Gland/Lesion Strain Ratio for Predicting Malignancy of Solid Breast Lesions in Chinese Patients
JAWK Tang, JCH Tse, JHM Cheng, AYT Lai, AKY Au, BST Leung, WWC Wong
Hong Kong J Radiol 2019;22:188-96
https://doi.org/10.12809/hkjr1916984
Objectives: To determine an optimal cut-off for gland/lesion strain ratio (GLR) in differentiation of benign and
malignant breast lesions. The diagnostic performances of elasticity score, Breast Imaging Reporting and Data
System (BI-RADS), and modified BI-RADS category were also assessed.
Methods: A retrospective review of all consecutive new solid breast lesions with B-mode ultrasound and strain
elastography assessment was conducted in a regional hospital in Hong Kong from January 2017 to January 2018.
Included subjects were Chinese women with diagnostic breast imaging and subsequent histological evaluation for
BI-RADS 3 to 5 solid breast lesion(s). Modified BI-RADS was determined by incorporating the two elastography
parameters. Results were analysed using Mann-Whitney U test and receiver operating characteristic curves.
Results: GLR for smaller lesions of <1 cm was not shown to be significantly different between malignant and
benign pathologies. Regarding lesions of 1 to 2 cm and >2 cm, median GLR and elasticity score were significantly
lower in benign lesions (p < 0.05). Taking an optimal GLR cut-off at 2.62, sensitivity of 84.5% and specificity
of 81.4% were yielded. The optimal cut-off of elasticity score was 3.5, giving sensitivity of 93.1% and specificity
of 81.4%. With these two cut-off thresholds, modified BI-RADS showed an area under the receiver operating
characteristic curve (Az) of 0.906. The Az were 0.852 for GLR, 0.926 for elasticity score and 0.827 for BI-RADS.
Modified BI-RADS showed higher Az than BI-RADS (p < 0.05).
Conclusion: GLR showed reasonable diagnostic performance for breast lesions of ≥1 cm in our cohort. Modifying
BI-RADS with GLR and elasticity score can improve diagnostic accuracy.
Author affiliation(s):
JAWK Tang, JCH Tse, JHM Cheng, AYT Lai, AKY Au, BST Leung, WWC Wong: Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
以超聲彈性成像的腺體／病變彈性比推斷華人女性的惡性實性乳腺病變
鄧永健、謝志瀚、鄭希敏、黎爾德、區嘉殷、梁肇庭、黃慧中
目的：釐定辨別良性或惡性乳腺病變的腺體／病變彈性比（GLR）的最佳截止值，並評估彈性評分、BI-RADS和按彈性成像結果的修訂版BI-RADS的診斷性能。
方法：對2017年1月至2018年1月期間在香港一家地區醫院進行B型超聲波和彈性成像評估的所有新發現實性乳房病變連續個案作回顧性研究。納入的受試者為在乳腺成像診斷中發現BI-RADS第3至5級實性乳房病變並隨後有組織學評估的華人女性。修訂版BI-RADS以結合兩個彈性成像參數而訂定的。數據是以Mann-Whitney U檢驗和ROC曲線作分析。
結果：對於少於1 cm的小病灶，GLR在惡性和良性病變間未有顯著差異。對於1至2 cm和超過2 cm的病變，良性病變的GLR中位數和彈性評分中位數顯著較低（p < 0.05）。最佳GLR截止值為2.62，靈敏度為84.5%，特異性為81.4%。彈性評分的最佳截止值為3.5，敏感性為93.1%，特異性為81.4%。利用這兩個截止值，修訂版BI-RADS的ROC曲線下面積為0.906。GLR的ROC曲線下面積為0.852，彈性評分的ROC曲線下面積為0.926，而BI-RADS的ROC曲線下面積為0.827。修訂版BI-RADS的ROC曲線下面積較BI-RADS為大（p < 0.05）。
結論：研究顯示GLR對1 cm或以上的乳房病變具有合理的診斷性能。使用GLR結合修訂的BI-RADS和彈性評分可提高診斷準確性。