈曼,陈伟国,龚新环.彩色多普勒在乳腺疾病中的应用及相关因素.中国超声医学杂志,1999,15：(5)540-543
18. Ophir J, Cespedes El, Ponnekanti H, et al. Elastograpy:A quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging,1991,13 (2):111-134
19.徐智章,俞清.超声弹性成像原理及初步应用.上海医学影像,2005,14(1),3-5
20. Pickerell DM. Elastography:imaging of tomorrow? J Diagn Med.2010, 26(3):109-113
21.Bamber JC. Ultrasound elasticity imaging:definition and technology. Eur Radiol,1999,9(Suppl 3):327-330
22.李玉林.病理学.6版.北京：人民卫生出版社,2004,318-319
23.沈建红,罗葆明,欧冰,等.乳腺恶性病变超声诊断的Logistic回归模型.中 国医学影像技术,2007,23(1)：88-90
24. Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity. Radiology,2003,43(10):850-855
25.智慧,肖晓云,杨海云,等.超声弹性成像比值法与评分法在乳腺肿物诊断中的比较.中华超声影像学杂志,2010,19(2)：142-144
26. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239(2):341-350
27. Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26(2):61-66
28. Thomas A, Fischer T, Frey H, et al. Real-time elastography-an advanced method of ultrasound:First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol,2006,28(3):335-340
1. Rim A, Chellman-Jeffers M. Trends in breast cacer screening and diagnosis. Cleve Clin J Med,2008,75(1):2-9
2. Hooley RJ, Andrejeva L, Scoutt LM. Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging. Ultrasound Q,2011,27(1):23-47
3. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Ultrasound.4th ed. Reston, VA:American College of Radiology,2003
4. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), MIR.4th ed. Reston, VA:American College of Radiology,2003
5. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Mammographu.4th ed. Reston, VA:American College of Radiology,2003
6.万文博,李俊来,王知力等,乳腺病灶影像报告数据系统分级的超声诊断指标量化研究.中华医学超声杂志,2011,8(6)：1241-1249
7. Hong AS, Rosen EL, Soo MS, et al. BI-RADS for sonography:positive and negative predictive values of sonographic features. AJR Am JpRoentgenol,2005,184(4):1260-1265
8. Gokalp G, Topal U, Kizilkaya E. Power Doppler sonography:anything to add to BI-RADS US in solid breast masses? Eur J Radiol,2009.70(1):77-85
9. Moon HJ, Kim MJ, Kwak JY, et al.Probably benign breast lesions on ultrasonography:a retrospective review of ultrasonographic features and clinical factors affecting the BI-RADS categorization. Acta Radiol,2010,51(4):375-382
10. Park CS, Lee JH, Yim MB, Schepps B, et al.Observer agreement using the ACR Breast Imaging Reporing and Data System(BI_RADS)-ultrasound,First Edition(2003). Korean J Radiol,2007,8(5)397-402
11. Lazarus E, Mainiero MB, Schepps B,et al. BI-RADS lexicon for US and mammography:interobserver variability and positive predictive value. Radiology,2006,239(2):385-391
12.智文祥,陈亚青,李文英,等.不同年资医师运用BI-RADS判断乳腺病灶特征的一致性.中国医学影像技术,2009,25(8)：1384-1386
13.赖兴建,朱庆莉,姜玉新等.乳腺病变超声乳腺影像报告和数据系统(BI-RADS)诊断一致性评估.中华超声影像学杂志,2010,19(8)：701-704
14. Heinig J, Witteler R, Schmitz R, et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet Gynecol,2008,32(4):573-578
15. Tan YY, Wee SB, Tan MP, et al. Positive predictive value of BI-RADS categorization in an Asian population. Asian J Surg,2004,27(3):186-191
16.牛晓燕,房世保,李萍等.超声弹性应变率比值法对触诊阴性乳腺实性肿块的诊断价值研究.中国超声医学杂志,2012,28(8)：698-701
17. Leong LC, Sim LS, Lee YS, et al. A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol,2010,65(11):887-894
18. Schaefer FK, Heer I, Schaefer PJ, et al. Breast ultrasound elastography-Results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol,2011,77(3):450-456
19. Chan A. Antiangiogenic therapy for metastatic breast cancer:current status and future directions. Drugs,2009,69(2):167-181
20.韩增辉,王建宏,钱蕴秋,等.小乳腺癌的高频声像图及能量多普勒血流特征.中国超声医学杂志,2001,17(7)：499-502
21. Adler DD, Carson PL, Robin JM, et al. Doppler ultrasound colour flow imaging in the study of breast cancer:preliminary findings. Ultrasound Med Bioi,1990,16(6):553-559
22. Sehgal CM, Weinstein SP, Arger PH, et al. A review of breast ultrasound. J Mammary Gland Biol Neoplasia,2006,11(2):113-123.
23.李颖嘉,龚渭冰,吴凤林.能量多普勒超声检测乳腺癌血管生成活性及其与腋窝淋巴结转移的关系.中华超声影像学杂志,2001,10(4)：228-230
24.朱庆莉,姜玉新,孙强,等.乳腺癌的彩色多普勒血流分布特征与组织病理学对照研究.中国医学影像技术,2005,21(10)：1516-1518
25. Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram:differentiation between benign and malignant Breast masses. Clin Imaging,1999,23(5):284-288
26. Mansour GM, El-Lamie IK, El Sayed HM. Preoperative breast ultrasound and Doppler velocimetric findings in patients with breast cancer. Eur J Gynaecol Oncol,2006,27(2):165-167
27. Stuhrmann M, Ronius R, Schietzel M. Tumor vascularity of breast lesions: potentials and limits of contrast-enhanced Doppler sonogmphy. Am J Roentgenol,2000,175:1585-1589
28. Schroeder RJ, Bostanjoglo M, Rademaker J, et al. Role of power Doppler techniques and ultrasound contrast enhancement in the differential diagnosis of focal breast lesions. Eur Radiol,2003,13(1):68-79
29.肖晓云,智慧,杨海云,等.超声造影5分法诊断乳腺肿物的价值初探.中华超声影像学杂志,2012,21(4)：328-330
30. Lencioni R, Cioni D, Bartolozzi C. Tissue harmonic and contrast-specific imaging:back to gray scale in ultrasound. Eur Radiol,2002,12(1):151-165
31.罗慧,罗奕伦,姜燕,等.超声造影增强强度在乳腺肿块诊断中的价值.中国超声医学杂志,2007,23(2)：107-110
32. Caumo F, Carbognin G, Casarin A, et al. Angiosonography in suspicious breast lesions with non-diagnostic FNAC:comparison with Power Doppler US. Radiol med(Torino),2006,111(1):61-72
33.王小燕,韦海明,蓝春勇,等.乳腺导管乳头状瘤的超声图像与超声造影对照分析.中国超声医学杂志,2011,27(3)：213-216
34.钟丽瑶,曹泽民,周平,等.超声造影剂不同注射方法对乳腺腋窝淋巴结的显示情况比较.医学临床研究,2011,28(2)：266-268
35.Ophir J, Cespedes I, Ponnekanti H, et al. Elastography:a quantitative method for imaging the elasticity of biological tissues. Ultrasonic Imaging,1991, 13:131-134
36. krouskop TA, Wheeler TM, Kallel F, et al. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging,1998,20(4):260-274
37. Itoh A,Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology,2006,239(2):341-350
38.罗葆明,欧冰,智慧.等.改良超声弹性成像评分标准在乳腺肿块鉴别诊断中的价值.现代临床医学生物工程学杂志,2006,12：396-398
39. Shiina T, Doyley MM, Bamber jc. Strain imaging using combined RF and envelope autocorrelation processing. In:Proceedings of the IEEE Ultrasonics Symposium. Savoy, Ⅲ:Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive,1996. 1331-1336
40.智慧,肖晓云,杨海云,等.弹性应变率比值在乳腺实性肿物良恶性鉴别诊断中的价值初探.中华超声影像学杂志,2009,18(7)：589-591
41.智慧,肖晓云,杨海云,等.超声弹性成像比值法与评分法在乳腺肿物诊断中的比较.中华超声影像学杂志,2010,19(2)：142-144
42.陈俊英、徐栋、钱超文,等.超声引导下粗针穿刺活检在乳腺癌新辅助化疗中的应用价值.浙江医学,2011,33(6)：938-940
43. Staren ED. Ultrasound guided biopsy of nonpalpble breast masses by surgeons. Ann Surg Oncol,1996,3(5):476-479
44.李俊来,苏莉,于德江,等.超声引导经皮穿刺活检对乳腺占位性病变的诊断价值.中医学影像技术,2006,22(8)：1230-1232
45. Nakano S, Sakamoto H, Ohtsuka M, et al. Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy. Breast Cancer,2007, 14 (3):292-296
46. Cangiarella J, Waisman J, Symmans WF, et al. Mammotomecore biopsy for mammary microcalcifcation:analysis of 160 biopsies from 142 women with surgical and radiologic follow-up. Cancer,2001,91(1):173-177
1. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sci Am,1998,4(1):35
2. American College of Radiology. Breast imaging reporting and data system atlas (BI-RADS atlas).4ed. Reston:Am Coll Radiol,2003:1-257
3. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239:341-350
4. Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26 (2):61-66
5.罗葆明,曾婕,欧冰,等.乳腺超声弹性成像检查感兴趣区域大小对诊断结果影响.中国医学影像技术,2007,23(9)：1330-1332
6. Zhi H,Xiao XY,Yang HY, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol.2008,15(11):1347-1353
7. Suzuki T, Toi M, Saji S, et al. Early breast cancer. Int J Cli Oncol,2006,11(2) 108-119
8. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann Surg Oncol,2001,8 (9):705-710
9. Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15 (6):668-670
10. Bm RG. Real-time ultrasound elasticity of the breast:Initial clinical results. Ultrasound Q,2010,26(2):61-66
11. Raza S, Odulate A, Ong EM, et al. Using Real-time tissue elastography for breast lesion evaluation:our initial experience. Ultrasound Med,2010,29(4):551-563.
12. Regini ES, Bagnera S, Tota D, et al. Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions. Radiol Med,2010, 115(4):551-562
13.智慧,肖晓云,杨海云,等.弹性应变率比值在乳腺实性肿物良恶性鉴别诊 断中的价值初探.中国超声影像学杂志,2009,18(7)：589-591
14. Swets JA. Measuring the accuracy of diagnostic systems. Science,1988,240: 1285-1293
15. G. Hatzung, S.Grunwald, M. Zygmunt,et al. Sonoelastography in the diagnosis of malignant and benign breast lesions:initial clinical experiences. Ultraschall in Med,2010,31:596-603
16.安彦虹,叶兆祥,李弋,等.乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值.中华放射学杂志,2011,45(4)：353-357
17.何俊诗,吏瑞雪,姬智艳,等.乳腺钼靶BI-RADSⅣ级临床影像表现分析.中华临床医师杂志(电子版).2012,6(3)：584-588
1. Sickles EA. Quality assurance. How to audit your own mammographypractice. Radial Clin North Am,1992,30(1):265-275
2. Lovrics PJ, Comacchi SD, Farrokhyar F, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early breast cancer. Am J Surg,2008,197(6):740-746
3. Haffty BG, Lee C, Philpotts L, et al. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sei Am,1998,4 (1):35-4
4. Skinner KA, Silberman H, Sposto R, et al. Palpable breast cancers are inherently different from nonpalpable breast cancers. Ann SurgOncol,2001,8(9):705-710
5. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Ultrasound.4th ed. Reston, VA:American College of Radiology,2003,77-79
6. Shiina T, Doyley MM, Bamber jc Strain imaging using combined RF and envelope autocorrelation processing. In:Proceedings of the IEEE Ultrasonics Symposium. Savoy, III:Institute of Electrical and Electronics Engineers Ultrasonics, Ferroelectrics, and Frequency Control Digital Archive,1996. 1331-1336
7. Waki K. Murayama N. Matsumura T, et al. Investigation of strain ratio using ultrasound elastography technique. In:Proceedings of ISICE:The First International Symposium on Information and Computer Elements,2007, Kitakyushu.449-452
8. Rim A, Chellman-Jeffers M. Trends in breast cacer screening and diagnosis. Cleve Clin J Med,2008,75(1):2-9
9. Hooley RJ, Andrejeva L, Scoutt LM. Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging. Ultrasound Q,2011,27(1):23-47
10. Adler DD, Carson PL, Robin JM, et al. Doppler ultrasound colour flow imaging in the study of breast cancer:preliminary findings. Ultrasound Med Bioi,1990, 16(6):553-559
11. Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram:differentiation between benign and malignant Breast masses. Clin Imaging,1999,23(5):284-288
12. Pakin DM, Bray F, Ferlay J, et al. Global cancer statistics,2002, CA Cancer J. Clin,2005,55(7):74-108
13. Parkin, Fernfindez LM. Use of statistics to assess the globe burden of breast cancer. Breast,2006,12(Suppl 1):70-80
14 Agarwal G Pradeep PV,Aggarwal V, et al. Spectrum of breast cancer in Asian women. World J. Surg,2007,31(5):1031-1040
15 Al-Sobhi SS, Helvie MA, Pass HA, et al. Extent of lumpectomy for breast cancer after diagnosis by stereotactic core versus wire localization biopsy. Ann Surg Oncol,1999,6(4):330-335
16 Custodio AS, Lemos S, Saleiro S, et al. Prognostic and predictive factors, treatment and clinical behavior of palpable versus nonpalpable breast cancer. Breast J,2009,15(6):668-670
17陈曼,陈伟国,龚新环.彩色多普勒在乳腺疾病中的应用及相关因素.中国超声医学杂志,1999,15：(5)540-543
18 Ophir J, Cespedes EI, Ponnekanti H, et al. Elastograpy:A quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging,1991,13(2):111-134
19徐智章,俞清.超声弹性成像原理及初步应用.上海医学影像,2005,14(1),3-5
20 Pickerell DM. Elastography:imaging of tomorrow? J Diagn Med.2010, 26(3):109-113
21 Bamber JC. Ultrasound elasticity imaging:definition and technology. Eur Radiol,1999,9(Suppl 3):327-330
22李玉林.病理学.6版.北京：人民卫生出版社,2004,318-319
23沈建红,罗葆明,欧冰,等.乳腺恶性病变超声诊断的Logistic回归模型.中国医学影像技术,2007,23(1)：88-90
24 Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity. Radiology,2003,43(10):850-855
25智慧,肖晓云,杨海云,等.超声弹性成像比值法与评分法在乳腺肿物诊断中的比较.中华超声影像学杂志,2010,19(2)：142-144
26 Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis. Radiology.2006,239(2):341-350
27 Barr RG. Real-time ultrasound elasticity of the breast:initial clinical results. Ultrasound Q,2010,26(2):61-66
28 Thomas A, Fischer T, Frey H, et al. Real-time elastography-an advanced method of ultrasound:First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol,2006,28(3):335-340