| Objective: To quantitatively determine the elastic modulus values of female pelvic masses by using ultrasonic shear wave elastography technique,preliminary research the statistical difference of elastic modulus between benign and malignant masses and different pathological types,and to explore the feasibility and application value of ultrasonic elastography in the nature determination of female pelvic mass.Methods: A total of 137 female patients with pelvic masses were collected from November 2015 to November 2016.All patients underwent ultrasonography before surgery in our hospital,including 90 cases of solid mass,47 cases of mixed tumor.Using philips i U22 color Doppler ultrasound diagnostic apparatus,equipped with SWE imaging technology software,the elastic modulus of the mass can be measured.All patients received conventional two-dimensional ultrasound scan,observed the basic situation of the tumor.Then enabled SWE mode,the multi-point measurement swere made on the mass and the maximum,minimum and mean values of the elastic modulus were recorded.Track the pathological results of each subject and grouped it with postoperative pathological results,analyzed the shear wave modulus values.The solid group were classified as solid-like group,benign group and malignant group.Solid-like group have 14 cases,divided into endometriosis group and hemorrhagic cyst group according to pathological type.Benign group have 60 cases,divided into leiomyoma group,special type leiomyoma group and sex Cordile tumor group.Malignant group were 19 cases,divided into epithelial tumor group and sarcoma group.Cystic solid mass were also divided into benign and malignant group.Benign group of 13 cases,divided into ovarian cystadenoma and mature cystic teratoma group according to pathological type.Malignant group of 34 cases,divided intomalignant adenocarcinoma group and immature teratoma group and metastatic tumor group.All the datas were analyzed by SPSS21.0.Respectively to compare the Statistical differences of the shear wave modulus between the benign and malignant tumor and the different pathological types.The all measurement data are expressed as mean ± standard deviation.P <0.05 for the difference was statistically significant.The ROC curve was drawn according to the pathological results and the shear wave modulus values.The optimal cutoff values of the shear wave modulus values for the identification of benign and malignant pelvic masses were obtained,and their sensitivity and specificity were evaluated.Results:1 The average,maximal and minimum elastic modulus values of the solid-like tumor group,benign solid mass group and malignant solid tumor group were compared with each other,the difference was statistically significant(P <0.05),and It believed that benign solid mass elastic modulus >malignant solid mass > solid-like tumor.2 Comparison between different pathological types of solid pelvic masses elastic modulus values:(1)Benign solid tumor group: The mean,maximum and minimum elastic modulus values of leiomyoma group,sex cord interstitial tumor group and special type of leiomyoma were compared respectively,results,there was no significant difference in the elastic modulus between the leiomyoma group and the sex cord stromal tumor group(P>0.05),and the elastic modulus values of both groups were significantly higher than that of the special type of leiomyoma group(P<0.05).(2)Malignant solid tumor group: The mean,maximum and minimum elastic modulus values of epithelial tumor group and Sarcoma Group were compared respectively,result,the difference was statistically significant(P<0.05),and the modulus of elasticity of epithelial tumor was higher than that of sarcoma group.(3)Solid-like tumor mass: Endometriosis cyst and hemorrhagic cysts,the mean,maximum and minimum elastic modulus values were compared respectively,the results were statistically significant difference(P<0.05),and that the endometriosis elasticmodulus value is greater than that of hemorrhagic cyst.3 The differential diagnostic cutoff value: Benign and malignant masses elastic modulus as the basis,pathology results as the gold standard,drawing ROC curve.The results obtained,the accuracy rate respectively was 75.0%,61.84%,78.95%,when the average elastic modulus value 12.56 KP,the maximum value 43.55 KP,the minimum value 6.8KP as the cut-off value respectively.The difference between the three groups in the accuracy rate was statistically significant(P<0.05).It is concluded that the accuracy of the minimum elastic modulus cutoff value in the identification of benign and malignant tumors is higher.Solid and solid-like masses elastic modulus value as the basis,pathology results as the gold standard,drawing ROC curve.Results the diagnostic accuracy rate respectively was 91.11%,84.44%,92.22%,when the average elastic modulus value 8.65 KP,the maximum value17.62 KP,the minimum value 4.5KP as the cut-off value respectively.There was no significant difference in the accuracy rate between the three groups(P>0.05).It was considered that the mean,maximal and minimum elastic modulus cutoff values all have a high accuracy ratein identifying the cystic solidness of the tumor,and there is no obvious difference.4 The sensitivity of combined conventional ultrasound with shear wave elastography in the diagnosis of malignant pelvic mass was 93.75%,specificity was 91.67%,positive predictive value was 75%,negative predictive value was 98.21%,and the correct rate was 92.11%.The sensitivity,specificity,positive predictive value and negative predictive value were81.25%,81.67%,54.17%,94.23% and 81.58%,respectively,in the diagnosis of malignant pelvic masses using conventional ultrasound.The accuracy rate of the two groups was statistically significant(P<0.05).The accuracy of elastography combined with conventional ultrasound in the diagnosis of pelvic malignant tumors was higher than that of conventional ultrasound alone.5 The mean,maximum and minimum elastic modulus values were compared respectively between and within the Benign cystic solid tumors group and malignant cystic solid masses group.Result there were all noobvious difference(P> 0.05).Conclusions: Ultrasound elastography is highly feasible and potential valuable for the identification of benign and malignant solid masses,pelvic solid mass and solid-like masses.On the basis of conventional ultrasound,elastography can be used to further enhance the accuracy of differential diagnosis of benign and malignant pelvic masses.However,it is of little significance in differentiating benign and malignant cystic solid masses. |
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