Diagnostic Value Of Conventional Ultrasound And Shear Wave Elastography For Benign And Malignant Non-mass-like Breast Lesions

Objective: The real-time shear-wave elastography(SWE)technique was used to quantitatively measure the elastic modulus parameters of non-mass-like breast lesions.The differential diagnosis value of this technique for non-mass-like breast lesions was discussed.Maximum Elastic Modulus(Emax),Mean Elastic Modulus(Mean Elastic Modulus,Emean),Minimum Elastic Modulus(Emin)and Elastic Modulus Ratio Between Lesions and Surrounding Parenchyma(Eratio)were analyzed to evaluate the diagnostic efficacy of these elastic parameters for non-mass-like breast lesions,and provide a more reliable reference for clinical implementation of individualized treatment options.To investigate the characteristics of conventional ultrasound(US)and shear wave elastography in non-mass-like breast lesions,and to analyze the diagnostic efficacy of single or combined application in the treatment of benign and malignant breast breast lesions.To investigate whether there is any difference in the elastic modulus of axillary metastatic lymph nodes and reactive proliferative lymph nodes in non-mass-like breast lesions.Methods: From September 2017 to July 2018,61 patients with non-mass-like lesions(NMLs)who were treated in our hospital for breast surgery were selected,all of whom were women.All patients were completed before surgery.Conventional ultrasound,shear wave elastography and mammography were performed,and pathological results were obtained by5 needle biopsy or surgery.Analyze the conventional US characteristics of 61patients(63 lesions)and use the classification criteria based on the breast imaging-reporting and data system(BI-RADS)proposed by the American College of Radiology(ACR)to evaluate the lesions.According to the pathological results as the gold standard,63 lesions included 32 benign lesions(50.8%)and 31 malignant lesions(49.2%).Analyze and compare the Emax,Emean,Emin and Eratio values of benign and malignant breast NMLs for statistical differences.Calculate the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of each elastic parameter by plotting a four-grid table,and the receiver operator characteristic curve(ROC curve)was drawn to analyze and compare the independent diagnostic performance of each elastic parameter.To evaluate whether there is a hard ring sign around the lesion on the ultrasound elasticity map,and to analyze its diagnostic value for malignant NMLs.Combine the conventional US and SWE elastic parameters to analyze its diagnostic efficacy for breast NMLs.According to the pathological results as the gold standard,whether there is statistical difference between the Emax value and the Emean value of the metastatic lymph nodes of the axillary lymph nodes and the reactive proliferative lymph nodes in NMLs.Results: Among the 45 patients(47 lesions),31 were benign(32 lesions),30 were malignant(31 lesions),including 42 hypoechoic areas,12 hypoechoic areas with microcalcifications,and limitations.There were 5 structural disorder6 zones,only 4 clustered or diffusely distributed microcalcification lesions,47 blood flow 0~I lesions,16 blood flow II~III lesions,19 lesions with a resistance index greater than 0.70,9 lesions with lymph node metastasis,2lesions with Intravascular tumor thrombus.There were significant differences in Emax,Emean and Eratio between benign and malignant breast NMLs(P<0.05),but there was no significant difference between Emin values of benign and malignant NMLs(P>0.05).When Emax value = 63.9 kPa and Emean value = 41.3 kPa,Eratio value = 3.6 as the diagnostic boundary,the area under the ROC curve is 0.928 ? 0.886 and 0.889,respectively.The diagnosis of breast NMLs with Emax value in all elastic parameters.The highest efficacy,but the difference was not statistically significant(P>0.05).In malignant NMLs,the Emax values of 7 invasive ductal carcinomas and 14 ductal carcinomas in situ were approximately(132.6±52.3)kPa and(81.3±46.1)kPa,respectively.The average Emax values of the two invasive lobular carcinomas were 51.3kPa.The BI-RADS classification was combined with the Emax value and the Emean value.The accuracy and specificity of the diagnosis were significantly improved compared with the conventional US(P<0.05).The incidence of "stiff rim sign" of malignant NMLs was significantly higher than that of benign lesions(P<0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of "stiff rim sign" in the diagnosis of NMLs were 38.7%,61.3%,66.7%,85.7%,and 61.2%,respectively.Combining conventional US and SWE can reduce the benign7 lesion biopsy rate by 41.3%(26/63).The Emax value of metastatic lymph nodes in the axillary lymph nodes of NMLs was larger than that of the proliferative lymph nodes,and the difference was statistically significant(P<0.05).There was no significant difference between the metastatic lymph nodes of the axillary lymph nodes and the Emean values of the reactive proliferative lymph nodes.(P>0.05).Conclusions: Non-mass-like lesions of the breast can be expressed as a lamellae hypoechoic zone,a hypoechoic zone with microcalcification,a localized structural disorder,a clustered or diffusely distributed microcalcification zone on a conventional US sonogram.The proportion of lymph node metastasis and blood flow II~III in malignant lesions was higher than that in benign lesions(P<0.05).When SWE technique was used to diagnose non-mass-like breast lesions,the Emax value,Emean value and Eratio value of malignant lesions were significantly higher than benign lesions,and the Emax value was the most effective.The Emax values of non-tumor type breast cancers with different pathological types are different,and the trend from large to small is invasive carcinoma>intraductal carcinoma>invasive lobular carcinoma.The sensitivity of conventional US diagnostic NMLs is acceptable,but the specificity is low.Combining conventional US and SWE can improve the accuracy,specificity and positive predictive value of the diagnosis.SWE technology can help the differential diagnosis of breast benign and malignant NMLs,and reduce the rate of needle biopsy of unnecessary benign lesions.Theappearance of "stiff rim sign" on the ultrasound elasticity map is helpful for the identification of non-mass-like breast benign and malignant lesions,and has a good clinical reference significance.SWE technology has certain reference value for identifying metastatic lymph nodes and reactive proliferative lymph nodes in NMLs,which can provide a basis for the selection of clinical surgical plans.