Abstract：Objective: To explore the application value of real time shear wave elastography(RT-SWE) in the diagnosis of breast masses, and to provide new ideas for the differential diagnosis of breast masses. Methods: 500 cases of breast lumps treated in the First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to February 2018 were included in this study. The RT-SWE technique was used to scan the various quadrants of the breast mass, taking the pathological results as the gold standard, the modulus of elasticity of benign and malignant masses was compared. Receiver operating characteristic(ROC) was plotted and the efficacy of RE-SWE in the diagnosis of breast lumps was analyzed, to explore its clinical application value. Results: 667 breast lesions were detected, including 408 benign masses and 259 malignant masses. The Emax, Emean, Emin, SD, ratio and shear wave velocities of benign tumors were all lower than those of malignant masses, the differences are statistically significant(P<0.05). Emean has the largest area under the curve(0.931), the diagnostic accuracy is 91.45% in discriminating the benign and malignant breast tumors, followed by the shear wave velocity, the area under the curve is 0.899, and the diagnostic accuracy is 89.81%. Conclusion: The Emean and shear wave velocity parameters of RT-SWE images can provide an objective reference for differentiating benign and malignant breast masses. It is worthy to be widely applied in the diagnosis of clinical breast masses.
薛姗姗，赵巧玲，阮骊韬，李 宁，盛 薇，周 灿. 实时剪切波弹性成像技术在乳腺肿块诊断中的临床应用价值[J]. 中国临床医学影像杂志, 2019, 30(11): 778-782.
XUE Shan-shan, ZHAO Qiao-ling, RUAN Li-tao, LI Ning, SHENG Wei, ZHOU Can. The clinical value of RT-SWE in the diagnosis of breast mass. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(11): 778-782.
[1]Athanasiou A, Latorre-Ossa H, Criton A, et al. Feasibility of imaging and treatment monitoring of breast lesions with three-dimensional shear wave elastography[J]. Ultraschall Medizin, 2017, 38(1): 51-59.
[2]Berg WA, Mendelson EB, Cosgrove DO, et al. Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity[J]. Am J Roentgenol, 2015, 205(2): 448-455.
[3]Gennisson J, Provost J, Deffieux T, et al. 4-D ultrafast shear-wave imaging[J]. IEEE, 2015, 62(6): 1059-1065.
[4]Seguin J, Mignet N, Ossa HL, et al. Evaluation of Antivascular Combretastatin A4 P Efficacy Using Supersonic Shear Imaging Technique of Ectopic Colon Carcinoma CT26[J]. Ultrasound Med Biol, 2017, 43(10): 2352-2361.
[5]彭晓静，胡彧，巩海燕，等. 实时剪切波弹性成像联合超声造影优化乳腺病变BI-RADS分类的价值[J]. 中国临床医学影像杂志，2017，28（6）：400-404.
[6]Berg WA, Cosgrove DO, Dore CJ, et al. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses[J]. Radiology, 2012, 262(2): 435-449.
[7]Shi XQ, LI JL, Wan Wb, et al. A set of shear wave elastography quantitative parameters combined with ultrasound BI-RADS to assess benign and malignant breast lesions[J]. Ultrasound Med Biol, 2015, 41(4): 960-966.
[8]Kim SJ, Jung HK. Shear wave elastography: Is it a valuable additive method to conventional ultrasound for the diagosis of small(≤2 cm) breast cancer?[J]. Medicine(Balimore), 2015, 92(42): e1540.
[9]Skerl K, Vinnicombe S, Giannotti E, et al. Influence of region of interest size and ultrasound lesion size on the performance of 2D shear wave elastography(SWE) in solid breast masses[J]. Clin Radiol, 2015, 70(12): 1421-1427.
[10]Zhang Q, Xiao Y, Chen S, et al. Quantification of elastic heterogeneity using contourlet-based texture analysis in shear-wave elastography for breast tumor classification[J]. Ultrasound Med Biol, 2015, 41(4): 588-600.
[11]Dobruch-Sobczak K, Nowicki A. Role of shear wave sonoelastography in differentiation between focal breast lesions[J]. Ultrasound Med Biol, 2015, 41(1): 366-374.
[12]Park J, Woo OH, Shin HS, et al. Diagonstic performance and color overlay pattern in shear wave elastography(SWE) for palpable breast mass[J]. Eur J Radiol, 2015, 84(10): 1943-1948.
[13]Youk JH, Son EJ, Han K, et al. Performance of shear-wave elastography for breast masses using differentregion-of-interest(ROI) settings[J]. Acta Radiologica, 2017, 59(7): 789-797.
[14]吴嘉仪，罗葆明，梁铭，等. 实时剪切波弹性成像调整圆形Q-box法与手动描绘Q-box法鉴别诊断乳腺良恶性病变[J]. 中国医学影像技术，2016，32（9）:1361-1364.
[15]Boehm K, Salomon G, Beyer B, et al. Shear wave elastography for localization of prostate cancer lesions and assessment of elasticity thresholds: implications for targeted biopsies and active surveillance protocols[J]. J Urol, 2015, 193(3): 794-800.
[16]曾庆劲，曾婕，吴涛，等. 剪切波弹性成像彩色图像评分法诊断良恶性乳腺实性病变[J]. 中国医学影像技术，2015，31（3）：405-408.
[17]林霞. 彩色多普勒超声对小乳腺癌与乳腺增生的诊断价值[J]. 转化医学电子杂志，2015，2（5）：35-36.
[18]Zhang Q, Xiao Y, Chen S, et al. Quantification of elastic heterogeneity using contourlet-based texture analysis in shear-wave elastography for breast tumor classification[J]. Ultrasound Med Biol, 2015, 41(2): 588-600.
[19]Barr RG, Nakashima K, Amy D, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast[J]. Ultrasound Med Biol, 2015, 41(5): 1148-1160.
[20]Lo CM, Lai YC, Chou YH, et al. Quantitative breast lesion classification based on multichannel distributions in shear-wave imaging[J]. Comput Meth Prog Biomed, 2015, 122(3): 354-361.
[21]韩竞，李安华，韩峰，等. 剪切波弹性成像技术评估乳腺病变的方法学探讨[J]. 中国超声医学杂志，2016，32（6）：503-506.
[22]Chauvet D, Imbault M, Capelle L, et al. In vivo measurement of brain tumor elasticity using intraoperative shear wave elastography[J]. Ultraschall Medizin, 2016, 37(6): 584-590.
[23]Youk JH, Son EJ, Gweon HM, et al. Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments[J]. Ultrasound Med Biol, 2014, 40(4): 2336-2344.
[24]曾庆劲，曾婕，郑荣琴，等． 剪切波弹性成像在乳腺实性病变良恶性鉴别诊断中的价值[J]． 中华超声影像学杂志，2014，23（2）：129-132.
[25]Wojcinski S, Brandhorst K, Sadigh G, et al． Acoustic radiation force impulse imaging with virtual touch tissue quantification: mean shear wave velocity of malignant and benign breast masses[J]． Int J Women Health, 2013, 5: 619-627．
[26]Tozaki M, Fukuma E． Pattern classification of shear wave TM elastography image for differential diagnosis between benign and malignant solid breast masses[J]． Acta Radiologica, 2011, 52(10): 1069-1075．
[27]崔可飞，司彩凤，付超. 剪切波新算法在乳腺实性结节良恶性诊断中的应用[J]. 中国超声医学杂志，2014，30（5）：395-399.
[28]陈小霜. 实时剪切波弹性成像对乳腺良恶性病变的鉴别诊断价值及其与病理特征关系的研究[D]. 福州：福建医科大学，2016.
[29]Bernal M, Chamming’s F, Couade M, et al. In vivo quantification of the nonlinear shear modulus in breast lesions: feasibility study[J]. IEEE, 2016, 63(1): 101-109.
[30]李晔，王知力. 乳腺导管内乳头状瘤：剪切波弹性成像评价乳腺病变良恶性误诊的潜在原因[J]. 中国医学影像学杂志，2015，23（12）：896-899.
[31]周瑜，岳庆雄，刘佳. 超声BI-RADS联合弹性应变率比值在乳腺肿块诊断中的价值[J]. 保健医学研究与实践，2016，13（1）：77-79.
[32]Li DD, Xu HX, Guo LH, et al. Combination of two-dimensional shear wave elastography with ultrasound breast imaging reporting and data system in the diagnosis of breast lesions: a new method to increase the diagnostic performance[J]. Eur Radiol, 2016, 26(9): 3290-3300.
[33]Bae JS, Chang JM, Lee SH, et al. Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ[J]. Eur Radiol, 2017, 27(1): 7-15.
