| Objective : Shear wave elastography(SWE)and three-dimensional smart superb microvascular imaging(Smart 3D SMI)combined with breast imaging reporting and data system(BI-RADS)were used to further evaluate BI-RADS 3 and 4 nodules in order to investigate the diagnostic efficacy of multimodality ultrasound for benign and malignant BI-RADS3 and 4 nodules.Methods:From May 2021 to February 2023,118 hospitalized patients with BI-RADS class 3 and 4 breast nodules were admitted to the Department of General Surgery and Oncologic Surgery of the First Affiliated Hospital of Jiamusi University,with a total of 118 nodules.All patients underwent conventional ultrasound,shear wave elastography,and ultrastructural vascular three-dimensional imaging before surgery.According to the fifth edition of the BI-RADS classification criteria revised by the American College of Radiology in2013,BI-RADS class 3 and 4 nodules were diagnosed by conventional ultrasound;the mean elastic modulus(Emean)of the lesions was measured and recorded to assess benign and malignant breast nodules by shear wave elastography;the internal and peripheral blood flow of the nodules and microvascular stereomorphology were observed emphatically by ultra-microvascular three-dimensional stereography,and benign and malignant breast nodules were assessed according to Adler classification and Smart 3D SMI blood flow architecture.Finally,compared with the postoperative pathological results,the diagnostic efficacy of conventional ultrasound,shear wave elastography,ultra-microvascular imaging and BI-RADS/SWE/Smart 3D SMI alone for benign and malignant BI-RADS3 and 4 nodules was compared and analyzed.Results:1.Pathological findings: 63 benign nodules(53.39%)and 55 malignant nodules(46.61%).2.Conventional ultrasound BI-RADS grade: 19 type 3 nodules,39 type 4a nodules,35 type 4b nodules,and 25 type 4c nodules;BI-RADS grade was compared with pathological results: 58 benign nodules(49.15%)and 60 malignant nodules(50.85%)were diagnosed;the agreement rate with pathological results was 78.81%,and the kappa value was 0.577,indicating moderate agreement between BI-RADS grade and pathological gold standard.3.SWE technique: 63 benign nodules(53.39%)and 55 malignant nodules(46.61%)were diagnosed;the agreement rate with pathological results was 84.75%,and the kappa value was0.697,indicating moderate agreement between SWE and pathological gold standard.4.Smart 3D SMI technical examination: 68 benign nodules(57.63%)and 50 malignant nodules(42.37%)were diagnosed;the agreement rate with pathological results was 82.20%,and the kappa value was 0.640,indicating moderate agreement between Smart 3D SMI and pathological gold standard.5.Any positive BI-RADS/SWE/Smart 3D SMI: 50 benign nodules(42.37%)and 68 malignant nodules(57.63%)were diagnosed;the agreement rate between any positive BI-RADS/SWE/Smart 3D SMI and pathological results was 85.59%,and the kappa value was0.715,indicating that there was a high degree of agreement between combined diagnostic parallel test and pathological gold standard.6.Evaluation of the ability of multimodality ultrasound in the diagnosis of benign and malignant breast nodules: The results of the receiver operating curve of multimodality ultrasound in the diagnosis of benign and malignant breast nodules showed that the area under the curve was expressed as any of the positive BI-RADS/SWE/Smart 3D SMI > SWE > Smart3 D SMI > BI-RADS grades,and the areas under the curve were 0.863,0.847,0.818,and 0.790,respectively.BI-RADS/SWE/Smart 3D SMI was positive for any item with the largest area under the curve and AUC of 0.863,with the highest sensitivity of 96.4%,specificity of 76.2%,positive predictive value and negative predictive value of 77.9% and 96.0%,respectively,and accuracy of 85.59% in the diagnosis of benign and malignant breast nodules.Conclusions : Ultrasonographic diagnosis of breast nodules should be based on two-dimensional ultrasound.SWE and Smart 3D SMI can provide nodule hardness and microvascular stereoscopic morphology blood flow information,which is a useful supplement to conventional ultrasound.Multimodality ultrasound is beneficial to improve the diagnostic efficacy of benign and malignant BI-RADS3 and 4 nodules. |
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