The Value Of Real-time Tissue Elastography Technology Diagnosis In Breast Solid Lesions

Objective: In search of the best diagnosis point between the benign and malignant ofbreast solid lesions, with the strain ratio and area ratio of the quantitative analysis ofreal-time tissue elastography (real-time tissue elastograph, RTE). Summarize the law, andto analyze its diagnostic performance. Contrast to the ultrasound BI-RADS grading method,to explore the diagnosis value of SR and area ratio to the breast solid lesions, and expect toidentify their benign and malignant favorable information.Materials and methods:139cases of breast solid lesions in patients withpreoperative routine ultrasound examination were included in the study， BI-RADSclassification method was used to score the lesions,≥4divided into malignant,≤3dividedinto benign, to observe the lesions’s location, size, shape, margin, border, calcification andinternal flow. Ultrasonic elasticity for lesions inspection again, recording2~3secondsdynamic ultrasonographic when image stabilization, repeating more than2times。Qlabsoftware was applicated to measure the strain ratio, area ratio of lesions.With pathology asthe gold standard, the strain ratio and area ratio at different point yes specific degrees to thehorizontal axis, sensitivity to the vertical axis, respectively establish ROC curve to find theright point, analysising the diagnosis efficiency of the two indicators of individual and jointinspection respectively.All data were processed with statistical software SPSS13.0.Results: With the pathological diagnosis as the gold standard, the ROC of strain ratioand area ratio were established. The area under the curve of strain ratio was0.953, that ofarea ratio was0.918. That determined cut-off point for strain ration was2.50. If the strainratio≤2.50for benignity, and＞2.50for malignancy, there is statistically significantdifference between the two groups(P＜0.001), the sensitivity，specificity，accuracy，positive predictive value and negative predictive value were88.00%(44/50),89.76%(114/127),89.27%(58/177),77.19%(44/57),95.00%(114/120), respectively in identifying malignant breast lesions. That determined the cut-off point for area ration was0.94. if the strain ratio≤0.94for benignity, and＞0.94for malignancy, at this point, P＜0.001, statistically significant difference between the two groups, the sensitivity，specificity,accuracy,positive predictive value and negative predictive value were84.00%(42/50),87.40%(111/127),86.44%(153/177),72.41%(42/58),93.28%(111/119),respectively in identifying malignant breast lesions. In order to having better understandabout SR and area ratio for breast lesions of benign and malignant diagnosis efficiency, tocombine the two measures of single positive (one of two index positive is consideredpositive) and associated dual positive (two indicators positive is considered positive)comparison. Draw the following conclusion: the combined single positive’s sensitivity,specificity, accuracy, positive predictive value, negative predictive value were:96.00%(48/50),82.68%(105/127),86.44%(153/177),68.57%(48/70) and98.13%(105/107), respectively; Joint double positive’s sensitivity, specificity, accuracy, positivepredictive value, negative predictive value were:76.00%(38/50),94.49%(120/127),89.27%(158/177),84.44%(38/45) and90.91%(120/132), respectively.BI-RADS grading method was used for the preoperative assessment,with pathologicaldiagnosis as the gold standard, calculated traditional ultrasound (two-dimension ultrasoundand color doppler flow imaging (cdfi) diagnosis efficiency, and its sensitivity, specificity,accuracy, positive predictive value, negative predictive value were:90.00%（45/50）、81.10%（103/127）、83.62%(148/177)、65.22%(45/69)、95.37%(103/108).Conclusion: Strain ratio and area ratio of Real-time tissue elastography improve thespecificity of traditional ultrasonic diagnosis, and is helpful to increase the accuracy of thediagnosis of benign and malignant breast solid lesions. Strain ratio is more objective andreliable than area ratio.But we need to add the diagnostic experience of some special casesin order to avoid misdiagnosis and special cases of misdiagnosis.