Diagnostic Value Of Bimodal Ultrasound Elastography Combined With BI-RADS For Breast Tumor

Objectives To compare the diagnostic efficacy of combined strain elastography(SE)and sound touch elastography(STE)in semi-quantitative and quantitative features to evaluate breast tumors and to explore whether elastography-assisted ultrasound(US)downgrading could reduce unnecessary biopsy of US Breast Imaging-Reporting and Data System(BI-RADS)category 4a masses.Methods 224 breast masses from 202 patients were assessed using conventional and elastography US in the prospective study.The pathological results functioned as the reference standard.Semi-quantitative analyses of GLR(gland-to-lesion)and FLR(fat-to-lesion)and quantitative analyses of the elasticity values of lesion area(Emax?Emean?Emin and ESD)and the 2mm outer tissue(Smax?Smean?Smin and Ssd)were performed.The diagnostic efficacy of single and bimodal elastography combined conventional US and selectively degrading BI-RADS 4a masses using the optimal elastic parameter were calculated.Results(1)In the assessment for SE,the area under the ROC curve(AUC)of FLR was slightly higher than GLR(0.782 vs.0.748,P=0.13),but the difference is not statistically significant.For the evaluation of STE,Smax had the highest AUC(0.814 vs.0.775 vs.0.727 vs.0.724 vs.0.774 vs.0.754,all P<0.05),which was significantly higher than Emax,Emean,Esd,Smean and Ssd respectively.(2)The sensitivity,specificity,accuracy of SE or STE combined with BI-RADS was 83.53%,85.71%,85.7%or 87.91%,87.22%,87.5%,respectively.Their specificity and accuracy were significantly higher than those of BI-RADS,while the sensitivity was significantly lower(P<0.05).(3)The sensitivity,specificity,accuracy of SE and STE combined with BI-RADS was 93.41,81.2%and 86.1%.Without significantly decreasing the sensitivity(P>0.05),the specificity and accuracy were significantly improved.The AUC of single elastography combined with BI-RADS was 0.93 1for SE,0.927 for STE that was significantly higher than 0.901 for BI-RADS(all P<0.001).Bimodal elastography combined with BI-RADS had an AUC of 0.936,which was slightly better than that of single elastography,but the difference was not significant(P>0.05).(4)After the selective degradation of BI-RADS 4a lesions aided by SE and STE respectively,which were named as BI-RADS? and BI-RADS?,their AUC was respectively 0.910 and 0.917.The AUC of BI-RADS? was significantly higher than that of BI-RADS(P=0.01),while BI-RADS? was slightly higher than BI-RADS without statistical difference(P>0.05).Conclusions SE and STE combined with BI-RADS improved the diagnostic efficiency of benign and malignant breast tumors,and potentially reduced the unnecessary biopsy of BI-RADS 4a masses.In the selective degradation,Smax showed better auxiliary value.