【摘要】 目的：比较声触诊弹性成像（sound touch elastography,STE）和应变弹性成像（strain elastography,SE）定性及定量参数对乳腺影像报告和数据系统（Breast Imaging Reporting and Data System,BI-RADS）4类乳腺病灶良恶性的鉴别诊断价值，并探讨其参数与BI-RADS 4类乳腺恶性病灶中人表皮生长因子受体2（human epidermal growth factor receptor 2,HER2）表达的相关性。方法：选取2022年11月—2023年9月于山西医科大学第一医院检查且诊断为BI-RADS 4类乳腺病灶患者的临床病理学资料，获取STE与SE定量、定性参数[STE弹性最大值(E_max)、STE定性评分值、SE应变比（strain ratio,SR）及SE定性评分值]，比较两种超声弹性技术参数鉴别BI-RADS 4类乳腺病灶良恶性的价值以及与BI-RADS 4类乳腺恶性病灶HER2表达的相关性。结果：共纳入106例患者，共106个病灶。BI-RADS 4类乳腺良性与恶性病灶的E_max、STE评分、SR和SE评分的差异有统计学意义（P<0.05）；与病理学检查结果相比较，E_max、STE评分、SR、SE评分根据截断值诊断BI-RADS 4类乳腺病灶良恶性的差异有统计学意义（P<0.05）,E_max、STE评分、SR的诊断效能与“金标准”相比一致性一般（Kappa=0.436,0.420,0.502）,SE评分的诊断效能与“金标准”相比一致性较强（Kappa=0.626）,SE评分（AUC=0.883）受试者工作特征（receiver operating characteristic,ROC）曲线的曲线下面积（area under curve,AUC）均高于E_max（AUC=0.743）、STE评分（AUC=0.756）、SR（AUC=0.783）诊断，具有最大的诊断效能，差异有统计学意义（P<0.05）；在BI-RADS 4类乳腺恶性病灶中，E_max与SE评分在HER2阳性表达与阴性表达之间差异有统计学意义（P<0.05）。E_max、SE评分与HER2阳性表达呈正相关（r=0.458、0.356）。E_max与SE评分诊断HER2阳性表达的最佳截断值为123.75 kPa和4分，灵敏度为81.2%和62.5%，特异度为60.5%和68.4%,AUC为0.766和0.689。结论：STE与SE技术在应用于鉴别BI-RADS 4类乳腺病灶时，SE评分的诊断效能较高；E_max、SE评分与HER2阳性表达均呈正相关，E_max与SE评分鉴别BI-RADS 4类乳腺恶性病灶HER2阳性表达具有重要价值。更多还原

【Abstract】 Objective:To compare the diagnostic value of qualitative and quantitative parameters of sound touch elastography（STE） and strain elastography （SE） in differentiating benign and malignant Breast Imaging Reporting and Data System （BI-RADS） 4breast lesions,and to explore the correlation between the parameters and the expression of human epidermal growth factor receptor2 （HER2） in BI-RADS 4 breast malignant lesions.Methods:The clinicopathological data of patients with BI-RADS 4 breast lesions diagnosed by ultrasound examination in The First Hospital of Shanxi Medical University were selected.The quantitative and qualitative parameters of STE and SE were obtained:STE maximum elasticity (E_max),STE qualitative score,SE strain ratio （SR）and SE qualitative score.To compare the value of two ultrasonic elastography parameters in differentiating benign and malignant BI-RADS 4 breast lesions and their correlation with HER2 expression in BI-RADS 4 breast malignant lesions.Results:A total of106 patients with 106 lesions were included.The difference of E_max,STE score,SR and SE score between benign and malignant lesions of BI-RADS 4 breast was statistically significant （P<0.05）.Compared with the pathological results,the difference of E_max,STE score,SR and SE score in the diagnosis of benign and malignant BI-RADS 4 breast lesions according to the cut-off value was statistically significant （P<0.05）.The diagnostic efficacy of E_max,STE score and SR was generally consistent with that of the gold standard （Kappa=0.436,0.420,0.502）,and the diagnostic efficacy of SE score was more consistent with that of the gold standard（Kappa=0.626）.The area under the receiver operating characteristic （ROC） curve （AUC） of SE score （AUC=0.883） was higher than that of E_max （AUC=0.743）,STE score （AUC=0.756） and SR （AUC=0.783） diagnosis,with the greatest diagnostic efficiency,and the difference was statistically significant （P<0.05）.In BI-RADS 4 breast malignant lesions,the difference of E_max and SE scores between HER2 positive expression and negative expression was statistically significant （P<0.05）.E_max and SE scores were positively correlated with HER2 positive expression （r=0.458,0.356）.The best cut-off value of E_max and SE score in the diagnosis of HER2positive expression was 123.75 kPa and 4 points,the sensitivity was 81.2%and 62.5%,the specificity was 60.5%and 68.4%,and the AUC was 0.766 and 0.689.Conclusion:The diagnostic efficacy of SE score was higher when STE and SE techniques were used to identify BI-RADS 4 breast lesions.E_max and SE scores were positively correlated with HER2 positive expression.E_max and SE score are of great value in identifying HER2 positive expression in BI-RADS 4 breast malignant lesions.更多还原