史宪全李俊来胡向东钱林学马 棣张 宏朱紫吟



病变大小对剪切波弹性最大值评价乳腺病变良恶性诊断效能的影响*

史宪全①李俊来②*胡向东①钱林学①马 棣①张 宏①朱紫吟①

［摘要］目的：探讨病变大小对剪切波弹性成像弹性最大值（Emax）评价乳腺病变良恶性诊断效能的影响。方法：选取260例经手术或穿刺活检确诊的乳腺患者（288例乳腺病灶），按照常规超声下病变最大直径1.5 cm为分组依据，其病变最大直径＜1.5 cm为小结节组，≥1.5 cm的划分为大结节组，应用受试者工作特诊曲线（ROC）确定Emax值评价乳腺病变良恶性的诊断临界值，计算灵敏度（SEN）、特异度（SPE）、阳性预告值（PPV）、阴性预告值（FPV）和准确度（ACC）。结果：应用Emax参数值评价288例乳腺病变良恶性的诊断临界值为57.42 kPa，小结节组病变153例，以57.42 kPa为诊断临界值，其SEN、SPE、PPV、FPV和AC分别为0.804、0.944、0.860、0.918 和0.895。单独计算小结节组的诊断临界值为46.51 kPa，以此计算所得的SEN、SPE、PPV、FPV和AC分别为0.870、0.935、0.851、0.943和0.915，SEN明显提升；大结节组诊断临界值由57.42 kPa调整为60.45 kPa时，其SEN、SPE、PPV、FPV和AC无变化。结论：应用Emax值评价乳腺病变良恶性，应根据病变大小调整诊断临界值，对于直径＜1.5 cm的病变，诊断临界值调低为46.51 kPa可明显提高SEN，ACC亦有小幅提升，而SPE仅轻微下降。

［关键词］剪切波弹性成像；乳腺；超声；诊断

史宪全，男，（1981- ），博士，主治医师。首都医科大学附属北京友谊医院超声科，从事超声诊断和超声引导下介入诊疗工作。

SHI Xian-quan， LI Jun-lai， HU Xiang-dong， et al

China Medical Equipment，2016，13（5）:79-82.

［Abstract］ Objective: To evaluate the influence of lesion size when assessing benign and malignant breast lesions by the maximum elasticity （Emax） of shear wave elastography. Methods: There were 288 breast lesions rolled in this study which were obtained pathology by biopsy or surgery. Lesions were classified into larger group when their diameter were above or equal with 1.5 cm， and others were classified into smaller group when their diameter were less than 1.5 cm. Cutoff values were confirmed by receiver operating characteristic curve （ROC）. The sensitivity（SEN）， specificity（SPE）， positive predictive value（PPV）， false predictive value（FPV） and accuracy（AC） were calculated and recorded. Results: For all 288 lesions， the cutoff value was 57.42 kPa when use Emax to assess benign and malignant. For the 153 smaller lesions， the SEN， SPE， PPV， FPV and AC were 0.804， 0.944， 0.860， 0.918 and 0.895 when we took the cutoff value at 57.42 kPa. But the cutoff value was 46.51 kPa when we calculated it for the smaller group independently. And in this condition， the SEN， SPE， PPV， FPV and AC were 0.870， 0.935， 0.851， 0.943 and 0.915. The sensitivity was improved apparently. No change occurred when the cutoff value adjusted for larger group. Conclusion: The cutoff value should be adjusted according to size of breast lesion when using Emax to assess benign and malignant. This study supposed that the cutoff value should be decreased to 46.51 kPa for lesions which diameter less than 1.5 cm. In this condition， the SEN improved apparently， the AC improved gently， and the SPE just dropped a little.

［First-author’s address］ Department of Ultrasound， Beijing Friendship Hospital， Capital Medical University， Beijing 100050， China.

目前，乳腺超声弹性成像技术迅速发展，且用以检测乳腺病变的硬度，进而评价乳腺病变的良恶性［1-4］。该技术与传统的触诊方法相比，能够检测触诊不能触及的位置相对较深和较小的病变，弥补了常规触诊的不足。……