Ultrasonic Shear Wave Elastography Corrects Breast Diseases Research On The Value Of BI-RADS 3 And 4a Classification

Objective: To analyze the value of shear wave elastograhy(SWE)in distinguishing benign and malignant breast lesions,and to compare with conventional US to further investigate its application value in the adjusting assessment of breast imaging report and data system(BI-RADS)category 3 and4 a lesions.Methods: We included a total of 197 cases who were first diagnosed with breast lesions in our hospital,which were all confirmed by pathology afterwards.Conventional US and SWE were performed before needle biopsy or surgery.All patients were classified into different BI-RADS groups based on conventional US findings.SWE features included qualitative observation of filling defects and quantitative measurement of the velocity modulus(Vmax)of the shear wave in lesions were recorded,the receiver operating characteristic curve(ROC)was constructed and with the maximum Youden index the optimal diagnostic threshold,sensitivity and specificity for the Vmax of benign and malignant lesions,were obtained to analyze the differences between benign and malignant diseases.Adjustments on conventional US BI-RADS category 3 and 4a lesions of were made according to Standard 1(2015 WFUMBGUIDELINES AND RECOMMENDATIONS FOR CLINICAL USE OF ULTRASOUND ELASTOGRAPHY)and Standard 2(proposed referring to the optimal diagnostic threshold for the Vmax and the median of shear wave Vmax of benign and malignant shear waves in the present study).The adjusted diagnostic efficacy of SWE for benign and malignant breast diseases was analyzed compared with conventional US,and we consider P<0.05 to be statistically significant.Results: Among the 197 breast lesions,(99 benign and 98 malignant),0/68 BI-RADS category 3(0.00%),2/19 BI-RADS category 4a(10.53%),12/22BI-RADS category 4b(54.55%),43/47 BI-RADS category 4c(91.49%),41/41BI-RADS category 5(100%)were diagnosed with malignant lesions,indicated that the sensitivity,specificity and area under the ROC curve(AUC)of conventional US BI-RADS for benign and malignant breast lesions were100%,68.69%,and 0.843,respectively.In the shear wave elasticity image,the filling defect of mammary gland malignant lesions accounted for 75.51%(74/98),the filling defect of benign lesions accounted for 12.12%(12/99),and the incidence of filling defects was higher than that of benign lesions.Significance(P<0.001).In the shear wave quantitative analysis,the median value of shear wave Vmax in benign lesions was 3.9(3.2-6.7)m/s,the median of malignant lesions was 8.4(7.6-8.8)m/s,and the shear wave Vmax of the malignant lesions was higher.than that of benign one(P<0.001).When Vmax6.9m/s was obtained as the cut-off value for diagnosing benign and malignant breast lesions,the sensitivity,specificity,and AUC achieved 86.73%,81.82%,and 0.881,respectively.With the conservative rule,the sensitivity,specificity,AUC of the adjusted standard 1 for diagnosing conventional US BI-RADS category 3,4a lesions were 100%,66.67%,and 0.833;while the aggressive onereached 100%,72.73%,and 0.864,respectively,the differences of diagnostic efficiency among the adjusted standard 1(whether the conservative or aggressive)and conventional US was of no statistical significance(P>0.05).The conservatively and aggressively adjusted Standard 2 acquired a diagnostic sensitivity,specificity,AUC of conventional ultrasound RADS 3,4a lesions of100%,72.73%,0.864 and 98.98%,80.81%,0.899,respectively.The diagnostic performance between the aggressive adjusted standard 2 and conventional US shows statistical significance(P<0.05),while the conservative one shows no statistical significance(P>0.05).When compared the results of adjusted standard1 and the adjusted standard 2 with each other,the diagnostic efficiency of the aggressive standard 2 was better than the conservative standard 1,the aggressive standard 1.and the conservative standard 2,and the differences were statistically significant(P<0.05).Conclusions: 1.Filling defects and velocity modulus of shear wave elastography are helpful for the differential diagnosis of benign and malignant breast lesions;2.Obtaining velocity modulus Vmax 6.9m/s promises a high specificity for the diagnosis of malignant lesions.3.Applications of shear wave elastography adjustment in BI-RADS category 3 and 4a can increase the diagnosis efficiency of conventional US,therefore reducing unnecessary biopsy or surgery.