Study On The Value Of Shear Wave Elastography In Differential Diagnosis Of Breast Lesions Of Different Sizes And The Prediction Of Ultrasonic Multimodal Manifestations For Axillary Lymph Node Metastasis Of Breast Cancer

Objective To investigate the effect of lesion size on the performance of real-time two-dimensional shear wave elastography in the diagnosis of breast lesions and to explore the best parameter and cut-off value for differentiating benign and malignant breast masses of different sizes.Methods A total of 380 breast lesions(126 malignant and 254 benign)confirmed by surgical resection and/or biopsy were collected from 338 female patients.According to the maximum diameter of breast masses,they were divided into four subgroups:(1)group 1,maximum diameter ≤1.0cm;(2)group 2,maximum diameter1.0 < maximum diameter ≤2.0cm;(3)Group 3,2.0 < maximum diameter≤3.0cm.(4)Group 4,maximum diameter > 3.0cm.The SWE image features of the four groups were analyzed,and the differences of elastic images between benign and malignant breast masses of different sizes were compared.The maximum elastic value(Emax),minimum elastic value(Emin),mean elastic value(Emean)and standard deviation(Esd)of benign and malignant lesions were compared among the four groups.According to the pathological results,the receiver operating characteristic(ROC)curve analysis of breast masses in each subgroup was performed to obtain the best cut-off value and positive predictive value,negative predictive value,sensitivity,specificity,accuracy and other indicators of each SWE parameter.Results On SWE images,most benign breast lesions appeared uniform blue color(214/254,84.25%),while most malignant lesions appeared heterogeneous color on SWE images,and most of them showed "hard rim sign" and "missing central sign" at the same time.Homogeneous blue SWE features were also observed in malignant breast lesions with maximum diameter less than 1.0 cm(8/126,6.35%),which partially overlapped with benign breast lesions.The overall SWE results of benign and malignant lesions were statistically different(P < 0.01).In large breast masses(the maximum diameter > 1.0cm),the Emax and Esd values of malignant lesions were significantly higher than those of benign lesions.In the group of the maximum diameter of breast masses ≤1.0cm,there was no significant difference in the SWE parameters between benign and malignant breast masses.With the increase of tumor size,the optimal thresholds of Emax and Esd increased(P < 0.01).In large breast masses(the maximum diameter > 1.0cm),the diagnostic efficacy of Esd is equivalent to that of Emax,and higher than that of Emean and Emin.Conclusions The values of 2D SWE parameters increase with the size of breast masses.Adjusting the threshold based on lesion size can produce higher diagnostic performance.Esd shows a stable diagnostic performance in the differential diagnosis of breast masses of different sizes,and its diagnostic efficacy is comparable to that of Emax.The SWE image features of benign lesions were mostly uniform blue,and malignant lesions often showed "hard ring sign" and " missing central sign " at the same time.Objective To investigate the value of ultrasonic SWE diagnostic threshold in classification of BI-RADS for breast lesions of different sizes.Methods 338 female patients with 380 surgically resected and/or biopsy confirmed breast nodules(malignant 126,benign 254)were collected and divided into 4subgroups according to the maximum diameter of breast mass:(1)Group 1,maximum diameter ≤1.0cm;(2)Group 2,1.0 < maximum diameter ≤2.0cm;(3)The third group,2.0 < maximum diameter ≤3.0cm.(4)The fourth group,whose maximum diameter was > 3.0cm,was classified as US-BI-RADS according to the two-dimensional ultrasonic characteristics of the breast mass.Combined with the SWE parameter thresholds and image features of each subgroup,the classification was again denoting as SWE-BI-RADS,and the difference in diagnostic efficacy of US-BI-RADS and SWE-BI-RADS in different subgroups of breast masses was compared.Results US-BI-RADS alone showed acceptable sensitivity(95.24%),but low specificity and accuracy(68.50% and 77.37%,respectively).Compared with US-BI-RADS alone,the specificity and accuracy of the combined application of the two methods were improved by 84.25% and 87.89%,respectively.After the adjustment of SWE quantitative parameters and qualitative indicators,40 cases of 4types of mass were reduced to 3 types,and 70 cases of 4 types of mass were upgraded to 5 types.Pathological results confirmed that the specificity,PPV and accuracy of SWE-BI-RADS classification were statistically significant compared with US-BI-RADS(all P < 0.05).Conclusion Conventional ultrasonic BI-RADS classification combined with SWE can improve the specificity and accuracy of ultrasonic diagnosis of breast nodules,and effectively reduce unnecessary puncture biopsy.Purpose To investigate the value of conventional ultrasound,shear wave ultrasound and elastic imaging features of breast cancer,conventional ultrasound features of axillary lymph nodes and pathological immunohistochemical indexes in predicting axillary lymph node metastasis,and to search for risk factor indicators of axillary lymph node metastasis.Method In this study,95 patients with breast cancer were retrospectively included by SPSS 20.0 statistical software.For all patients,age,breast nodule size,shape(including longitudinal/transverse diameter),boundary and edge,blood flow grade,SWE parameters of nodule(Emax,Emin,Emean,Esd),axillary lymph node short diameter,aspect ratio(L/S),cortical thickness and blood flow pattern,and immunohistochemical indices of coarse needle biopsy ER,PR,Cerb B-2 and Ki-67 and other dependent variables.According to the pathological results of lymph nodes,patients were divided into the lymph node metastasis group and the lymph node without metastasis group.With axillary lymph node metastasis as dependent variable,univariate Chi-square test and multivariate Logistic regression analysis were performed,respectively,and P < 0.05 was considered statistically significant.To look for risk factors for axillary lymph node metastasis in breast cancer.Result Univariate Chi-square test showed that breast cancer mass size,Emax value of SWE,Esd value,longitudinal diameter of lymph node > 8mm,cortical thickness of lymph node,perilymph node type blood flow,and immunohistochemical Ki-67 had significant differences between axillary lymph node metastasis group and non-metastatic group(P < 0.05).Multivariate Logistic regression analysis showed that tumor size,Emax value of SWE,longitudinal diameter of lymph node > 8mm,perilymph node type blood flow,and immunohistochemical Ki-67 were the most important risk factors for predicting axillary lymph node metastasis of breast cancer(P < 0.05).The OR values(95%CI)were 4.037(1.325-12.298),3.467(1.083-11.092),6.182(1.947-19.634),1.206(1.077-1.351),1.014(1.001-1.026)respectively.Conclusion Tumor size,Emax value of ultrasound SWE,short axis diameter of lymph node ≥8mm,perilymph node type blood flow and immunohistochemical Ki-67 are important and valuable risk factors for axillary lymph node metastasis of breast cancer.