| ?Objective?(1)The repeatability of Virtual Touch Quantification(VTQ)in Acoustic Radiation Force Impulse Imaging(ARFI)was discussed,as the methodology basis of VTQ in the application of solid breast lesions.(2)We applied Virtual Touch Image(VTI)in ARFI jointed Adobe Photoshop grey quantitative technique to quantitative evaluate the overall hardness of the solid breast lesions,at the same time by using Virtual Touch Quantification(VTQ)in ARFI to quantitative evaluae the local hardness of lesions,and contrasted these datas with pathological results respectively,thus the application value of the two elastic quantification technology in identifying benign and malignant solid breast lesions was explored.?Methods?1.VTQ technology repeatability research:We selected Breast Imaging Recording and Data System(BI-RADS)type I [1]10 cases by mammography or ultrasound diagnosis,mean age was 43.35±12.21 years old,who was examined by SIMENS ACUSON S2000 with high frequency line array 9L4 probe.The apparatus has built-in ARFI technology(including VTQ).The trials were divided into three groups:(1)The same part of mammary gland in one patient was detected by the same doctor at different time for twice by VTQ.(2)Two doctores detected the same site by VTQ.(3)The same doctor detected the different deep of the mammary gland on the same patient by VTQ.the difference of the shear wave velocity(Vs)between groups is statistical analysed to assess the repeatability of VS as a quantitative indicators in mammary gland hardness.2.The contrast of elastic quantification assessment of solid breast lesions hardnesswith pathology:(1)98 patients with 108 solid breast lesions(2 males,96 females,average age was 41.63 ± 13.82),who is outpatient or hospitalization of our hospital from January 2014 to December 2015,were enrolled in this study.Pathology results were obtained in each case by biopsy or surgical.(2)After examing the breast lesions by conventional ultrasound(two-dimensional and color Doppler),We applied VTI technology to obtain the lesions tissue elastic graph,collected and stored the imaging.(3)We obtained the Vs of the center part of lesions as well as the normal glandular tissue in the same patients by VTQ technology,which represented the hardness of themselves respectively.(4)The VTI lesions tissue elastic graphs were leaded into Adobe Photoshop CS4 image processing system to caculate the lesions overall gray-scale average value,representing the overall hardness of breast lesions.(5)Comparison with the pathological results,we analysed respectively the difference between benign and malignant breast lesions in overall hardness(VTI elastic graph overall gray-scale average value),and in the central local hardness(VTQ lesions central Vs).Application of ROC curve,We obtained the best cutoff point of the two index in identifying solid benign and malignant breast lesions,and through diagnostic test to determine and compare the diagnostic efficiency.At the same time,we compared respectively the hardness difference between the central part of the benign or malignant breast lesions with surrounding normal glandular tissue by Vs.?Result?1.The repeatability of VTQ:There was no statistical significance between different time frames(t=1.460,P=0.178),dfferent examiner(t=2.236,P=0.052)or different depth(F=0.440,P=0.649).2.The contrast of elastic quantification assessment of solid breast lesions hardnesswith pathology:(1)Quantitative assessment overall hardness of solid benign and malignant breast lesions by VTI combined with gray quantitative techniques of Photoshop:The overall gray-scale average value in VTI elastic graphs of malignant lesions was 39.21±16.60,and the benign lesions was 63.94±19.42,respectively.There was statistically significant difference(P=0.000).The best cutoff point was 50.75,when value was less,the lesions was considered as malignant.The area under the curve(AUC)was 0.845.(2)Quantitative assessment local hardness of solid benign and malignant breast lesions and normal glandular tissue by VTQ:The average Vs of center part of malignant lesions was(6.96±2.50)m/s,and the benign lesions was(2.62±1.82)m/s,respectively.There was statistically significant difference(P=0.000).The best cutoff point was 2.78m/s,when value was greater,the lesions was considered as malignant.The area under the curve(AUC)was 0.886.The average Vs of center part of benign lesions was(2.62±1.82)m/s,and that of surrounding normal glandular tissue was(1.31±0.18)m/s.There was statistically significant difference between them(P=0.000).The average Vs of center part of malignant lesions was(6.96±2.50)m/s,and that of surrounding normal glandular tissue was(1.31±0.18)m/s.There was statistically significant difference between them(P=0.000).(3)The comparison of diagnostic efficiency between the two elastic quantification technology above all:The best cutoff point of gray-scale average value was 50.75,with sensitivity of 79.41%,specificity of 77.27%,accuracy of 78.21%,which was highly consistent with the pathological result.(Correction chi-square=0.235,P=0.628,Kappa=0.561,P=0.000)The best cutoff point of Vs was 2.78m/s,with sensitivity of 91.18%,specificity of 88.64%,accuracy of 89.74%,which was highly consistent with the pathological result.(Correction chi-square =0.125,P=0.724,Kappa=0.793,P=0.000)The consistency check of the two methods shows consistency between them.(Correction chi-square =0.000,P=1.000,Kappa=0.459,P=0.000)?Coclusions?1?It showed highly repeatability of VTQ on the condition that interaction and training between examiner and patient.2?Quantitative assessment on overall hardness of solid breast lesions by VTI combined with gray quantitative techniques of Photoshop was feasible,while The overall gray-scale average value of VTI elastic graphs in malignant lesions was less than in benign lesions,the best cutoff point was 50.75.3?Quantitative assessment of local hardness of solid breast lesions by VTQ was feasible,while the Vs of center part in malignant lesions was greater than in benign lesions,the best cutoff point was 2.78m/s,and this two were all greater than normal glandular tissue.4?The two elastic quantification technology shows consistency in identifying solid benign and malignant breast lesions,the diagnostic efficiency in local hardness was higher than the overall hardness.If the overall gray-scale average value of VTI elastic graphs less than 50.75 or the Vs of center part of lesions greater than 2.78m/s was diagnosed as malignant,the diagnostic results was both highly consistent with the pathological result,they were both help to differentiate the nature of solid breast lesions,so they were good complement to the two-dimensional ultrasound. |
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