Study On The Value Of Real-time Shear Wave Elastography In Differential Diagnosing And Relationship With Pathological Feature For Breast Tumors

ObjectiveTo investigate the value of shear wave elastrography(SWE) in differential of breast benign and malignant lesions and to improve the accuracy of ultrasonic diagnosis in breast malignant cancer through comparison in diagnosis efficiency of conventional ultrasonography(two-dimensional+Color Doppler Ultrasonography)combined with SWE and conventional ultrasonography for breast benign and malignant lesions in combination with Breast Imaging Reporting and Data System(BI-RADS) and analysing the SWE characteristic of breast malignant soild-lesions and its dependence with pathological foundation.MethodsAccording to inclusion and exclusion criteria of the study,select 238 cases breast patients(258 lesions) with conventional Ultrasonography and SWE in our hospital from January 2015 to January 2016,and all the cases had lesion excision or tissue biopsy and got pathological results.1、Comparsion of diagnostic efficiency between conventional Ultrasonography and US+SWE in breast benign and malignant lesions,and Comparsion and analysis of elastic modulus and its variation value of differernt breast disease.1.1 Firstly,the breast patients were examined by conventional Ultrasonography and the first classification of BI- RADS of the lesions were classified by the results.1.2 Then SWE.The lesions were analyzed comprehensively and proactively according to the three characteristics as “variable sign” of variable instability elastic signal,“Hard-ring sign”around breast malignant soild-lesions and “black hole sign”of lack of shear wave elastic signal in breast malignant soild-lesions,and then the first BI-RADS was also re-adjusted(US+SWE—1).1.3 Lastly,according to the diagnostic gold pathology, the first BI-RADS of lesions was also re-adjusted by a measure for the best cut-off poin for diagnosis of malignancy by ROC carre(US+SWE—2).According to the three classification of BI- RADS above and the diagnostic gold pathology, the diagnostic efficiency of conventional ultrasonography were compared with US+SWE—1 and US+SWE—2 in breast benign and malignant lesions.2、The influence factor of “black hole sign”inside and “Hard-ring sign”around lesions of breast malignant soild-lesions were analyzed and its dependence factors were also analyzed.3、The correlation between elastic modulus of invasive breast cancer and focal size as well as A/T ratio were investigated,and the elastic modulus of different ultrasound image,histological grade and molecular typing of breast cancer were compared.Results1、 According to the biopsy or surgery pathology:Malignant group:Chemotherapy group: 33 cases(37 lesions), preoperative diagnosis by biopsy pathology and for therapy.N-chemotherapy group: 145 casesinvasive breast cancer:131 cases(136 lesions)early stages of breast cancer 14 cases(ductal carcinoma in situ 9casesandmicroinvasive breast carcinoma 5 cases)(14 lesions)Benign group: 60 cases(71 lesions)2、According to the diagnostic gold pathology, the conventional Ultrasonography coincidence rate for breast lesions was 91.0%,specificity 76.1% and positive predictive value 89.6% were less than 95.9% and 93.0% of US+SWE—1(P < 0.05), but sensitivity and negative predictive value of both were similar(P>0.05).3、According to the areas under the curve(AUC), taking 56.0k Pa as the threshold of the maximum elasticity value(Emax).The coincidence rate, sensitivity,specificity,positive predictive value and negative predictive value of US+SWE—2were 90.5%,97.3%,76.1%,89.6% and 93.1%, and all were similar with conventional Ultrasonography(P>0.05). The diagnostic efficiency of US+SWE—1 was higher than US+SWE—2 and conventional Ultrasonography,but diagnostic efficiency of the latter two were similar.4、A/T ratio and depth of lesions and the microscopic reaction zone surrounding the tumor were all the independent influence factors of “black hole sign”of breast malignant soild-lesions(P<0.05).But only the microscopic reaction zone surrounding the tumor was the independent influence factors of“Hard-ring sign”around malignant soild-lesions(P<0.05).5 、 Emax and Emax range for lesions with calcification of breast cancer in non-chemotherapy group which lacking of shear wave elastic signal were similar with non-calcification(P>0.05).Emax and Emax range of lesions with hyperechoic halos were higher than non-hyperechoic halos(P =0.000).There was a linearly independent correlation between Emax of invasive breast cancer in non-chemotherapy group with focal maximum diameter and A/T ratio( P > 0.05).Emax and Emax range of histological grade from grade 1 to 2 of invasive breast cancer in non-chemotherapy group showed a increasing trend,but it had no obvious change from grade 2 to3.Molecular typing of invasive breast cancer in non-chemotherapy group was divided into Luminal group and non-Luminal group,and Emax and Emax range of the two group were similar(P>0.05).Conclusions1 、 There is certain clinical value that using the three characteristics about“variable sign”, “Hard-ring sign”around lesions and “black hole sign”as complement for the diagnosis of breast malignant lesions.2、 Emax and Emax range of invasive breast cancer is>early stages of breast cancer and breast cancer after chemotherapy>benign breast lesions.3 、 The microscopic reaction zone surrounding the tumor is the independent influence factors of “black hole sign”and “Hard-ring sign”of breast malignant soild-lesions,and the former sign is related with A/T ratio and depth of lesions.4、Emax and Emax range of lesions with hyperechoic halos were higher than non-hyperechoic halos,but calcification, lesion size and A/T ratio are don’t affect the elastic modulus.5、The elastic modulus of invasive breast cancer with histologic grade 1 is less than grade 2 and 3,and it is similar between different molecular typing.