Background: Because the halo around the tumor in shear wave elastography (SWE) is defined as the "stiff rim" sign, the diagnosis of breast lesions with the stiff rim sign is popular. However, only a few studies have described the stiff rim sign quantitatively. Objective: This study aimed to investigate the usefulness of the stiff rim sign in the diagnosis and tumor, node, metastasis stage of breast cancer. Methods: Two hundred and ten breast lesions were analyzed retrospectively. The maximum, mean, minimum Young's modulus (YM), and the YM standard deviation in the lesion, the peritumoral stiffness (shell), and the region containing lesion and shell were obtained. The suspicious SWE feature with the best diagnostic performance was chosen to downgrade or upgrade the Breast Imaging Reporting and Data System (BI-RADS) classification. The coincidence rates of SWE and B-mode ultrasound in T staging and their positive predictive value (PPV) for T staging were compared. Results: The presence of "stiff rim" sign was selected to upgrade or downgrade the BI-RADS classification because of its best performance. In pathological benign lesions, 18.9% (25 of 132) of lesions should undergo biopsy if BI-RADS combined with the stiff rim sign were referred while it was 57.6% (76 of 132) if BI-RADS alone was referred. The coincidence rate of T2 staging evaluated by SWE was significantly higher than B-mode ultrasound (about 30% increase, P < 0.001). The PPVs of SWE for T1 and T2 staging were higher than B-mode ultrasound (P < 0.05). Conclusions: BI-RADS combined with "stiff rim" sign is expected to improve the diagnostic performance of breast lesions to avoid unnecessary biopsy. The maximum diameter of the lesion measured in SWE is more accurate than B-mode ultrasound in the estimation of T staging, which is beneficial to the treatment and prognosis of breast cancer.

中文翻译：

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剪切波弹性成像获得的“Stiff Rim”征在乳腺癌诊断和指导治疗中的作用

背景：由于剪切波弹性成像（SWE）中肿瘤周围的晕圈被定义为“边缘僵硬”征，因此具有僵硬边缘征的乳腺病变的诊断很流行。然而，只有少数研究定量描述了僵硬的边缘标志。目的：本研究旨在探讨硬缘征在乳腺癌诊断及肿瘤、淋巴结、转移分期中的应用价值。方法：对210个乳腺病灶进行回顾性分析。获得了病灶的最大、平均、最小杨氏模量（YM）和YM标准差、瘤周刚度（shell）以及含有病灶和shell的区域。选择具有最佳诊断性能的可疑 SWE 功能来降级或升级乳房成像报告和数据系统 (BI-RADS) 分类。比较SWE和B超T分期的符合率及其对T分期的阳性预测值（PPV）。结果：选择“stiff rim”标志的存在来升级或降级BI-RADS分类，因为它的性能最好。在病理性良性病变中，如果 BI-RADS 结合僵硬的边缘征，则 18.9%（132 个中的 25 个）应进行活检，而如果仅 BI-RADS 则为 57.6%（132 个中的 76 个）。SWE评估的T2分期符合率明显高于B超（增加约30%，P<0.001）。SWE对T1和T2分期的PPV高于B超（P < 0.05）。结论：BI-RADS 与“刚性边缘”相结合 体征有望提高乳腺病变的诊断性能，避免不必要的活检。SWE测量的病灶最大直径在估计T分期时比B超更准确，有利于乳腺癌的治疗和预后。