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目的探讨超声实时组织弹性成像(real-time tissue elastography,RTE)对乳腺良恶性病变的鉴别诊断价值。方法选取2010年12月—2015年12月广安市人民医院超声科行超声检查的131例有乳腺病变的患者作为研究对象。先行常规彩色多普勒超声(彩超)检查,再进行RTE检查,用改良5分法对肿块进行弹性成像评分;测量肿块与周围同深度组织的弹性应变率比值,以3.08为界点判断肿块的良恶性。并与术后的病理检查结果进行对比。结果 131例患者共有182个乳腺肿块,经常规彩超检查判断为良性肿块128个,恶性肿块54个。经RTE检查判断为良性肿块121个,其弹性成像评分为(1.74±0.81)分,弹性应变率比值为1.83±1.22;恶性肿块61个,其弹性成像评分为(4.45±0.59)分,弹性应变率比值为8.68±5.58。131例患者的182个乳腺肿块均行手术切除,病理检查结果为良性病变共121个肿块,恶性病变61个肿块。常规彩超诊断乳腺恶性病变的准确性、灵敏度和特异度分别为76.4%、59.0%、85.1%,RTE分别为96.7%、95.1%、97.5%,差异有统计学意义(P<0.05)。结论 RTE有助于乳腺疾病的良恶性鉴别,超声弹性应变率比值能为乳腺良恶性病变提供客观的诊断标准。
Objective To investigate the differential diagnosis of benign and malignant breast lesions by real-time tissue elastography (RTE). Methods Totally 131 patients with breast lesions who underwent ultrasonography in Guang An People’s Hospital of Guang’an from December 2010 to December 2015 were selected as the research object. First, routine color Doppler ultrasound (color Doppler ultrasound) examination, and then RTE examination, with a modified 5-point method of elastography scoring; measured mass and the surrounding elastic tissue with the same strain rate ratio to 3.08 as the cut-off point to determine the mass Benign and malignant. And compared with postoperative pathological examination results. Results There were 182 breast masses in 131 patients, 128 were benign masses and 54 malignant masses were detected by conventional color Doppler ultrasound. The results of RTE showed 121 benign masses with elastography score of (1.74 ± 0.81), elastic strain rate ratio of 1.83 ± 1.22, 61 malignant masses with elastography score of (4.45 ± 0.59), elastic strain The odds ratio was 8.68 ± 5.58. There were 182 breast masses in 131 cases underwent surgical resection. The pathological examination showed 121 lesions in benign lesions and 61 lesions in malignant lesions. The accuracy, sensitivity and specificity of conventional color Doppler ultrasound in the diagnosis of malignant breast lesions were 76.4%, 59.0% and 85.1%, respectively, and the RTEs were 96.7%, 95.1% and 97.5% respectively. The difference was statistically significant (P <0.05). Conclusion RTE is helpful to distinguish benign and malignant breast diseases. The ratio of ultrasonic elastic strain rate can provide objective diagnostic criteria for benign and malignant breast lesions.