| Objective:1.To analyze the characteristics of benign and malignant breast tumors by applying acoustic radiation force impulse imaging(ARFI),including virtual touch tissue imaging(VTI)and virtual touch tissue quantitative(VTQ),and investigate the value of the ARFI technology in qualitative and quantitative diagnosis of benign and malignant breast tumors,then further assess the value of the VTQ technology in diagnosing breast tumors of different sizes in subgroups.2.To assess the value of molybdenum target X-Rays photography in diagnosing breast tumors of different sizes in subgroups.3.To investigate the joint value of the ARFI technology and molybdenum target X-Rays photography in diagnosing benign and malignant breast tumors.Materials and methods:The objects were 67 cases of female patients of ordinary surgery received in Wuxi Second People's Hospital during 2016 August and 2017 February with an median age of52.3,aging from 26 to 79 years old,and a total of 80 tumors were included.All patients had gone throng the examination of ARFI technology and molybdenum target X-Rays photography.After surgery,all tumors had been confirmed by pathology,including 46 benign tumors and 34 malignant tumors.The ultrasonic examination applied the color Doppler Acuson S2000 Siemens.After a regular overall ultrasonic examination on the tumors,recording the two-dimensional ultrasound image and features of the blood flow and confirming the best view,then the VTI and VTQ technology were applied to obtain the VTI images and VTQ parameters of the breast tumors.VTI images were evaluated,and VTQ technology was applied to measure SWV values of the tumors and the surrounding normal mammary glands with the samedepth,each measured 3 times,then took the average.Calculate the SWV values of the tumors/ the SWV values of the surrounding normal mammary glands(SWV ratios).The mammography examinations applied full-field digital mammography,machine was GE Senographe DMR+,which regularly shot CCP position and MLO position so as to observe the characters of the tumor.The benign and malignant tumors were judged according to the diagnostic classification of breast imaging report and data system(BI-RADS).80 tumors were divided into three subgroups according to the long axis in ultrasonogram:Group S1 for those whose diameters were less than 1cm,a total of 21 tumors;group S2 for those whose diameters raged from 1cm to 2cm,a total of 34 tumors;and group S3 for those whose diameters were more than 2cm,a total of 25 tumors.To take the postoperative pathology as the gold standard,the above results were analyzed by software of applied statistics to respectively assess the values of ARFI technology,molybdenum target X-Rays photography and the above two combined in diagnosing benign and malignant breast tumors.P< 0.05 was statistically significant.Result:1.VTI 1~3 scores were judged to be benign,4~5 scores were malignant,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the differential diagnosis of breast tumors were 79.41%(27/34)? 82.61%(38/46)?83.75%(67/80)?77.14%(27/35)?84.44%(38/45).2.The VTQ results were as follows:?The interior average value of SWV,the average value of SWV of the surrounding normal mammary glands and the SWV ratio of malignant tumors were 5.3±2.54m/s?1.65±0.57m/s?3.63±2.17.The interior average value of SWV,the average value of SWV of the surrounding normal mammary glands and the SWV ratio of benign tumors were 2.95±2.03m/s?1.75±0.58m/s?1.81±1.46.The interior average value of SWV of malignant tumors was higher than that of benign tumors,whose difference was statistically significant(P<0.01).The interior average value of SWV rate of malignant tumors was higher than that of benign tumors,whose difference was statistically significant(P<0.01).?The average values of SWV of malignant tumors in group S1,group S2 and groupS3 were 3.3±1.29m/s?4.94±2.46m/s?7.19±2.07m/s.The values of SWV of benign tumors in group S1,group S2 and groupS3 were 2.45±2.18m/s?2.33±1.20m/s?4.41±2.35m/s,The value of SWV of malignant tumors in group S3 was obviously higherthan those in group S1 and group S2,whose difference was statistically significant(P<0.01).The value of SWV of benign tumors in group S3 was also higher than those in group S1 and group S2,whose difference was statistically significant(P<0.05).?To take the pathological results as gold standard,after building the ROC curve of SWV in the inner region of the breast tumor,the area under curve(AUC)was 0.83,the maximum youden index was 0.6138,which corresponds to SWV of optimal diagnostic critical value of3.0m/s.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of diagnosing benign and malignant breast tumors by SWV values were respectively85.29%(29/34)?76.09%(35/46)?80.00%(64/80)?61.38%(29/40)?87.5%(35/40).(4)By building the ROC curves of the SWV values and SWV ratios of the tumors in the three subgroups and comparing the SWV values and SWV ratios between groups,it appeared that the AUC of SWV ratio in Group S1 was 0.84,the AUC of SWV value in Group S1 was0.67,whose difference was statistically significant(P<0.05).3.The molybdenum target X-Rays photography results were as follows: ? By molybdenum target X-Rays photography according to standards of BI-RADS to diagnose benign and malignant breast tumors,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were respectively 73.53%(25/34)?80.43%(37/46)?78.75%(63/80)?73.53%(25/34)?80.43%(37/46).?To count the sensitivity and specificity of molybdenum target X-Rays photography in the diagnosis of breast tumors in three subgroups,the result showed that the sensitivity of mammography in group S3 was83.33%,which was significantly higher than group S1(66.67%)and group S2(69.23%),after comparing one to another,there had no significant difference(P> 0.05).4.By ARFI(VTI+VTQ)technology combined with molybdenum target X-Rays examination to diagnose benign and malignant breast tumors,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were respectively 97.06%(33/34)? 71.74%(33/46)? 82.50%(66/80)? 71.74%(33/46)?97.06%(33/34).Conclusion:1.Based on the two-dimensional ultrasound,ARFI is able to qualitatively and quantitatively analyze the hardness of breast tumors and is of clinical significance to diagnosing benign and malignant breast tumors.The SWV ratio is especially valuable in diagnosing small benign and malignant breast tumors,whose diameter is less than 1cm.2.The technology of molybdenum target X-Rays photography according to BI-RADS diagnostic standards is of great importance in diagnosing benign and malignant breast tumors,especially for those lager tumors,whose diameter is more than 2cm,the sensitivity is higher.3.To take pathological results as gold standard,there is no obvious difference in diagnostic sensibility by the individual application of ARFI technology or molybdenum target X-Rays photography.But the way to combine the two is more efficient than the individual application,and is helpful to improve the differential diagnosis of benign and malignant breast tumors. |
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