Diagnostic Value Of Shear Wave Elastography Combined With Contrast-enhanced Ultrasound In Benign And Malignant Breast Lesions

Objectives To analyze the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the two diagnoses separately and jointly,which by searching for sensitive parameters of shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS),and to explore the diagnostic value of shear wave elastography and contrast-enhanced ultrasound in benign and malignant breast tumors.Methods From November 2017 to February 2019,56 female patients with total of 60 breast tumors of BI-RADS grade 3 or 4 were selected from the outpatient or inpatient department of the Affiliated Hospital of North China University of Science and Technology.All the subjects were confirmed by operation or puncture pathology.SWE and CEUS were performed before operation.The age of the patients ranged from 30 to 73 years,with an average age of(53.82±11.41)years.The maximum diameter of the tumors ranged from 0.46 cm to 6.70 cm,with an average of(2.16±1.23)cm.Ultrasound parameters were as follows: 1)SWE parameters: Max,Min,Mean,SD and Ratio of breast mass to adipose tissue.2)CEUS parameters: enhancement intensity,contrast agent distribution,enhancement mode,perfusion defect,edge characteristics of dynamic image,intratumoral vascular morphology,arrival time of contrast agent(s),peak time(TP),Peak concentration,area under time-strength curve(AUCt),mean transit time(MTT),margin of post-contrast,presence or absence of perforating vessels,and size of post-contrast space.Excel workbook was used to establish the database and SPSS 21.0 statistical software was used to analyze the data.The normality of measurement data is tested by Kolmogorov-Smirnov test,and the normal distribution is expressed by sx ±,independent sample t-test was used,non-normal distribution was expressed by quartile interval M [P25-P75],and Wilcoxon sign rank sum test was used.Counting data are expressed by frequency or rate,and chisquare test is used for comparison.ROC curve analysis was used to find the critical value of each parameter in quantitative diagnosis of shear wave elastography.To analyze the consistency of the two methods with pathological results by using Kappa test.Kappa value>0.80 indicates the strongest consistency,0.60<Kappa?0.80 shows higher consistency,0.40<Kappa?0.60 illustrates general consistency,and Kappa?0.40 indicates poor consistency.Qualitative and quantitative analysis of SWE,CEUS and their combined diagnostic value were carried out by using binary logistic regression and regression equation was established.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the two diagnostic methods were calculated.The difference was statistically significant with P<0.05.Results 1 General information results: There were significant differences in age,body mass index,fasting blood sugar and carbohydrate antigen 153(CA153)between benign and malignant breast tumors(P<0.05),but there were no significant differences in menarche age,total cholesterol(CHOL),triglyceride(TG)between benign and malignant breast tumors(P>0.05),indicating that age,body mass index,fasting blood sugar and CA153 are valuable in the diagnosis of benign and malignant breast tumors.2 Pathological results: Of the 60 breast masses,23 were benign and 37 were malignant.The maximum diameter of occupied space ranged from 0.46 cm to 6.70 cm,with an average of(2.16 ±1.23)cm.3 Quantitative diagnosis of SWE: Emax,Emin,Emean,SD and Ratio had significant difference between benign and malignant(P<0.05).The area under the curve of each quantitative parameter of SWE was>0.70.Emax was the best diagnostic value.When the diagnostic critical value was 36.75 k Pa,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 87.0%,89.2%,85.0%,89.0% and 79.0%,respectively.4 Qualitative diagnosis of SWE: The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of elastic model for benign and malignant breast tumors were 89.1%,82.6%,86.7%,89.1% and 82.6%,respectively,the Kappa value was 0.72,P<0.05,indicating that the qualitative indicators of SWE were in good agreement with pathological results.5 Quantitative and qualitative analysis of SWE: The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of diagnosis were 91.9%,86.9%,90.0%,91.9% and 86.9%,respectively.The Kappa value was 0.79,P<0.05.This indicated that the quantitative and qualitative combined analysis of SWE had a high consistency with pathological results in the diagnosis of breast tumors.6 Quantitative analysis of contrast-enhanced ultrasound: Peak and TP had significant difference between benign and malignant breast tumors(P<0.05),while MTT and AUCt had no significant difference between benign and malignant breast tumors(P>0.05),the ROC curves of Peak and TP were drawn according to the pathological results.The area under the ROC curves was 0.81 and 0.66,respectively.Therefore,the diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of Peak were 75.7%,86.9%,80.0%,90.3% and 69.0% respectively.7 Qualitative analysis of CEUS: There were significant differences between benign and malignant breast tumors in enhancement intensity,dynamic margin characteristics,intratumoral vascular morphology,post-contrast margin,presence or absence of large vessels and size of tumors(P<0.05).There was no significant difference in contrast agent distribution,enhancement mode and perfusion defect(P>0.05).The findings of contrast-enhanced ultrasonography in malignant tumors were mainly high enhancement,mainly radial and perforating branches enhancement,irregular internal vascular morphology and course,large vessel supply and larger volume after contrast-enhanced ultrasonography,while those in benign tumors were mainly low or equal enhancement,mainly ring-enhanced ultrasonography,the shape and course of internal vessels remained unchanged after contrast-enhanced ultrasonography.With the above-mentioned parameters of CEUS morphological differences between benign and malignant tumors as indicators,each index was scored.After calculating the total score,ROC curve was drawn with pathological results as the gold standard.The critical score was 11.5 points,which was higher than that of malignant tumors,and benign tumors which were lower than that of benign tumors,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of diagnosis were 83.7%,91.3%,86.7%,93.9% and 77.8%,respectively.The Kappa value was 0.73,P<0.05,which indicated that the qualitative indicators of CEUS were consistent with pathological results.8 CEUS combined quantitative and qualitative analysis: the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of diagnosis were 86.5%,87.0%,86.7%,91.4% and 87.0%,respectively.The Kappa value was 0.79,P<0.05.This indicated that CEUS combined quantitative and qualitative analysis had a high consistency with pathological results in the diagnosis of breast tumors.9 The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of SWE combined with CEUS were 94.6%,91.3%,93.3%,94.5% and 91.3%,respectively.The Kappa value was 0.86,P<0.05.It showed that the analysis of SWE combined with CEUS in the diagnosis of benign and malignant breast tumors had the strongest consistency with pathological results.Compared with the two methods,SWE has higher diagnostic value than CEUS;the quantitative diagnosis of SWE is slightly more valuable than qualitative diagnosis,and the qualitative diagnosis of CEUS is more valuable than quantitative diagnosis;the diagnostic value of SWE and CEUS is higher in the diagnosis of benign and malignant breast tumors,and the diagnostic value of the combined diagnosis of SWE and CEUS is higher.Conclusions 1 The diagnosis of benign and malignant breast tumors by SWE showed that the hardness of malignant breast tumors was higher than that of benign ones.Quantitative indicators including Emax,Emin,Emean,SD and Ratio were more sensitive to the diagnosis of benign and malignant breast tumors.The diagnostic thresholds were 36.75 k Pa,31.20 k Pa,34.30 k Pa,2.25 and 4.90,respectively.2 CEUS qualitative indicators including enhancement intensity,edge characteristics of dynamic maps,vascular morphology,presence or absence of large vessels,and volume after contrast are sensitive to the diagnosis of benign and malignant breast tumors.The main features of contrastenhanced ultrasound in malignant tumors were high enhancement,mainly radial and perforating branches enhancement,irregular internal vessels,large blood vessels and larger volume after contrast-enhanced ultrasound,while the main features of contrast-enhanced ultrasound in benign tumors were low or equal enhancement,mainly ring-enhanced ultrasound,and the shape and course of internal blood vessels remained unchanged after contrast-enhanced ultrasound.3 From the research point of view,the value of shear wave elastography combined with contrast-enhanced ultrasound in differentiating benign and malignant breast tumors is higher than that of the two alone.Figure 6;Table 16;Reference 13...