CAJ | 학술논문

目的：探讨剪切波超声弹性成像(SWE)在乳腺良恶性疾病鉴别诊断中的价值。方法选择茂名市人民医院2012年1月~2014年1月收治的女性乳腺疾病患者208例作为研究对象，采用SWE与乳腺影像报告与数据系统(BI-RASD)对所有患者进行定性诊断，比较乳腺腺体及良恶性病变的弹性模量值，并比较弹性最大值、弹性平均值及BI-RASD对乳腺良恶性疾病的诊断效能。结果病理诊断良性病灶176个，恶性病灶60个。SWE成像乳腺纤维瘤、乳头状瘤及乳腺病以均一的蓝色为主要表现，炎性脓肿以蓝色为主，内部可见未着色区；浸润性导管癌、浸润性小叶癌和导管内癌主要表现红色为主的杂乱色彩，导管内乳头状癌以蓝色为主，内部可见红色及无着色区域。恶性病变弹性最大值、弹性平均值均大于良性病变和乳腺腺体组织(P<0.01)，良性病变大于乳腺腺体组织(P<0.01)，弹性最小值良恶性病变差异无统计学意义(P>0.05)，但均大于乳腺腺体(P<0.01)。弹性最大值诊断乳腺疾病的敏感性、特异性和准确度与BI- RASD分级比较差异有统计学意义(χ2=17.788、26.072、4.470，P=0.000、0.000、0.035)。结论 SWE操作简单、无需加压，可直接显示出病灶的弹性值，能够客观、量化评价病灶内部的硬度，有助于临床医师更为全面了解病灶的组织特征，为乳腺疾病的鉴别诊断提供了新途径。
목적：탐토전절파초성탄성성상(SWE)재유선량악성질병감별진단중적개치。방법선택무명시인민의원2012년1월~2014년1월수치적녀성유선질병환자208례작위연구대상，채용SWE여유선영상보고여수거계통(BI-RASD)대소유환자진행정성진단，비교유선선체급량악성병변적탄성모량치，병비교탄성최대치、탄성평균치급BI-RASD대유선량악성질병적진단효능。결과병리진단량성병조176개，악성병조60개。SWE성상유선섬유류、유두상류급유선병이균일적람색위주요표현，염성농종이람색위주，내부가견미착색구；침윤성도관암、침윤성소협암화도관내암주요표현홍색위주적잡란색채，도관내유두상암이람색위주，내부가견홍색급무착색구역。악성병변탄성최대치、탄성평균치균대우량성병변화유선선체조직(P<0.01)，량성병변대우유선선체조직(P<0.01)，탄성최소치량악성병변차이무통계학의의(P>0.05)，단균대우유선선체(P<0.01)。탄성최대치진단유선질병적민감성、특이성화준학도여BI- RASD분급비교차이유통계학의의(χ2=17.788、26.072、4.470，P=0.000、0.000、0.035)。결론 SWE조작간단、무수가압，가직접현시출병조적탄성치，능구객관、양화평개병조내부적경도，유조우림상의사경위전면료해병조적조직특정，위유선질병적감별진단제공료신도경。
Objective To investigate the value of shear wave elastography (SWE) in the diagnosis of benign and malig-nant breastlesions. Methods 208 female patients with breast lesions admitted to People's Hospital of Maoming City from January 2012 to January 2014 were selected as the study objects, and all the patients obtained the SWE and breast imaging reporting and data system (BI-RASD) qualitative diagnosis. Compared the elastic modulus values of breast lesions, benign and malignant lesions, compared the elastic maximum, average values, and diagnosis efficiency of BI-RASD on the benign and malignant breast lesions. Results 176 benign lesions and 60 malignant lesions were diagnosed by the pathology. SWE imaging of breast fibroma, papillomatosis and breast disease showed uniform blue, and manifes-tations of inflammatory abscess were blue, the uncolored areas were not seen inside; invasion ductal carcinoma, inva-sive lobular carcinoma and intraductal carcinoma showed red as a main color with messy color, intraductal papillary carcinoma showed blue as a main color, and the red and the non colored section were seen interior. Elastic maximum and elastic average of malignant lesions were bigger than those of the benign lesions and breast gland tissue (P<0.01), benign lesions were greater than the mammary gland tissue (P< 0.01); there was no statistically significant difference in elastic minimum value between benign and malignant lesions (P> 0.05), but greater than that of the mammary gland tissue (P<0.01). Compared elastic modulus maximum value in the diagnosis of the sensitivity, specificity and accuracy of breast diseases with BI-RASD classification, the differences were statistically significant (χ2=17.788, 26.072, 4.470, P=0.000, 0.000, 0.035). Conclusion SWE has the advantages of simple operation, without pressure, and can directly show the elasticity value of the lesions. It can objectively quantitatively evaluate internal hardness of lesions, help the clinician understand organizational characteristics of lesions, provide a new way for the diagnosis of breast diseases.