The Clinical Studies Of Real--time Ultrasonic Elastography Combined With Conventional Ultrasound In Differentiating Benign And Malignant Breast Tumors

Objective: To compare the value of real--time ultrasonic elastography( UE) score with conventional ultrasound in differentiating the benign and malignant of breast tumor,and analysis of each Superiority and limitations.By measuring strain ratio(SR) of breast tumors with the same level of glandular tissue, Reflect the relative stiffness of the tumors. The Receiver Operator Characteristic curve(ROC curve) which decided the probability of malignant breast tumors was obtained on the basis of Strain ratio.To get the best cut-off point for the identification of breast tumors,and provide a new detection indicators of benign and malignant. To compare the differences of sensitivity,specificity,accuracy of above four methods(conventional ultrasound,ultrasonic elastogarphy,ultrasonic elastography combined with conventional ultrasound,strain ratio) of identification of malignant and benign tumors of the breast. To compare the differences of ROC in the diagnosis of benign and malignant breast tumors.Methods: 110 female patients with 129 breast tumors were examined during August 2013 to December 2014 in The Third Hospital of Yan Cheng. The average age of all Patients were 37.6±9.8. The instrument was HITAC HI VISION Avius and the linear probe frequency was from 6MHz-13 MHz.All breast tumors were performed by UE and conventional ultrasound before surgery.All pictures were saved into the hard disc. Use Stata17.0 software for analysis the data, Calculate the sensitivity,specificity,accuracy of the four methods. To Compare the area under the ROC curve(AUC) of the four methods as the value of diagnosis. Results(1) The sensitivity, specificity, accuracy of conventional ultrasound were 79.17﹪(38/48),83.95﹪(68/81),82.17﹪(106/129).(2) The sensitivity, specificity, accuracy of UE score were 83.33﹪(40/48),90.12﹪(73/81),87.6﹪(113/129).(3) By combination of the conventional and UE score, The sensitivity, specificity, accuracy of conventional ultrasound were 89.58 ﹪(43/48),92.59﹪(75/81),91.47﹪(118/129), and all were better than one used alone.(4) With Pathologic diagnosis as the gold standard, ROC curves were received. According to ROC curve,3.6 was the best cutoff point of the strain ratio(SR) in differentiating malignant from benign breast tumors, the sensitivity, specificity and accurate rate were 91.66%(44/48),91.35%(74/81),91.47%(118/129).(5) The AUC of conventional ultrasound, UE score, conventional ultrasound combined with elastography score, strain ratio were 0.7330,0.8299,0.9061,0.8533.(6) The specificity of elastography score combined with conventional ultrasound were better and statistically significant(P<0.05) than other three methods.The specificity, accuracy of UE score were better and statistically significant(P<0.05) with conventional ultrasound. It has no statistically significant(P>0.05)with elastography score combined with conventional ultrasound and SR.(7) The ROC of the four methods were compared by U test. The conventional ultrasound compared with other three methods were statistically significant(P<0.05).The other three methods were no statistically significant(P>0.05).Conclusion(1) conventional ultrasound,UE score,conventional ultrasound combined with elastography score,SR has a good diagnostic value in identifing benign and malignant tumors of the breast.(2) Compared with the other three methods, although SR has no statistically significant(P>0.05),but it can reflect the hardness of the lesions objectively. Its sensitivity is the best.(3) The specificity of elastography score combined with conventional ultrasound were better and statistically significant(P<0.05) than other three methods, and it has a good value for the identification of breast tumors.