The Diagnostic Value Of Shear Wave Elastography Combined With Smart Three-dimensional Superb Microvascular Imaging In Breast Tumors

Objective: To compare the diagnostic value of superb microvascular imaging(SMI)and smart three-dimensional superb microvascular imaging(Smart 3D SMI)in breast lesions.To explore the diagnostic efficiency of shear wave elastography(SWE) with different Young’s modulus parameters,and select the optimal Young’s modulus parameters for distinguishing benign and malignant breast lesions in SWE.To analyze the diagnostic value of SWE and Smart 3D SMI alone and combined in benign and malignant breast lesions.Methods: A total of 178 female patients(213 lesions)with breast cancer diagnosed by surgical pathology or puncture biopsy from September 2021 to March 2022 were selected from the First Affiliated Hospital of Dalian Medical University.Pathological findings were used as the gold standard to compare the age of onset and the diameter of benign and malignant breast lesions.Canon i900 color ultrasonic diagnostic instrument with a linear array probe frequency of 10-18 MHz was used.SMI and Smart 3D SMI modes were activated respectively to observe the microvascular condition of the tumor after routine scan and perform microvascular number classification and morphological classification.To compare the diagnostic value of SMI and Smart 3D SMI in breast lesions.SWE mode was started to measure the values of Young’s modulus parameters of the lesions,including Emax,Emean,Esd and Eratiod.With pathological results as the gold standard,receiver operator characteristic curve corresponding to each Young’s modulus parameter was drawn.ROC curve and the area under curve(AUC)were calculated to determine the best diagnostic threshold of each Young’s modulus parameter.The diagnostic value of each Young’s modulus parameter was compared to determine the best Young’s modulus parameter with the best diagnostic efficiency.The best SWE’s modulus parameter was combined with Smart 3D SMI to compare the diagnostic value of SWE and Smart 3D SMI alone and in combination.SPSS 27.0 and Med Calc statistical software were used for statistical analysis,and Kappa test was used for consistency analysis of diagnosis results.Results: 1.There were a total of 213 breast lesions in this study,108 of which were benign lesions.The onset age and diameter of benign and malignant breast lesions were statistically different(P < 0.01).2.SMI: The SMI microvascular Adler grade of benign and malignant breast lesions was significantly different(χ2 = 62.83,P < 0.01).The detection rate of benign breast lesions by SMI microvascular assay was 72.22%,and the Adler grading was mainly Grade 0 and Grade I.The detection rate of malignant lesions was 80.00%,and the Adler grade was mainly Grade II and Grade III.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of SMI in the diagnosis of benign and malignant breast lesions were 80.00%,72.22%,76.06%,73.68%,78.79%,respectively.The correlation between SMI diagnosis results and pathological gold standard was moderately consistent(Kappa = 0.522).3.Smart 3D SMI: The microvascular morphologic classification of benign and malignant breast lesions showed statistical difference(χ2 = 105.65,P < 0.01).The detection rate of benign breast lesions by Smart 3D SMI microvascular assay was 85.19%,and the morphological types were mainly non-vascular,linear and dendritic.The detection rate of malignant lesions was 84.76%,and the main morphological types were stump type and crab foot type.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of Smart 3D SMI in the diagnosis of benign and malignant breast lesions were 84.76%,85.19%,84.98%,84.76%,85.19%,respectively.The correlation between Smart 3D SMI diagnosis and pathological gold standard was highly consistent(Kappa = 0.699).4.The ROC curve of SMI and Smart 3D SMI for the diagnosis of breast lesions was drawn,and the AUC was calculated to be 0.761 and 0.850,respectively.The diagnostic efficacy of the two was statistically different(Z = 4.59,P < 0.001),and the diagnostic efficacy of Smart 3D SMI was better than that of SMI.5.SWE examination: The values of all Young’s modulus parameters in the malignant lesion group were higher than those in the benign lesion group,with statistical significance(P < 0.01).The ROC curves of Emax,Emean,Esd and Eratio were plotted,and the AUCs were 0.914,0.887,0.898 and 0.829,respectively.The maximum values of Emax,Emean,Esd and Eratio Yoden index are 0.728,0.653,0.690 and 0.571 respectively.Therefore,the optimal diagnostic boundary values corresponding to each parameter can be obtained: 59.85 k Pa,29.55 k Pa,15.75 k Pa and 3.85 kpa showed that Emax had the best diagnostic efficacy(P < 0.01).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of Emax in the diagnosis of benign and malignant breast lesions were 86.67%,86.11%,86.38%,85.85%,86.92%,respectively.The Emax diagnosis results of SWE were highly consistent with the pathological gold standard(Kappa = 0.728)6.The ROC curves of single and combined application of SWE and Smart 3D SMI in the diagnosis of breast lesions were drawn,and the AUCs were calculated to be 0.864,0.850 and 0.912,respectively.The differences between the combined application and the diagnosis results of SWE and Smart 3D SMI were statistically significant(P < 0.01).There was no significant difference in diagnostic results between SWE and Smart 3D SMI(P = 0.5533),and the comparison confirmed that SWE combined with Smart 3D SMI had the best diagnostic efficacy(P < 0.01).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined application of Smart 3D SMI and SWE in the diagnosis of breast lesions were 97.14%,85.19%,91.08%,86.44%,96.84%,respectively.There was a strong agreement between the combined diagnosis and the pathological gold standard(Kappa = 0.822).Conclusions: 1.The distribution of age of onset and diameter of lesions is different in benign and malignant breast lesions.The age of onset and diameter of lesions in malignant breast lesions are significantly higher than those in benign breast lesions.2.Both SMI microvascular Adler grading and Smart 3D SMI microvascular morphological classification have high diagnostic value for the differentiation of benign and malignant breast lesions.3.Smart 3D SMI is superior to SMI in the diagnosis of breast lesions.4.Among the Young’s modulus parameters of SWE,Emax has the highest diagnostic value for benign and malignant breast lesions.When Emax = 59.85 k Pa is taken as the diagnostic threshold,it has the best diagnostic efficacy.5.The combined application of SWE and Smart 3D SMI in the diagnosis of breast lesions is superior to the single application of the two,and the diagnostic results of the combined application are highly consistent with the pathological gold standard.