| Objective:The purpose of this study is to investigate the diagnostic value of bimodal ultrasound elastography in evaluating the internal and peripheral tissue hardness of breast lesions and its diagnostic value combined with BI-RADS classification in BI-RADS category 4 to 5 breast lesions.Method:89 female patients with 96 breast lesions which were BI-RADS category 4 to 5 confirmed by histopathology in Cancer Hospital of Shan Tou University Medical College from October2019 to December 2020 were included in this study.US、SWE and SE examinations were performed on the patients in sequence to obtain the results of BI-RADS classification,the SWE quantitative modulus of Tumor interio(G)and the tissue in the 0.5mm,1.0mm,1.5mm,2.0mm,2.5mm,and 3.0mm regions outside the border of lesions(S),including Emean,Emax,Emin and Esd.And the SE semi quantitative modulus of Tumor interio and the tissue in the0.5mm,1.0mm,1.5mm,2.0mm,2.5mm and 3.0mm regions outside the border of lesions,including B / A,B / Shell and A / Shell.The gold standard is the pathological results obtained from surgery or biopsy.To compare the diagnostic efficiency of different elastography parameters of breast lesions.The diagnostic efficacy of single and Bi-modal elastography combined BI-RADS and selectively up or downgrade BI-RADS category 4 lesions using the aptimal elastic parameter were calculated.Z test was used to test the AUC of single diagnosis and combined diagnosis.Result:1.There was no significant difference in all parameters of shear wave elastography except Emin in the diagnostic benign and malignant breast lesions(P > 0.05).Emean,Emax and Esd had certain value in the diagnosis of benign and malignant breast lesions(P < 0.05).Gmax had the best diagnostic efficiency,AUC was 0.790,sensitivity was 79.07%,and specificity was69.81%.Among the parameters of 0.5 mm,1.0 mm,1.5 mm,2.0 mm,2.5 mm and 3.0 mm,the diagnostic efficiency of 1.0 mm Smax was the best,AUC was 0.817,sensitivity was 81.40%,specificity was 67.92%,accuracy was 73.96%,positive predictive value was 81.40%,negative predictive value was 67.92%,Emax was better than 1 mm Smax had better diagnostic efficacy,but the difference was not statistically significant(P > 0.05).2.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the SE semi quantitative B/A were 62.79%,83.02%,73.96%,62.79% and 83.02%,respectively.Among the semi quantitative values of B / Shell and A / Shell,the diagnostic efficiency of 1.0mm B / Shell was the best,with AUC of 0.721,sensitivity of 67.44% and specificity of 77.36%.The diagnostic efficiency of B / A was better than that of 1.0 mm B /shell,but the difference was not statistically significant(P > 0.05).3.1 mm Smax and B / A(cut of point was 86.37 k Pa,4.50)were applied to electively up or downgrade BI-RADS category 4 lesions,the AUC of method one,method two and method three were 0.916,0.900 and 0.936 respectively。According to the different methods,some breast lesions was degraded to BI-RADS category 3,the malignant rate of method one was 0,method two was 5.41%,and method three was 0.4.In the combination of 1 mm Smax + BI-RADS,B / A + BI-RADS and 1 mm Smax + B/ A + BI-RADS,AUC were 0.935,0.907 and 0.931,respectively.The diagnostic performance of +1 mm Smax + BI-RADS was better than that of BI-RADS alone(P > 0.05),but the diagnostic performance of 1 mm Smax + B / A + BI-RADS was lower than that of 1 mm Smax+ BI-RADS(0.931 vs 0.935),the difference was not statistically significant(P > 0.05).Conclusion:1.Dual mode ultrasound elastography has good diagnostic performance in the diagnosis of benign and malignant breast lesions by measuring the hardness of breast lesions(G)and surrounding tissues(S).In shear wave elastography,1 mm Smax has the best diagnostic performance,and in strain elastography B / A has the best diagnostic performance.2.Dual mode ultrasound elastography combined with BI-RADS classification can reduce unnecessary biopsy of BI-RADS category 4A breast lesions,and shear wave elastography1 mm Smax have better auxiliary application value.3.Dual mode ultrasound elastography combined with BI-RADS classification can improve the diagnostic performance of breast lesions.Among the three combined methods of1 mm Smax + BI-RADS,B / A + BI-RADS,1 mm Smax + B / A + BI-RADS,are better than any other elastography alone,1 mm Smax + BI-RADS can improve the diagnostic performance,specificity and accuracy of breast lesions,the positive predictive value,consistent with pathology without significantly reducing the sensitivity. |
