超音波彈性影像之手動操作模式對於鑑別良惡性乳房腫塊之影響

Impact of manual operations of Ultrasound Elastography on differentiating between benign and malignant breast masses

謝佳穎(Chia-Ying Hsieh)

指導教授 ： 高一峯

高雄醫學大學/健康科學院/醫學影像暨放射科學系碩士班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00129

摘要

乳房超音波灰階影像之診斷，依病灶之形狀、邊緣、回音、後方回音表現以及鈣化呈現等項目進行良惡性評估，其對於乳房腫瘤偵測之敏感性高，但其特異性較低，導致病人許多不必要的組織切片檢查。由於乳房病灶的良惡性與其組織的軟硬程度有著高度的關聯性，因此乳房彈性影像近年來應運而生，以輔助提升乳房腫瘤偵測之特異性。然而，南部某區域教學醫院放射診斷科2013年導入乳房超音波彈性影像的結果顯示，其診斷效果並不如預期，由於乳房超音波彈性影像的檢查結果相當依賴使用者的操作方式，因此，本研究針對不同的乳房超音波彈性影像操作方式與乳房腫塊良惡性鑑別度之間的關聯進行一系列的研究探討。
本研究分成兩大部份，第一部分主要探討不同的手動圈選病灶的感興趣區對於良惡性腫塊鑑別診斷的關聯；第二部份為研究施壓含蓋範圍（FOV）對於良惡性腫塊鑑別診斷的影響。第一部分的研究資料為32個病人所收集的35個病灶 ，第二部份為59個病人所收集的63個病灶，所有的病灶都同時包含彈性影像和組織切片檢查結果，資料的分析以組織切片結果作為病灶良惡性的標準，並用來評估彈性影像對鑑別良惡性腫塊的效率，而鑑別度以接受者操作特性曲線 （ROC）的曲線下面積（Az）來表示。
第一部份結果顯示，比較人工圈選感興趣區的方式，圈選病灶最硬處和圈選病灶最大面積之間，並無統計學上的顯著差異（p=1）；第二部份比較施壓範圍對於良惡性腫塊鑑別度的結果顯示，無特別限制施壓範圍情況下，Az 為0.651，而限制施壓範圍不包含肺部下，Az為0.855，施壓範圍不包含肺部的情況下，可有效提升彈性影像對於良惡性腫瘤的鑑別能力。
本研究針對不同的乳房超音波彈性影像操作方式對於乳房腫塊良惡性鑑別度的影響進行研究，結果顯示圈選病灶最硬處和病灶最大面積之間並無顯著差異，而施壓範圍不包含肺部可有效提升彈性影像良惡性腫瘤的鑑別度，研究的結果有助於降低手動操作的誤差，提供臨床超音波作業人員進行病灶彈性影像分析時的標準，進一步提升乳房超音波彈性影像的診斷準確性。

關鍵字

超音波 ； 彈性影像 ； 乳房腫塊

並列摘要

The breast ultrasound gray-scale image is evaluated according to the shape, margin, echo pattern, posterior acoustic features and calcification of the lesion, so as to distinguish whether the lesion is benign or malignant. Its sensitivity of detecting breast tumor is high, but the specificity is much lower, which causes the patients to have many unnecessary biopsies. As the benign or malignant breast lesion is highly correlated with the hardness of the tissues, the breast elastography has emerged in recent years to assist in improving the specificity of the breast tumor detection. However, the results of the Radiological diagnosis Department in a regional teaching hospital in southern Taiwan, which introduced the breast ultrasound elastography in 2013, show that the diagnostic effects were not as good as expected. The inspection of the breast ultrasound elastography depends heavily on the operating methods of the users, so this study conducts a series of examinations on the correlation between different operating methods of the breast ultrasound elastography and the discrimination of benign and malignant breast masses.
The study comprises two parts: the first part chiefly discusses the correlation between different ROIs (region of interest) of manually selected lesions and the differential diagnosis of benign or malignant lesions and the second part studies the impact of the pressurized field of view (FOV) on the differential diagnosis of benign or malignant lesions. The first part collected 35 lesions from 32 patients, while the second part collected 63 lesions from 59 patients. All lesions include both the elastography and biopsies, and the data analysis used the results of biopsies as the standard to evaluate the efficiency of the elastography in discriminating benign or malignant masses. And the discrimination is represented by the area (Az) under the receiver operating characteristic (ROC) curve.
The first part of the study compared the manual methods of selecting ROIs (region of interest) and the results show that there were no significant differences (p =1) between the hardest part and the greatest area of the selected lesions. The second part of the study compared the impact of the pressurized FOV on the discrimination of benign or malignant lesions and the results show that Az was 0.651 when there was no specifically restricted pressurized FOV and Az was 0.855 when the restricted pressurized FOV didn’t include the lung. When the pressurized FOV didn’t include the lung, the discrimination of the elastography on benign or malignant tumors can be improved effectively.
The study investigates the influence of different operating methods of breast ultrasound elastography on the discrimination of benign or malignant breast masses. The results show that there were no significant differences between the hardest part and the greatest area of the selected lesions and the pressurized FOV excluding the lung would improve the discrimination of the elastography on benign or malignant tumors. The study results help to decrease the error of manual operation, provide the standards for clinical ultrasound operating personnel to analyze the elastography of the lesions and further improve the diagnostic accuracy of breast ultrasound elastography.

並列關鍵字

ultrasound ； elastography ； breast mass

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