Diagnostic Performance Of Shear Wave Elastography Combined With Tumor Markers In Differentiating Malignant From Benign Breast Lesions And Their Association With Pathological Parameters

Objective:To determine the diagnostic performance of shear wave elastography(SWE)quantitative parameters and tumor markers(CEA and CA15-3)in differentiation of malignant and benign breast tumors.The value of SWE combined with tumor markers in the diagnosis of breast cancer was then investigated.Finally,evaluate the association between SWE quantitative parameters,CEA,CA15-3 and histological prognostic factors.Methods:1)Routine ultrasound,SWE and tumor markers(CEA and CA15-3)were prospectively examined in 201 breast masses(89 benign and 112 malignant)that met the inclusion criteria before surgery.SPSS,Medcalc and Graphpad software were used for statistical analysis.Histological results were considered as gold standard to draw the ROC curves.And then the diagnosis performance of SWE,CEA,CA15-3 and combined SWE and tumor markers were evaluated,including the area under the curve(AUC),sensitivity and specificity.2)An association analysis of these quantitative parameters and histological prognostic factors were subsequently performed.Results:1)The maximum elasticity,mean elasticity,CEA and CA15-3 of the malignant tumors were(168.64±73.21)kPa,(118.84±60.50)kPa,(5.17±11.24)ng/ml and(19.06±15.21)U/ml,respectively,which were significantly higher than those of the benign masses(p<0.05).The mean elasticity had a higher diagnostic value compared to the maximum elasticity,CEA and CA15-3,which yielded an AUC of 0.94.Combining mean elasticity,CEA and CA15-3 can effectively improve the sensitivity for the differential diagnosis of breast lesions without reducing specificity.2)Both single-factor analysis and multiple linear regression analysis revealed that tumor size,axillary lymph node metastasis and HER-2 expression were correlated with mean elasticity(p=0.001,0.001 and 0.023,respectively).No statistically significant association was found between tumor markers(CEA and CA15-3)and histological prognostic factors of breast cancers(p>0.05).Conclusions:1)SWE quantitative parameters possessed great diagnostic efficacy in differential diagnosis of benign and malignant masses,among which mean elasticity provided highest diagnostic efficiency.The combined SWE and tumor markers had a better diagnostic performance in the diagnosis of breast masses in comparison with these parameters alone.2)Higher stiffness values correlated with large tumor size,axillary lymph node metastasis and positive expression of HER-2.SWE has the potential to be a non-invasive method for providing prognostic information of breast cancer.