The Value Of Combination Of Shear Wave Elastography(SWE)and Conventional Ultrasonography(US)in The Diagnosis Of Suspicious Breast Masses

Objective To determine the optimal parameters and cutoff values of SWE modulus in the diagnosis of suspicious breast masses and to evaluate the diagnostic efficiency of SWE,US-BI-RADS and their combination in the diagnosis of suspicious breast masses.Methods A total of 248 masses in 219 patients were included prospectively,gray-scale and color doppler characteristics were observed in vertical and horizontal plane,according to which breast masses were classified as US-BI-RADS.Parameters of SWE like Emean,Emax,Emin,SD and Eratio were performed.Pathological results were used as the reference standard to analyze the differences between benign and malignant masses,the ROC curves of SWE parameters were constructed to determine the optimal parameters and cutoff values.Gray scale,color doppler characteristics and SWE parameters were combined to obtain UE-BI-RADS.The diagnostic efficiency of US-BI-RADS and SWE parameters was compared with their combination.Results Pathological results were obtained in 156 patients with a total of 178 masses finally,104 were benign and 52 were malignant.Emean,Emax,SD,Eratio of malignant were higher than benign,Emin of malignant was lower than benign(P<0.05).The cutoff values of Emean?Emin?Emax?SD?Eratio were 46.2k Pa?0.2k Pa?114.3k Pa?25.55 k Pa and 3.5,respectively.The diagnostic efficiencies of Eratio,SD and Emax were higher than that of Emean and Emin,there was no significant difference between Eratio,SD and Emax(P<0.05).The AUC of Eratio,SD,Emax,US-BI-RADS and UE-BI-RADS in differentiating benign and malignant breast masses were 0.838,0.837,0.832,0.882 and 0.870 respectively,with no statistically significant difference(P < 0.05).SWE alone showed low sensitivity,specificity and accuracy,while US-BI-RADS alone showed moderate sensitivity and low specificity.When compared with US-BI-RADS,the specificity,accuracy and NPV of UE-BI-RADS increased from 79.66%,82.58% and 84.68% to 88.14%,87.08% and 92.04%,while the sensitivity decreased from 88.33% to 85.00%.Combined with SWE parameters,the number of 4A masses decreased from 76 to 19,and the malignant rate increased from 9% to 36.8%.Conclusion SWE is helpful in the diagnosis of suspicious breast masses.SWE combined with US-BI-RADS improve the specificity,accuracy and NPV without significant loss of sensitivity,reducing unnecessary biopsy effectively.Objective To investigate the value of SWE combined with conventional ultrasound in the identification of suspicious breast masses.Methods A total of 178 masses in 156 patients underwent conventional ultrasound and SWE.A multivariate logistic regression model was established to screen out the ultrasonic characteristics and parameters for the diagnosis of suspicious breast tumors.The diagnostic cutoff value of the Logistic regression model was obtained according to the ROC curve,and tested in the external validation samples.Results The tumor margin,microcalcification,blood flow,spiculated,Eratio and age were screen out as the independent risk factors according to the multivariate Logistic regression model,with OR of 5.787,5.766,4.608,3.579,1.177 and 1.058,respectively.The regression model was constructed,Logit(P)=-7.138 +1.756× margin +1.752×microcalcification+1.528×blood flow+1.275×spiculated +0.157×Eratio+0.057× age.In this model,the cut-off value of P equal to 0.427,and the AUC of the ROC curve was 0.948,with sensitivity of 90% and specificity of 86.44%.In the external validation samples,the sensitivity and specificity were 100% and 86.44%,respectively.Conclusion Multivariate logistic regression model is important in the diagnosis of suspicious breast masses.Objective To summarize the ultrasonic characteristics of lumpy breast adenosis,improve the understanding of this disease,and provide the basis for diagnosis and differential diagnosis.Methods The ultrasonic characteristics of 84 cases of breast adenosis confirmed by pathology results were analyzed retrospectively.The characteristics of gray scale and color doppler were observed in vertical and horizontal planes,the elastic modulus parameter Eratio is obtained in SWE.The diagnostic coincidence rate was obtained according to the BI-RADS classification criteria.Results The average age of 84 patients with breast lumpy adenosis was 42 ± 9 years,rang from 23 to 68 years.The mean diameter of lumps was below 20 mm(95.2%).In grayscal,the characteristics of lumpy adenosis included circumscribed margins(82.1%),parallel growth(81%),non-acoustic shadowing(77.4%)and heterogeneous(73.8%).In color doppler,the lumps lack of blood supply(83.3%)and with low RI(83.3%).In SWE mode,Eratio usually below 3.5(78.6%).With BI-RADS 4A and 4B as the cut-off values of benign and malignant,the accuracy rate of conventional ultrasound combined with SWE in diagnosing lumpy breast adenosis was 86.9%,and the misdiagnosis rate was 13.1%.Conclusion Conventional ultrasound combined with SWE is useful in the diagnosis of adenosis,judgment should be made by combining clinical data,image characteristics and SWE parameters,ultrasound-guided biopsy should conducted when necessary to improve the diagnostic coincidence rate and reduce the misdiagnosis rate.