孔岩　闫明寰　丁远　郭丽娟　苏蔚

[关键词] 乳腺结节;剪切波弹性成像;乳腺癌;分子亚型;三阴性乳腺癌;Ki-67

[中图分类号] R445.1          [文献标识码] B          [文章编号] 1673-9701（2021）23-0111-05

Clinical value of shear wave ultrasound elastography indexes of benign and malignant breast nodules

KONG Yan   YAN Minghuan   DING Yuan   GUO Lijuan   SU Wei

The First Affiliated Hospital of Xinxiang Medical University， Xinxiang   453000，China

[Abstract] Objective To rank the diagnostic performance of various indexes of shear wave elastography， and to explore the relationship between them and the molecular classification of malignant nodules. Methods A total of 200 patients with breast nodules （100 benign and 100 malignant） treated in our hospital and underwent ultrasound examination and surgical treatment from December 2016 to June 2020 were selected. Two-dimensional ultrasound， shear wave elastography and nodule pathology were collected and analyzed. Results There were significant differences in age， maximum diameter of nodules and SWE indexes （Emax， Emin， Emean， Eratio， Esd） between the benign group and the malignant group（P<0.05）.The AUC of Emax=0.998， AUC of Emean=0.990， Eratio AUC=0.994.The Luminal A-like type had the smallest diameter and Emax， while the Her-2 positive （HR-positive） type had the largest diameter and Emax， with statistically significant differences（P=0.020， 0.047）. The Her-2 positive （HR-positive） type had the largest Eratio， which was larger those of all the non-Her-2 positive， with statistically significant differences（P=0.036， 0.012， 0.035）. Conclusion Shear wave elastography indexes have good accuracy in identifying benign and malignant breast nodules. They have a certain correlation with the molecular subtypes of breast cancer， which can provide preliminary references for the prognosis of breast cancer.

[Key words] Breast nodules; Shear wave elastography; Breast cancer; Molecular subtypes; Triple-negative breast cancer; Ki-67

乳腺結节是乳房的常见疾病，其成因不明，可能与女性内分泌水平、遗传、基因突变和环境因素等相关[1-2]。虽然乳腺结节多为良性病变，但随着发病率的逐年增高和患者年轻化，乳腺结节的出现也逐步引起广大注重健康女性的高度关注[3]。因此为满足广大女性的需求，筛选出一种快速简便鉴别乳腺结节性质的检查手段就显得尤为必要。剪切波弹性成像（Shear wave elastography，SWE）是基于对病灶组织和周围正常组织的硬度评价，通过对相关参数进行运算分析从而为鉴别结节性质提供参考的一种超声检查技术。近年来的研究表明SWE可以有效提高乳腺结节的超声诊断准确率、降低手术（或穿刺）活检率，因而成为乳腺疾病诊断方面的超声医学成像研究热点[4-5]。为进一步对SWE各项指标的诊断效能优选排序，并探究其是否与恶性结节分子分型存在内在联系，本研究对我院就诊的200例乳腺结节患者的超声和临床资料进行了整理分析，已期为乳腺癌的预后提供一些初步的参考，现报道如下。

1 资料与方法

1.1 一般资料

本研究以2016年12月至2020年6月于新乡医学院第一附属医院以乳腺结节症状于普外科就诊，同时行超声检查和手术（或穿刺）治疗的200例患者为研究对象，其中100例为良性结节，100例为恶性结节，所有患者均为单侧乳腺单发结节，且术前未接受任何治疗。……