The Study Of Clinical Value In Benign And Malignant Reclassification Of BI-RADS 4 Lesions By SWE Combined With SMI

Objective:To investigate the diagnostic value of benign and malignant reclassification for the breast lesions of BI-RADS 4 by shear wave elastography(SWE)combined with superb micro-vascular imaging(SMI).Methods:A total of 112 patients(142 lesions)of performing routine breast ultrasound examination in Zigong First People’s Hospital from June 2020 to January 2022,who were diagnosed BI-RADS 4 and required surgery or biopsy,were selected as the study subjects.SWE and SMI examinations were completed before surgery.The mean elastic Young’s modulus(Emean)of each lesion was recorded by SWE,and the average from repeating 3 times.Emean ≥5 5kPa was malignant,Emean<55kPa was benign;microflow was obtained by SMI and Alder grading was performed:Adler grade 0-Ⅰ was considered benign,and Alder grade Ⅱ-Ⅲ was considered malignant.Finally,with tissue biopsy and surgical pathology as the gold standard,the sensitivity,specificity and accuracy of SWE and SMI test for benign and malignant reclassification of BI-RADS 4 breast lesions were analyzed.Then,the receiver operating characteristic curve(ROC)was drawn to obtain the diagnostic efficiency curve of SWE combined with SMI test,as well as the optimal cut-off value of Emean.Results:1.General data:A total of 112 patients were collected,47.2±10.0 years;A total of 142 lesions were included,of which 99 were benign lesions with a maximum diameter of 13.5±8.9 mm.There were 43 malignant lesions and the maximum diameter line range was 26.91±11.6 mm.The maximum diameter of malignant lesions was larger than that of benign lesions,and the difference was statistically significant(P<0.05).2.The results of SWE:The average Emean value of benign lesions was 18.8±14.1kPa,and that of malignant lesions was 110.8±58.9kPa.The Emean value of malignant lesions was significantly higher than that of benign lesions,and the difference was statistically significant(P<0.05).3.The results of SMI:Alder grade 0 to Ⅲ of benign breast lesions were 25.2%(25/99),45.4%(45/99),16.1%(16/99),13.1%(13/99),respectively.With the corresponding,Alder grade 0 to Ⅲ was 2.32%(1/43),2.32%(1/43),39.53%(17/43)and 55.81%(24/43)in malignant breast lesions.Alder grade of micro-flow in malignant breast lesions was higher than that in benign group.4.Comparison of diagnostic sensitivity,specificity and accuracy:The diagnostic sensitivity,specificity and accuracy of BI-RADS were 83.72%,95.96%and 92.25%,respectively.SWE were 83.72%,94.94%and 91.55%,respectively.SMI were 95.35%,70.71%and 78.17%,respectively.SWE+SMI were 93.00%,95.95%and 94.4%,respectively.The diagnostic accuracy of combined SWE and SMI is higher than that of single BI-RADS,SWE and SMI.5.Area under ROC curve(AUC):The AUC of BI-RADS,SWE and SMI were 0.898,0.870 and 0.830,respectively,which were all lower than the method of SWE combined with SMI to adjust BI-RADS4 classification(0.945).Conclusion:1.Compared with BI-RADS,SMI can provide more detailed ultravascular information in benign and malignant breast lesions.2.SWE can accurately quantify the tissue hardness of benign and malignant breast lesions.3.SWE combined with SMI can further improve the differential diagnosis of BI-RADS 4 breast lesions.