The Value Of Shear Wave Elastography Quantitative Parameters Combined With Ultrasound BI-RADS Category In Differential Diagnosis Of Breast Benign And Malignant Lesions

Objective:To discuss the value of SWE quantitative parameters combined with ultrasound BI-RADS category in differential diagnosis of breast benign and malignant lesions.Methods:229 lesions of 197 patients who had visited a doctor during October,2018 and December,2019 were chosen as the objects of the study.Routine ultrasound examinations were first done to get the lesions' information of shapes,orientations,margins,Internal echos,calcifications,blood flow characteristics,special signs,etc.Lesions were classified and estimated through the ultrasound BI-RADS category of version 2013.Then SWE check were done to measure and record the lesions' information of Emeans,Esds,Eratios.Each parameter was measured 3 times to obtain the average one.ROC curve was built by the gold standard of the pathological results.The diagnostic value of SWE quantitative parameters and ultrasound BI-RADS category applied to lesions seperatedly and unitedly was estimated.The value of SWE optimized quantitative parameters adjusting the categories of ultrasound BI-RADS 4A lesions was discussed.Results:The accuracy,sensitivity,specificity,positive predictive value,negative predictive value,of which the diagnosis of breast benign and malignant lesions had applied ultrasound BI-RADS,were 66.8%,98.9%,45.3%,54.8%and 98.4%,respectively.SWE quantitative parameters Emean,Esd and Eratio in the malignant lesion group were significantly higher than those in the benign lesion group,and the difference between the two groups was statistically significant(P<0.001).Among the three SWE quantitative parameters,the area under the ROC curve of Emean was the largest(0.91),and the cutoff value was 40.5kPa.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value of Emean cutoff were 89.5%,86.9%,91.2%,87.0%and 91.2%,respectively.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value of Emean cutoff combined with ultrasound BI-RADS categories in diagnosis of breast benign and malignant lesions were 90.8%,96.7%,86.9%,83.2%and 97.5%,respectively.When Emean(40.5kPa)was used to optimize the category of ultrasound BI-RADS 4A,the 90.8%(59/65)category 4A lesions could be adjusted to category 3,but two malignant lesions could be reduced to category 3,resulting in an increase in the malignant rate of category 3 lesions from 1.59%(1/63)to 4.76%(3/63).Conclusion:The ultrasound BI-RADS category is highly sensitive to the differential diagnosis of benign and malignant breast masses,which can provide important imaging evidence for the selection of clinical treatment plans.S WE technology can objectively and accurately obtain the quantitative parameters of the hardness of the lesion tissue,which has important reference value for the differential diagnosis of benign and malignant breast masses.Ultrasound BI-RADS category combined with SWE quantitative parameter Emean has the highest accuracy in the differential diagnosis of benign and malignant breast masses,which is the best diagnostic method in this study.Emean cutoff value can be used to adjust the categories of BI-RADS category 4A lesions,which can reduce unnecessary puncture biopsy or surgery.However,for some suspicious small lesions of category 4A,especially those closely related to breast catheters,comprehensive research and judgement are needed to minimize the risk of missed diagnosis in accordance with SWE technology when performing treatment of reducing BI-RADS category.