Shear-wave Elastography Improves the Specificity of Breast US: The BE1 Multinational Study of 939 Masses
Shear-wave Elastography Improves the Specificity of Breast US: The BE1 Multinational Study of 939 Masses
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DOI：
10.1148/radiol.11110640
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发表时间：
2012-02-01
期刊：
影响因子：
19.7
通讯作者：
Cohen-Bacrie, Claude
中科院分区：
文献类型：
--
作者：
Berg, Wendie A.;Cosgrove, David O.;Cohen-Bacrie, Claude
目的：为了确定是否增加剪切波（SW）弹性成像功能可以提高准确性的超声（US）评估乳腺masses.Materials和Methods：从2008年9月至2010年9月，958名妇女同意重复标准的乳房US补充定量SW弹性成像检查在这个前瞻性的多中心机构审查委员会批准，符合健康保险责任法案的协议。记录了B型乳腺成像报告和数据系统（BI-RADS）的特征和评估。进行SW弹性成像评价（肿块和周围组织最坚硬部分的平均、最大和最小弹性;病变与脂肪弹性比; SW弹性成像与B型病变直径或面积比; SW弹性成像病变形状和均匀性）。独立评估定性彩色SW弹性成像刚度。939个肿块可分析; 102个BI-RADS 2类肿块被假定为良性; 837个3类或更高级别病变的参考标准可用。考虑到BI-RADS类别4a或更高的恶性肿瘤测试阳性，SW弹性成像功能下的受试者工作特征曲线（AUC），灵敏度和特异性的影响后，重新分类类别3和4a群众determined.Results：中位参与者年龄为50岁，289 939（30.8%）肿块是恶性的（中位肿块大小，12毫米）。B型BI-RADS AUC为0.950; 8/303（2.6%）个BI-RADS 3类肿块、18/193（9.3%）个4a类病变、41/97（42%）个4 b类病变、42/57（74%）个4c类病变和180/187（96.3%）个5类病变为恶性。通过使用视觉颜色硬度选择性地升级3类和缺乏硬度降级4a类肿块，特异性从61.1%（650中的397）提高到78.5%（650中的510）（P <0.001）; AUC增加到0.962（P = 0.005）。SW弹性成像图像上的椭圆形和定量最大弹性80 kPa（5.2 m/sec）或更低的特异性（69.4% [650例中的451例]和77.4% [650例中的503例]，两者P <0.001），灵敏度或AUC没有显著改善。在BI-RADS特征分析中添加SW弹性成像特征可提高乳腺US肿块评估的特异性，而不会损失灵敏度。
Purpose: To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses.Materials and Methods: From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined.Results: Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P < .001); AUC increased to 0.962 (P = .005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P < .001 for both), without significant improvement in sensitivity or AUC.Conclusion: Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.