Comparison Of Differential Diagnostic Value Of Strain Elastography And Shear Wave Elastography For Benign And Malignant Breast Nodules

【Objective】To compare and analyze the diagnostic value of strain elastography and shear wave elastography for benign and malignant breast nodules.【Methods】A total of 139 breast nodules from 120 patients with breast nodules admitted to the Department of Nail and Breast Surgery,Subei People’s Hospital from February 2018 to December 2018 were selected for ultrasound examination.First,routine ultrasound scanning was performed to determine breast imaging reporting and data system(BI-RADS).Then,the strain-type elastic imaging scan was performed to determine the Elastic Score(ES)and measure the Strain Ratio(SR);Finally,the nodules were examined by shear wave elastography,and the maximum Young’s modulus Emax was measured.The normal distribution characteristics were tested and the differences between benign and malignant groups were compared.Draw the receiver operating characteristic curve(ROC)of the subject with three parameters for differential diagnosis of benign and malignant breast nodules,calculate the Area Under the Cure(AUC),and obtain the best cut-off point value.Combined with pathological results,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of conventional Ultrasonic(US)and the diagnostic results of various parameters of two kinds of elastography are obtained.Kappa coefficient was used to evaluate the consistency test of pathological results and conventional ultrasound,two different elastography parameters ES,SR and Emax on the diagnosis results of benign and malignant breast nodules.The consistency strength was compared.Mc Nemar was usedto test the diagnosis results of conventional ultrasound and two elastography,and the accuracy of their differential diagnosis of benign and malignant breast nodules was compared.【Results】In this study,the elastic score(ES),strain rate ratio(SR),and maximum Young’s modulus(Emax)of benign breast nodules were 2.63 ± 0.95,2.40(1.76 ～ 3.20),and26.10(18.55 ～ 33.00)k Pa.,The elastic score(ES),strain rate ratio(SR),and maximum Young’s modulus(Emax)of malignant breast nodules are 4.09 ± 0.83,4.30(3.65 ～5.74),91.10(55.75 ～ 134.20)k Pa,and nodules The benign and malignant differences were statistically significant(P <0.05).The ROC curve showed that the area under the curve of the receiver operating characteristic curve for ES,SR,and Emax differential diagnosis of benign and malignant breast nodules was 0.906,0.922,and 0.931,respectively.The cutoff values are 3.5,3.42,and 43.35 k Pa.The Kappa consistency test results of the diagnostic results of conventional ultrasound and two elastography techniques and the diagnostic results of pathological results showed that the kappa coefficient of conventional ultrasound diagnostic results was 0.575(P <0.001),with moderate intensity consistency.The kappa coefficient of ES is 0.738(P <0.001),which has strong strength consistency.The kappa coefficient of SR is 0.813(P <0.001),which has strong strength consistency.The kappa coefficient of Emax is 0.865(P <0.001),which has strong strength consistency.Emax was more accurate in diagnosing benign and malignant breast nodules than SR,ES,and conventional ultrasound(97.12 %% vs92.81% vs 89.92% vs 82.73%).Among them,the three parameters of elastography were compared in pairs,and the difference was not statistically significant(P> 0.05).The three parameters of conventional ultrasound and elastography were compared in pairs,and the difference was statistically significant(P<0.05).【Conclusions】1.Compared with the simple differential diagnosis system of breast diseases,the new combined method will help and improve the differential diagnosis performance of breast diseases.Compared with the simple conventional ultrasound,when one of thetwo is added to the conventional ultrasound,the diagnostic performance is significantly improved,unnecessary biopsy can be reduced,and it has application value.2.The strain rate ratio method,which is also strain-type elastography,has the same value as the modified five-point method in differential diagnosis of benign and malignant breast nodules.The strain rate ratio method obtains more objective and less operator-dependent results for differential diagnosis of benign and malignant lesions by comparing the difference in elastic behavior between lesions and surrounding normal tissues.3.Strain type elastography and shear wave elastography are of equal value in diagnosing benign and malignant breast nodules.