| Background: The use of ultrasound elastography for the differential diagnosis of benign and malignant breast nodules is well recognised,but the diagnostic reference thresholds for different models of instruments from different manufacturers vary.Siemens launched a new ACUSON Sequoia Doppler ultrasound instrument in China in2020,and there is a lack of reference values for benign and malignant differential diagnosis using this model of instrument for breast ultrasound elastography in China.Objective: To investigate the diagnostic value of shear wave velocity values derived from different sampling methods of ultrasound strain elastography and shear wave elastography of the new ACUSON Sequoia Doppler ultrasound instrument from Siemens for Breast Imaging Reporting and Data System(BI-RADS)class 3-5 nodules.Methods: A total of 211 patients with pathologically confirmed breast masses from February 2021 to February 2022,with 218 masses,were collected and subjected to conventional ultrasonography using the new ACUSON Sequoia ultrasound instrument from Siemens,graded according to the BI-RADS classification.Then,strain elastography(SE)was performed to obtain the semi-quantitative parameters of area ratio(AR)and strain ratio(SR),Shear wave elastography(SWE)is then performed to obtain shear wave elastic velocity values.The parameters were determined: the shear wave velocity value(SWVmax)at the stiffest part of the mass,the shear wave velocity value(SWV)covering the entire breast mass,and the shear wave velocity mean(SWVmean)of the five sampling regions(ROI)of interest placed at 12,3,6,9 o’clock of the mass and the center of the lesion.The data were analyzed using the statistical software SPSS 26.0,and the Receiver Operating Characteristic(ROC)curves were plotted to derive the cut-off values and the Area Under the Curve(AUC)for each parameter of the two elastography methods for the diagnosis of benign and malignant nodules in the BI-RADS 3-5 category of the breast.The results were analyzed to determine the optimal diagnostic parameters for strain elastography and shear wave elastography,and to compare the diagnostic efficacy of the two elastography techniques and the clinical application value of the combination with BI-RADS for the correction of breast nodules in categories 3-5.Results:(1)The BI-RADS classification of the lesions in this study was 3-5 with an AUC of 0.809,and the best diagnostic value for assessing the benignity and malignancy of breast lesions was between 4A-4B,Sensitivity,specificity,positive predictive value and negative predictive value were 67.1%,90.4%,80.9% and 82% respectively.(2)The mean SR value for benign lesions was 7.59±5.98 and the mean AR for benign lesions was 1.01±0.27,while the mean SR value for malignant lesions was 19.99 ± 12.8 and the mean AR for malignant lesions was 1.22 ± 0.19,all of which were statistically significant when compared between groups(P < 0.001).(3)The mean values of SWV,SWVmax,and SWVmean for benign lesions were(1.74±0.59)m/s,(2.53±0.93)m/s,and(1.89±0.62)m/s,respectively,and the mean values of SWV,SWVmax,and SWVmean for malignant lesions were(2.95±1.12)m/s,(4.30±(1.30)m/s,(3.15±1.08)m/s,the shear wave elastography parameters of malignant lesions were higher than those of benign lesions,and the comparison between the two groups was statistically significant(P<0.001).(4)The AUCs of strain elastography parameters SR and AR were0.875 and 0.796,respectively,and the AUC of SR was higher than that of AR.The best threshold value for diagnosing benign and malignant breast lesions was 10.175 for SR and 0.875 for AUC,corresponding to a sensitivity of 81.7%,specificity of 80.1%,positive predictive value of 71.3%,and negative predictive value of 87.9%.(5)The AUC of the elastic parameters SWV,SWVmean and SWVmax for shear wave elastography were 0.841,0.842 and 0.862,respectively.The AUC of SWVmax was higher than that of SWV and SWVmean,and the best threshold value for diagnosing benign and malignant breast masses was 3.45 m/s for SWVmax with an AUC of 0.862,which corresponded to a sensitivity of 74.4%.The sensitivity was 74.4%,the specificity was 86%,and the positive predictive value was 76.3% and negative predictive value was 84.8%.(6)The AUC for combining SR with BI-RADS classification was 0.902,sensitivity was 85.4%,specificity was 79.4%,positive predictive value was 71.4% and negative predictive value was 90%;the AUC for combining SWVmax with BI-RADS classification was 0.893,sensitivity was 79.3%,specificity was 85.3%,positive predictive value was 76.5% and negative predictive value was 87.2%.The differences between SR and BI-RADS classification combined and SWVmax and BI-RADS classification combined were not statistically significant(P > 0.05).(7)The AUC for the combination of SE,SWE and BI-RADS classification was 0.927,sensitivity was84.1%,specificity was 94.1%,positive predictive value was 90.8% and negative predictive value was 90.8%,and the differences were statistically significant when comparing the combination of the three with strain-elastic technique and conventional ultrasound combination and shear-wave elastic technique and conventional ultrasound combination(P < 0.005).Conclusion:(1)Conventional ultrasound BI-RADS classification,SE and SWE are all clinically useful for the diagnosis of benign and malignant breast lesions and can provide some clinical assistance.When the two elastic methods are paired with conventional ultrasound alone,there is no significant difference in diagnostic value and they are of similar diagnostic value.(2)Among the different elastography parameters of shear wave elastography,SWVmax has a slightly higher diagnostic value than SWV and SWVmean and is the best diagnostic parameter in SWE.(3)The diagnostic efficacy of SR in strain elastography is higher than that of AR and is more valuable in the diagnosis of benign and malignant breast nodules.(4)Compared to one diagnostic method alone,the combination of SE with 2D ultrasound,SWE with 2D ultrasound and the combination of all three methods effectively improved the diagnostic accuracy of benign and malignant breast tumours,with the combination of all three methods having a better diagnostic effect.(5)SE combined with 2D ultrasound and SWE combined with2 D ultrasound have similar diagnostic value for identifying benign and malignant breast masses. |
PDF Full Text Request