弹性应变率比值法与声触诊组织量化技术对乳腺肿块的诊断价值
|
摘要
目的比较弹性应变率比值法与声触诊组织量化(VTQ)技术对乳腺肿块的诊断价值。方法经手术病理证实的49例女性乳腺疾病患者共计52个乳腺肿块进行压迫式弹性成像和VTQ检查,分别测量肿块与周围正常腺体的应变率比值、肿块内部的剪切波传播速度。构建受试者工作特征(ROC)曲线,分析两种超声弹性成像方法对乳腺肿块的诊断价值,并采用Z检验进行比较。结果弹性应变率比值法鉴别乳腺良恶性病变的曲线下面积为0.919,最优诊断界点为0.499,灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为93.6%、72.0%、78.8%、94.7%、84.6%; VTQ技术鉴别诊断乳腺良恶性病变的曲线下面积为0.796,最优诊断界点为2.90 m/s,灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为68.0%、92.6%、89.5%、75.8%、80.8%。两种超声弹性成像方法的ROC曲线下面积比较差异无统计学意义(Z=1.580,P=0.057)。两者联合鉴别诊断乳腺良恶性病变,灵敏度为84.0%,特异度为88.9%,PPV为87.5%,NPV为85.7%,准确率为86.5%。结论弹性应变率比值法与VTQ技术能够(半)定量评价乳腺肿块的硬度,两者对乳腺肿块的鉴别诊断价值相近。弹性应变率比值法的灵敏度高于VTQ技术,而特异度却低于VTQ技术。两者联合应用可提高超声鉴别诊断乳腺良恶性病变的灵敏度、特异度和准确率。
Objective To compare the diagnostic performances of strain ratio of compression elastography and virtual touch tissue quantification( VTQ) in the differentiation of benign and malignant breast lesions. Methods A total of 49 female patients with 52 breast lesions were enrolled in this study. Both compression elastography and VTQ were performed,and SR and shear wave velocity were measured. Receiver operating characteristic( ROC) curves were used to analyze the diagnostic performances and Z tests were used to compare the area under the curve. Results For the SR method,the AUC,optimal cutoff value,sensitivity,specificity,positive predictive value,negative predictive value( NPV) and accuracy was 0.919,0.499,93.6%,72.0%,78.8%,94.7%,and 84.6%,respectively. For the VTQ method,the AUC,optimal cutoff value,sensitivity,specificity,PPV,NPV and accuracy was 0.796,2.90 m/s,68.0%, 92.6%,89.5%,75.8% and 80.8%,respectively. There was no significant difference in AUC between the two methods( Z= 1.580,P= 0.057). When compression elastography and VTQ were used in combination,the sensitivity,specificity,PPV,NPV and accuracy was 84.0%,88.9%,87.5%,85.7% and 86.5%,respectively. Conclusion Both SR and VTQ are helpful in the( semi-) quantitative evaluation of the stiffness of breast lesions. Their diagnostic performances are similar. The SR method shows higher sensitivity but lower specificity than VTQ. The combination of compression elastography and VTQ can significantly improve the diagnostic performance of ultrasound to differentiate benign and malignant breast lesions.
Objective To compare the diagnostic performances of strain ratio of compression elastography and virtual touch tissue quantification( VTQ) in the differentiation of benign and malignant breast lesions. Methods A total of 49 female patients with 52 breast lesions were enrolled in this study. Both compression elastography and VTQ were performed,and SR and shear wave velocity were measured. Receiver operating characteristic( ROC) curves were used to analyze the diagnostic performances and Z tests were used to compare the area under the curve. Results For the SR method,the AUC,optimal cutoff value,sensitivity,specificity,positive predictive value,negative predictive value( NPV) and accuracy was 0.919,0.499,93.6%,72.0%,78.8%,94.7%,and 84.6%,respectively. For the VTQ method,the AUC,optimal cutoff value,sensitivity,specificity,PPV,NPV and accuracy was 0.796,2.90 m/s,68.0%, 92.6%,89.5%,75.8% and 80.8%,respectively. There was no significant difference in AUC between the two methods( Z= 1.580,P= 0.057). When compression elastography and VTQ were used in combination,the sensitivity,specificity,PPV,NPV and accuracy was 84.0%,88.9%,87.5%,85.7% and 86.5%,respectively. Conclusion Both SR and VTQ are helpful in the( semi-) quantitative evaluation of the stiffness of breast lesions. Their diagnostic performances are similar. The SR method shows higher sensitivity but lower specificity than VTQ. The combination of compression elastography and VTQ can significantly improve the diagnostic performance of ultrasound to differentiate benign and malignant breast lesions.
引文
[1]Ophir J,Cespedes I,Ponnekanti H,et al.Elastography:a quantitative method for imaging the elasticity of biological tissues[J].Ultrason Imaging,1991,13(2):111-134.
[2]Hooley RJ,Scoutt LM,Philpotts LE.Breast ultrasonography:state of art[J].Radiology,2013,268(3):642-659.
[3]Barr RG.Sonographic breast elastography:a primer[J].J Ultrasound Med,2012,31(5):773-783.
[4]Ricci P,Maggini E,Mancuso E,et al.Clinical application of breast elastography:state of the art[J].Eur J Radiol,2014,83(3):429-437.
[5]Bamber J,Cosgrove D,Dietrich CF,et al.EFSUMBguidelines and recommendations on the clinical use of ultrasound elastography.Part 1:Basic principles and technology[J].Ultraschall Med,2013,34(2):169-184.
[6]Cosgrove D,Piscaglia F,Bamber J,et al.EFSUMBguidelines and recommendations on the clinical use of ultrasound elastography.Part 2:Clinical applications[J].Ultraschall Med,2013,34(3):238-253.
[7]American College of Radiology(ACR).ACR BI-RADS-Ultrasound/ACR Breast Imaging Reporting and Data System,Breast Imaging Atlas[S].Reston:American College of Radiology,2013.
[8]周建桥,詹维伟.超声乳腺影像报告数据系统及其解读[J].中华医学超声杂志(电子版),2011,8(6):1332-1341.
[9]吴长君,张光晨,孟巍,等.声触诊组织量化技术鉴别乳腺良恶性肿块的价值[J].中华超声影像学杂志,2011,20(11):965-967.WU Changjun ZHANG Guangchen MENG Wei,et al.Diagnostic value of virtual tough tissues quantification in discriminating breast benign and malignant solid tumor[J].Chinese Journal of Ultrasonography,2011,20(11):965-967.
[10]Hudert CA,TzschTzsch H,Guo J,et al.US time-harmonic elastography:detection of liver fibrosis in adolescents with extreme obesity with nonalcoholic fatty liver disease[J].Radiology,2018,288(1):99-106.
[11]Grenier N,Gennisson JL,Cornelis F,et al.Renal ultrasound elastography[J].Diagn Interv Imaging,2013,94(5):545-550.
[12]Magri F,Chytiris S,Chiovato L.The role of elastography in thyroid ultrasonography[J].Curr Opin Endocrinol Diabetes Obes,2016,23(5):416-422.
[13]Terminology and Diagnostic Criteria Committee,Japan Society of Ultrasonics in Medicine.Clinical practice guidelines for ultrasound elastography:prostate[J].JMed Ultrason(2001),2016,43(3):449-455.
[14]Balleyguier C,Ciolovan L,Ammari S,et al.Breast elastography:the technical process and its applications[J].Diagn Interv Imaging,2013,94(5):503-513.
[15]Li GY,Cao Y.Mechanics of ultrasound elastography[J].Proc Math Phys Eng Sci,2017,473(2199):20160841.
[16]Zhao QL,Ruan LT,Zhang H,et al.Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method[J].Eur J Radiol,2012,81(11):3245-3249.
[17]Liu B,Zheng Y,Shan Q,et al.Elastography by acoustic radiation force impulse technology for differentiation of benign and malignant breast lesions:a meta-analysis[J].J Med Ultrason(2001),2016,43(1):47-55.
[18]Jayaraman J,Indiran V,Kannan K,et al.Acoustic radiation force impulse imaging in benign and malignant breast lesions[J].Cureus,2017,9(6):1301.
[19]Barr RG,De Silvestri A,Scotti V,et al.Diagnostic performance and accuracy of the 3 interpreting methods of breast strain elastography:a systematic reviewand Metaanalysis[J].J Ultrasound Med,2019,38(6):1397-1404.
[20]Yoon JH,Song MK,Kim EK.Semi-quantitative strain ratio determined using different measurement methods:comparison of strain ratio values and diagnostic performance using one-versus two-region-of-interest measurement[J].Ultrasound Med Biol,2017,43(5):911-917.
[21]Yoon JH,Kim MH,Kim EK,et al.Interobserver variability of ultrasound elastography:howit affects the diagnosis of breast lesions[J].AJR Am J Roentgenol,2011,196(3):730-736.
[22]Deffieux T,Gennisson JL,Bercoff J,et al.On the effects of reflected waves in transient shear wave elastography[J].IEEE Trans Ultrason Ferroelectr Freq Control,2011,58(10):2032-2035.
[23]欧冰,智慧,杨海云,等.比较声触诊组织量化技术与弹性应变率比值法诊断乳腺疾病[J].中国医学影像技术,2012,28(10):1835-1838.OU Bing,ZHI Hui,YANG Haiyun,et al.Comparison of virtual tissue quantification and strain ratio of ultrasonic elastographpy in differential diagnosis of benign or malignant breast lesions[J].Chinese Journal of Medical Imaging Technology,2012,28(10):1835-1838.
[24]Franchi-Abella S,Elie C,Correas JM.Performances and limitations of several ultrasound-based elastography techniques:a phantom study[J].Ultrasound Med Biol,2017,43(10):2402-2415.
[25]Chang JM,Moon WK,Cho N,et al.Breast mass evaluation:factors influencing the quality of US elastography[J].Radiology,2011,259(1):59-64.
[2]Hooley RJ,Scoutt LM,Philpotts LE.Breast ultrasonography:state of art[J].Radiology,2013,268(3):642-659.
[3]Barr RG.Sonographic breast elastography:a primer[J].J Ultrasound Med,2012,31(5):773-783.
[4]Ricci P,Maggini E,Mancuso E,et al.Clinical application of breast elastography:state of the art[J].Eur J Radiol,2014,83(3):429-437.
[5]Bamber J,Cosgrove D,Dietrich CF,et al.EFSUMBguidelines and recommendations on the clinical use of ultrasound elastography.Part 1:Basic principles and technology[J].Ultraschall Med,2013,34(2):169-184.
[6]Cosgrove D,Piscaglia F,Bamber J,et al.EFSUMBguidelines and recommendations on the clinical use of ultrasound elastography.Part 2:Clinical applications[J].Ultraschall Med,2013,34(3):238-253.
[7]American College of Radiology(ACR).ACR BI-RADS-Ultrasound/ACR Breast Imaging Reporting and Data System,Breast Imaging Atlas[S].Reston:American College of Radiology,2013.
[8]周建桥,詹维伟.超声乳腺影像报告数据系统及其解读[J].中华医学超声杂志(电子版),2011,8(6):1332-1341.
[9]吴长君,张光晨,孟巍,等.声触诊组织量化技术鉴别乳腺良恶性肿块的价值[J].中华超声影像学杂志,2011,20(11):965-967.WU Changjun ZHANG Guangchen MENG Wei,et al.Diagnostic value of virtual tough tissues quantification in discriminating breast benign and malignant solid tumor[J].Chinese Journal of Ultrasonography,2011,20(11):965-967.
[10]Hudert CA,TzschTzsch H,Guo J,et al.US time-harmonic elastography:detection of liver fibrosis in adolescents with extreme obesity with nonalcoholic fatty liver disease[J].Radiology,2018,288(1):99-106.
[11]Grenier N,Gennisson JL,Cornelis F,et al.Renal ultrasound elastography[J].Diagn Interv Imaging,2013,94(5):545-550.
[12]Magri F,Chytiris S,Chiovato L.The role of elastography in thyroid ultrasonography[J].Curr Opin Endocrinol Diabetes Obes,2016,23(5):416-422.
[13]Terminology and Diagnostic Criteria Committee,Japan Society of Ultrasonics in Medicine.Clinical practice guidelines for ultrasound elastography:prostate[J].JMed Ultrason(2001),2016,43(3):449-455.
[14]Balleyguier C,Ciolovan L,Ammari S,et al.Breast elastography:the technical process and its applications[J].Diagn Interv Imaging,2013,94(5):503-513.
[15]Li GY,Cao Y.Mechanics of ultrasound elastography[J].Proc Math Phys Eng Sci,2017,473(2199):20160841.
[16]Zhao QL,Ruan LT,Zhang H,et al.Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method[J].Eur J Radiol,2012,81(11):3245-3249.
[17]Liu B,Zheng Y,Shan Q,et al.Elastography by acoustic radiation force impulse technology for differentiation of benign and malignant breast lesions:a meta-analysis[J].J Med Ultrason(2001),2016,43(1):47-55.
[18]Jayaraman J,Indiran V,Kannan K,et al.Acoustic radiation force impulse imaging in benign and malignant breast lesions[J].Cureus,2017,9(6):1301.
[19]Barr RG,De Silvestri A,Scotti V,et al.Diagnostic performance and accuracy of the 3 interpreting methods of breast strain elastography:a systematic reviewand Metaanalysis[J].J Ultrasound Med,2019,38(6):1397-1404.
[20]Yoon JH,Song MK,Kim EK.Semi-quantitative strain ratio determined using different measurement methods:comparison of strain ratio values and diagnostic performance using one-versus two-region-of-interest measurement[J].Ultrasound Med Biol,2017,43(5):911-917.
[21]Yoon JH,Kim MH,Kim EK,et al.Interobserver variability of ultrasound elastography:howit affects the diagnosis of breast lesions[J].AJR Am J Roentgenol,2011,196(3):730-736.
[22]Deffieux T,Gennisson JL,Bercoff J,et al.On the effects of reflected waves in transient shear wave elastography[J].IEEE Trans Ultrason Ferroelectr Freq Control,2011,58(10):2032-2035.
[23]欧冰,智慧,杨海云,等.比较声触诊组织量化技术与弹性应变率比值法诊断乳腺疾病[J].中国医学影像技术,2012,28(10):1835-1838.OU Bing,ZHI Hui,YANG Haiyun,et al.Comparison of virtual tissue quantification and strain ratio of ultrasonic elastographpy in differential diagnosis of benign or malignant breast lesions[J].Chinese Journal of Medical Imaging Technology,2012,28(10):1835-1838.
[24]Franchi-Abella S,Elie C,Correas JM.Performances and limitations of several ultrasound-based elastography techniques:a phantom study[J].Ultrasound Med Biol,2017,43(10):2402-2415.
[25]Chang JM,Moon WK,Cho N,et al.Breast mass evaluation:factors influencing the quality of US elastography[J].Radiology,2011,259(1):59-64.