| Objective: To explore the value of ultrasound BI-RADS combined with elastography(VTQ,SR)in the differential diagnosis of benign and malignant breast tumors.Methods: From August 2018 to October 2019,96 patients with breast masses who were treated in the First Affiliated Hospital of Wannan Medical College were selected.There were102 masses,with an average age of 48.65 ± 10.53 years.All breast masses were operated on or punctured.Pathologically confirmed.During the operation,routine breast ultrasound was performed first,and the size,shape,edge,border,orientation,internal echo,posterior echo,posterior echo,calcification,blood supply,and axillary lymph nodes were observed and recorded after breast lesions were found.Ultrasound BI-RADS classification was performed.Then use the elastography acoustic touch tissue quantification(VTQ)technology to measure the SWV value,and take the average value after 7 measurements;use the strain ratio(SR)value measurement method to measure the SR value,and measure 3 times.take the average.The three indexes of ultrasound BI-RADS classification,VTQ,and SR were selected,and the diagnosis results were given scores,and the scores were added one by one to obtain a comprehensive ultrasound score.There are four types of combined scoring methods: 1.Three methods combined scoring,2.Ultrasound BI-RADS classification and VTQ combined score,3.Ultrasound BI-RADS classification and SR combined score,4.VTQ and SR combined score.Statistical processing was performed using SPSS23.0 software.Measurement data were expressed as (?) ± s.Comparison of variables was performed using t test.Using the pathological results as the gold standard for the diagnosis of benign and malignant breast lesions,by drawing the ROC curve,the optimal cutoff points of the four combined scores of ultrasound BI-RADS,VTQ,SR,and combined use were obtained,and the corresponding sensitivity was calculated.Sex,specificity,area under the curve.Analyze the characteristics ofultrasound images of breast masses,including number of nodulesthe,morphology,edges,borders,orientation,internal echo,posterior echo,microcalcification,coarse calcification,blood flow signals,and axillary lymph nodes,and set them as independent variables.Dependent variable.Prior univariate analysis used 2 test to select statistically significant variables,P value <0.05 was statistically significant;the variables selected by univariate analysis were subjected to Logistic regression analysis,P value <0.05 was statistically significant.The variables selected were analyzed by Logistic regression analysis,and a P value of <0.05 was statistically significant.Results:(1)In this study,the pathological results of breast lesions after surgical resection or biopsy were used as the standard.A total of 96 patients and 102 breast masses were used.Among them,there were 63 malignant masses and the age of the patients was 52.11 ± 8.72years;39 benign masses and the ages of the tumor patients were 43.07 ± 10.91 years.There was a significant difference between the two(P <0.05).The maximum diameter of malignant masses was 25.17 ± 9.99 mm on average,and the maximum diameter of benign masses was20.72 ± 7.20 mm on average.There were significant differences between the benign and malignant groups(P <0.05).(2)The average value of SWV for benign breast lesions determined by VTQ technique is approximately(3.39 ± 1.69)m / s;the average value of VTQ for breast malignant lesions is approximately(7.73 ± 1.83)m / s,which is statistically significant(P <0.05).The best cut-off value of the average SWV for judging benign and malignant breast masses is 5.37 m / s.The corresponding sensitivity and specificity are 88.9% and 92.3%,respectively,and the area under the curve is 0.931.(3)SR technology judges the average SR of benign breast lesions is about 2.16 ± 0.96;the average SR of malignant breast lesions is about 4.52 ± 1.76,which is statistically significant(P <0.05).The best cut-off value is 3.16 and the area under the curve is 0.947.The corresponding sensitivity and specificity are 87.3% and 92.3%,respectively.(4)Ultrasound BI-RADS classification: The classification range of breast lesions in this study is 3-5,and the area under the curve is 0.907.The sensitivity and specificity were 82.5% and84.6%,respectively.(5)The areas under the curve of ultrasound BI-RADS classification,VTQ,and SR were 0.907,0.931,and 0.947,respectively.There was a statistically significant difference between ultrasound BI-RADS classification and VTQ(P <0.05);there was a statistically significant difference between ultrasound BI-RADS classification and SR(P <0.05).There was nosignificant difference between VTQ and SR(P> 0.05).(6)The best scoring cutoffs for judging benign and malignant breast masses by four combined methods are between 2 and 3 points,between 2 and 3 points,between 1 and 2 points,and between 0 and 1 points,correspondingly.Sensitivity was 87.3%,79.4%,92.1%,96.8%,and specificity was 92.3%,97.4%,84.6%,87.2%.(7)The areas under the curve of the four combined methods are 0.958,0.942,0.936,and0.960,respectively.The first joint is compared with the second joint,the first joint is compared with the third joint,the first joint is compared with the fourth joint,the second joint is compared with the fourth joint,and the third joint is compared with the third joint.There was a statistically significant difference between the four combinations(P <0.05),and there was no significant difference between the second and third combinations(P> 0.05).(8)Univariate analysis showed that the morphology,orientation,boundary,margin,posterior echo,microcalcification in the mass,blood flow signal grading,and axillary lymph node enlargement were statistically significant in breast lesions(P <0.05).Multivariate Logistic analysis showed that the marginal angle,marginal burr,microcalcification in the mass,and axillary lymph node enlargement were risk factors for breast lesions.(OR value> 1);direction positionwas a protective factor for breast lesions.(OR value <1)).The OR values in descending order are edge angle,edge burr,axillary lymph node enlargement,microcalcification in the mass,and direction position.Conclusions:(1)The diagnostic value of purely palpable tissue quantification technology and strain rate ratio method for the diagnosis of benign and malignant breast masses is superior to that of ultrasound BI-RADS classification alone;purely palpable tissue quantification technology and strain rate ratio method alone The diagnostic value of benign and malignant breast lesions is similar.All three methods are helpful for the identification of benign and malignant breast lesions and provide diagnostic help for clinicians.(2)The combined use of ultrasound BI-RADS classification,acoustic palpation tissue quantification technology,and strain ratio can reduce the rate of misdiagnosis of breast lesions,reduce unnecessary biopsy,and help the early diagnosis of lesions and the early treatment of patients.(3)Through univariate analysis and multivariate analysis,it was found that marginal angulation,marginal burr-like,microcalcification in the mass,and axillary lymph node enlargement were risk factors for breast lesions.Direction position was a protective factor for breast lesions.The factors associated with malignant breast lesions are edge to angle in orderfrom edge to edge,burr-like edge,axillary lymph node enlargement,microcalcification within the mass,and direction position.These factors are of great help to the clinician in identifying benign and malignant breast lesions. |
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