李晔, 王知力. 常规超声和剪切波弹性成像在评价非肿块型乳腺癌中的应用[J]. 解放军医学院学报, 2015, 36(12): 1181-1185. DOI: 10.3969/j.issn.2095-5227.2015.12.006
引用本文: 李晔, 王知力. 常规超声和剪切波弹性成像在评价非肿块型乳腺癌中的应用[J]. 解放军医学院学报, 2015, 36(12): 1181-1185. DOI: 10.3969/j.issn.2095-5227.2015.12.006
LI Ye, WANG Zhili. Application of ultrasound and shear wave elastography for evaluation of non-mass-like breast cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2015, 36(12): 1181-1185. DOI: 10.3969/j.issn.2095-5227.2015.12.006
Citation: LI Ye, WANG Zhili. Application of ultrasound and shear wave elastography for evaluation of non-mass-like breast cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2015, 36(12): 1181-1185. DOI: 10.3969/j.issn.2095-5227.2015.12.006

常规超声和剪切波弹性成像在评价非肿块型乳腺癌中的应用

Application of ultrasound and shear wave elastography for evaluation of non-mass-like breast cancer

  • 摘要: 目的 探讨非肿块型乳腺癌的常规超声表现和弹性特征,提高超声检查对非肿块型乳腺癌的诊断水平。 方法 对2014年3月- 2015年4月在本院超声诊断科进行超声检查并经手术或穿刺活检病理确诊的63例女性乳腺非肿块型病变患者(67个病灶)进行实时剪切波弹性成像检查,其中良性组34个病灶,恶性组33个病灶,比较两组的常规超声表现和弹性特征。分析常规超声和剪切波弹性成像及联合诊断的效能。 结果 33个非肿块型乳腺癌病灶中,17个(51.5%)表现为片状低回声区,12个(36.4%)表现为片状低回声区伴微钙化,1个(3.0%)表现为结构紊乱区,3个(9.1%)表现为钙化区,其中7个(21.2%)有腋窝淋巴结转。非肿块型乳腺癌病灶的弹性模量的最大值、平均值、最小值及病灶与周围弹性模量比值均高于良性非肿块型乳腺病变(P< 0.01)。在超声弹性图上,39.4%(13/33)的非肿块型乳腺癌病灶周边出现局部彩色区域,呈“硬环征”。“硬环征”诊断的敏感度是39.4%,特异度是91.2%,阳性预测值是81.3%,阴性预测值是60.8%。应用剪切波弹性参数和常规超声结合后,提高了诊断的特异度。 结论 剪切波弹性成像有助于非肿块型乳腺癌的诊断,“硬环征”的存在对鉴别非肿块型乳腺病变的良恶性具有一定参考价值。

     

    Abstract: Objective To discuss the ultrasound performance and elastic characteristics of non-mass-like breast cancer, and improve the ultrasound diagnosis of it. Methods Sixty-seven lesions of 63 female patients who were diagnosed as non-masslike breast lesions by operation or biopsy were examined by ultrasound and shear wave elastography (SWE) in our hospital from March 2014 to April 2015, of which 34 cases were benign lesions and 33 cases were malignant lesions. Ultrasound and shear wave elastography were performed to compare the difference between the two groups of image characteristics and elastographic features. Conventional US, SWE, and combined conventional US and SWE features were performed to analyze their diagnostic performance. Results A total of 33 non-mass-like lesions were examined, 17 lesions (51.5%) showed patchy hypoechoic area, 12 lesions (36.4%) showed patchy hypoechoic area with microcalcification, 1 lesion (3.0%) showed disorganized area, 3 lesions (9.1%) showed diffuse microcalcification, including 7 lesions (21.2%) had axillary lymph node metastasis. The maximum, mean, and minimum elasticity and elasticity ratio between lesions and surrounding parenchyma of non-mass-like breast cancer were all significantly higher than those of benign groups (P< 0.01). In shear-wave elastography images, 39.4% (13/33) of non-mass-like breast cancer showed a localized area of color around the lesions, which presented “stiff rim sign”. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of the “stiff rim sign” were 39.4%, 91.2%, 81.3% and 60.8%, respectively. With use of combination of SWE features and conventional US, the diagnostic specificity would be improved. Conclusion SWE contributes to the diagnosis of non-mass-like of breast cancer, and the “stiff rim sign” is of certain reference value for improving the differential diagnosis.

     

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