ABSTRACT
Objective:To evaluate the application value of three-dimensional shear wave elastography(3D-SWE) with quantitative parameters and qualitative analysis of stiff rim sign in differentiating benign and malignant breast masses.Methods:One hundred and seventeen female patients (121 breast masses) admitted to the First Affiliated Hospital of Soochow University from January 2020 to February 2021 were examined by conventional ultrasound, two-dimensional shear wave elastography (2D-SWE) and 3D-SWE. Surgical or puncture pathology were used as the gold standard, the ROC curves of 2D-SWE and 3D-SWE were drawn to obtain the optimal qualitative and quantitative indicators. Afterwards, BI-RADS category was adjusted according to the optimal indicators, which could be used to evaluate the diagnostic value in differentiating benign and malignant breast masses.Results:The area under ROC curve (AUC) of BI-RADS category was 0.846, the sensitivity and specificity were 89.6% and 79.6%, respectively. The AUC value of mass-to-fat elasticity ratio(Eratio) of coronal plane was 0.869, which was the highest among all quantitative parameters and was significantly higher than that of 2D-SWE ( P<0.05). In addition, the AUC value of stiff rim sign of coronal plane was significantly higher than those of 2D-SWE, sagittal plane and transverse plane (All P<0.05). The AUC of combination of stiff rim sign of coronal plane and conventional US was 0.901, which was significantly higher than that using conventional ultrasound alone( P<0.05). Conclusions:Compared with 2D-SWE, Eratio and stiff rim sign of coronal plane of 3D-SWE yield better diagnostic efficiency.Adjusting stiff rim sign coronal plane to BI-RADS category can effectively improve the diagnostic efficiency.
ABSTRACT
Objective To evaluate the diagnostic performance of shear wave elastography ( SWE) with quantitative analysis and qualitative analysis of stiff rim sign between benign and malignant breast lesions . Methods Sixty-five female patients(65 lesions) underwent breast surgery or aspiration biopsy at the Second Affiliated Hospital of Zhejiang University were included . Elastic modulus of breast lesions and its rim in 1 mm ,2 mm ,3 mm were quantitive analyzed by SWE before surgery or aspiration biopsy ,Stiff rim sign was observed at the same time . Then ,the areas of receiver operating characteristic curves( AUC) of quantitative parameters of SWE and stiff rim sign were calculated to assess their clinical values in differentiating benign and malignant breast lesions ,and the correlation between them was evaluated . Afterwards , BI-RADS category was adjusted according to the optimal parameters combining the performance of SWE feature and conventional US features ,which could be used to evatulate the diagnostic effectiveness in differentiating benign and malignant breast lesions . Results The pathological results demonstrated 32 benign cases and 33 malignant cases in all patients .The maximum cut-off point of BI-RADS category was set between 4a and 4b .AUC value was 0 .935(0 .845-0 .981) ,while the sensitivity and specificity were 84 .8％ and 90 .6％ ,respectively .Maximum elasticity of 2 mm(E2Smax) area surrounding the malignant lesions were significantly higher than those in benign lesions ( P = 0 .001 ) . Among all quantitative SWE features ,E2Smax showed the highest AUC ( 0 .773) ,with sensitivity of 78 .8％ and specificity of 71 .9％ . In addition ,the stiff rim sign as qualitative parameter showed the highest AUC (0 .800) ,with sensitivity 81 .8％ and specificity 78 .1％ . The correlation coefficient between E2Smax and stiff rim sign was 0 .63 ,which was regarded as moderate correlation . the AUC of combination of stiff rim sign or E2Smax and conventional US features was 0 .937 and 0 .902 ,and the sensitivities were 81 .8％ , 93 .9％ ,the specificities were 90 .6％ and 75 .0％ . Conclusions SWE features ,especially E2Smax and hard rim sign are found moderate correlation ,and can improve a more accurate diagnosis in differentiating benign and malignant breast lesions combining with conventional US features .