剪切波弹性成像与ADC值在乳腺病变鉴别中的诊断效能及相互关联
回顾性分析53例BI-RADS 4/5乳腺病变，SWE的Emax诊断恶性AUC为0.74，最佳阈值>69.47 kPa；ADC诊断AUC为0.94，阈值<1182×10⁻⁶ mm²/s。两者呈中度负相关（ρ=-0.39），但一致性差，不能互换；ADC单独诊断效能更优，SWE可作为多参数超声的补充。
要点
- 乳腺病变鉴别中ADC的AUC为0.94，显著优于SWE Emax的0.74。
- SWE Emax与ADC虽负相关，但一致性差，临床不可互换使用。
- SWE仍可作为多参数超声的补充工具，辅助病变 characterization。
核心结论
- ADC在乳腺病变良恶性鉴别中诊断效能优于SWE Emax，但两者不可互换，SWE可作为多参数超声的补充工具。
研究设计与样本
- 回顾性研究纳入53例女性患者（平均年龄55.2±11.7岁），均为活检证实的BI-RADS 4或5乳腺病变，同时接受SWE和乳腺MRI（含DWI）检查。
诊断标准与关键数值
- SWE Emax鉴别良恶性的AUC为0.74，最佳阈值>69.47 kPa，敏感度62%、特异度81%。
- ADC鉴别良恶性的AUC为0.94，最佳阈值<1182×10⁻⁶ mm²/s，敏感度92%、特异度93%。
- SWE Emax与ADC呈中度负相关（ρ=-0.39，p=0.004），回归分析R²=0.19，Bland-Altman一致性界限±46%，提示一致性差。
临床应用与阅片要点
- ADC可作为乳腺病变良恶性鉴别的独立参数，诊断准确性高。
- SWE Emax与ADC虽负相关但不可互换，SWE宜作为多参数超声的补充手段。
局限性
- 回顾性研究，样本量较小（53例），需更大队列验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To compare shear-wave elastography (SWE) and diffusion-weighted imaging (DWI)-derived apparent diffusion coefficient (ADC) values in the differentiation of benign and malignant breast lesions, and to assess the correlation and potential interchangeability between these imaging biomarkers.
MATERIAL AND METHODS: In this retrospective study, 53 female patients (mean age: 55.2 ± 11.7 years) with biopsy-proven BI-RADS 4 or 5 breast lesions underwent both SWE and breast MRI, including DWI. SWE parameters (Emax, Emean, Emin) and ADC values were quantitatively analyzed and compared using Mann-Whitney U tests. Diagnostic performance was evaluated via ROC analysis. Correlation and interchangeability between SWE and ADC were assessed using Spearman's rank correlation, regression analysis, and Bland-Altman plots.
RESULTS: Among 53 lesions (26 malignant, 27 benign), SWE Emax demonstrated the best diagnostic performance among SWE parameters (AUC = 0.74), with an optimal cut-off of > 69.47 kPa (sensitivity: 62%, specificity: 81%). ADC values achieved superior diagnostic accuracy (AUC = 0.94), with a cut-off of < 1182 × 10⁻⁶ mm2/s (sensitivity: 92%, specificity: 93%). A moderate inverse correlation was found between SWE Emax and ADC values (ρ = - 0.39, p = 0.004), but regression (R2 = 0.19) and Bland-Altman analysis (limits of agreement ± 46%) indicated poor agreement and limited predictive utility.
CONCLUSION: These findings confirm that as tissue stiffness increases, water molecule diffusivity decreases. While SWE Emax and ADC values show a statistically significant inverse correlation, they are not interchangeable in clinical practice. ADC demonstrated superior performance as a standalone parameter for lesion characterization, whereas SWE retains value as a complementary tool within a multiparametric ultrasound approach. Further studies are warranted to confirm these findings in larger cohorts.
引用
- Aricò FM, Portaluri A, Arena P, et al. Exploring shear-wave elastography and apparent diffusion coefficient in breast lesion characterization: diagnostic accuracy and inter-modality correlation. Radiol Med. 2026. PMID: 42217149. doi:10.1007/s11547-026-02228-7
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。