Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Application of Point Shearwave Elastography to Breast Ultrasonography: Initial Experience Using "S-Shearwave" in Differential Diagnosis

Point Shearwave Elastography의 유방 초음파에서의 적용: "S-Shearwave"를 이용한 감별진단의 초기경험

  • Myung Hwan Lee (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Eun-Kyung Kim (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Eun Ju Lee (Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine) ;
  • Ha Yan Kim (Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine) ;
  • Jung Hyun Yoon (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine)
  • 이명환 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 김은경 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 이은주 (연세대학교 의과대학 의생명시스템정보학교실, 의학통계지원실) ;
  • 김하얀 (연세대학교 의과대학 의생명시스템정보학교실, 의학통계지원실) ;
  • 윤정현 (연세대학교 의과대학 세브란스병원 영상의학과)
  • Received : 2019.05.02
  • Accepted : 2019.07.01
  • Published : 2020.01.01
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Abstract

Purpose To evaluate the optimal measurement location, cut-off value, and diagnostic performance of S-Shearwave in differential diagnosis of breast masses seen on ultrasonography (US). Materials and Methods During the study period, 225 breast masses in 197 women were included. S-Shearwave measurements were made by applying a square region-of-interest automatically generated by the US machine. Shearwave elasticity was measured three times at four different locations of the mass, and the highest shearwave elasticity was used for calculating the optimal cut-off value. Diagnostic performance was evaluated by using the area under the receiving operator characteristic curve (AUC). Results Of the 225 breast masses, 156 (69.3%) were benign and 69 (30.7%) were malignant. Mean S-Shearwave values were significantly higher for malignant masses (108.0 ± 70.0 kPa vs. 43.4 ± 38.3 kPa; p < 0.001). No significant differences were seen among AUC values at different measurement locations. With a cut-off value of 41.9 kPa, S-Shearwave showed 85.7% sensitivity, 63.9% specificity, 70.7% accuracy, and positive and negative predictive values of 51.7% and 90.8%, respectively. The AUCs for US and S-Shearwave did not show significant differences (p = 0.179). Conclusion S-Shearwave shows comparable diagnostic performance to that of grayscale US that can be applied for differential diagnosis of breast masses seen on US.

목적 S-Shearwave를 이용하여 유방 병변을 감별하는데 있어 최적의 cut-off 값과 종괴 내 위치를 알아보고 진단적 가치를 평가하고자 한다. 대상과 방법 연구 기간 동안 197명의 여성에서 225개의 유방 병변을 평가하였다. S-Shearwave 값은 초음파 기기에서 자동적으로 생성된 사각형의 region-of-interest로 측정하였다. 병변 내 서로 다른 네 군데에서 각각 세 번 측정하였으며 세 개의 중위 값 중 최대 값을 이용해 각각의 위치에서 최적의 cut-off 값을 계산하였다. 진단적 가치는 area under the receiving operator characteristics curve (이하 AUC)를 통해 평가하였다. 결과 총 225개의 유방 병변 중 156개(69.3%)는 양성, 69개(30.7%)는 악성이었다. 평균 SShearwave 값은 악성 병변이 양성 병변에 비해 유의미하게 높았다(108.0 ± 70.0 kPa vs. 43.4 ± 38.3 kPa, p < 0.001). 하지만 병변 내 위치에 따른 값의 유의미한 차이는 없었다. Cut-off 값을 41.9 kPa로 사용했을 때, 민감도 85.7%, 특이도 63.9%, 정확도 70.7%, 양성예측도 51.7% 및 음성예측도 90.8%였다. 초음파와 S-Shearwave 간의 AUC는 유의미한 차이를 보이지 않았다(p = 0.179). 결론 S-Shearwave는 유방 병변의 감별진단을 하는데 grayscale 초음파에 필적하는 진단적 가치를 가진다.

Keywords

Acknowledgement

This study has been supported by the research fund of Samsung Medison, Co. Ltd.

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