Application Of Shear-wave Elastography(SWE) Combined With Superb Microvascular Imaging(SMI) In Differential Diagnosis Of Benign And Malignant Breast Masses

Objective:This study was to investigate the diagnostic value of shear wave elastography(SWE)and superb microvascular imaging(SMI)alone or in combination to identify benign and malignant breast lesions.Methods:109 patients with a total of 123 breast masses who were examined by ultrasonography including SWE and SMI examination data and confirmed by operation or puncture pathology.The Young's modulus in the mass was obtained by elastic measurement and the roc curve was drawn.The cut-off value,sensitivity,specificity and accuracy of the mean value(Emean)and the maximum(Emax)of Young's modulus were obtained.Emax / fat Young's modulus ratio R1 was used to draw the roc curve and analyze the curve data.CDFI and SMI were used to classify the vascular distribution of breast masses according to the ”alder blood flow classification criteria”.VI was measured under SMI mode;Evaluate the sensitivity,specificity and accuracy of SWE,SWE combined with SMI in the diagnosis of benign and malignant breast masses.Results:(1)According to the pathological results,the 123 masses were divided into two groups : benign group(53)and malignant group(70);(2)The maximum and average Young's modulus of malignant lesions(97.28 ±33.84 kPa and54.49±33.70kPa)was significantly higher than that of benign lesions(45.49±33.34 kPa and 15.91 ±9.31kPa)(p < 0.01).(3)The area under the ROC curve of R1 was 0.912,the diagnostic sensitivity and specificity were 73.58% and 92.86%respectively when the optimal diagnostic threshold was 9.13.(4)CDFI and SMI werestatistically significant for mass flow assessment(p <0.05);for malignant masses,the SMI classification was significantly higher than CDFI(p <0.01).(5)The blood vessel index(VI)of the two groups was 8.12±3.83,16.16±4.06,respectively(p<0.01).(6)SWE combined with SMI is effective in the diagnosis of breast masses.Compared R1 with R1+SMI,The sensitivity was 73.58%,94.34%,the specificity was 92.86%,90.00%,and the accuracy was 84.55%,91.87%,respectively,and the difference was statistically significant(P<0.01).Emax combined with SMI,the rate of misdiagnosis decreased from 27.14% of Emax alone to 8.57%.Conclusion:SWE and SMI have certain application value in the differential diagnosis of benign and malignant breast tumors.The combination of the two can improve the sensitivity,specificity and accuracy of ultrasound diagnosis of breast mass.