BackgroundStrain elastography can be purely qualitative or semiquantitative using both strain score and strain ratio. The aim of this study was to establish the accuracy of semiquantitative elastography using both strain score and strain ratio in differentiating benign from malignant breast masses. The diagnostic performance of the two methods was analysed for any statistically significant difference.MethodsA prospective study was carried out from May to December 2014 in the University of Nairobi, Department of Diagnostic Imaging and Radiation Medicine. One hundred and eighteen patients referred for breast ultrasound following clinical detection of masses certified the inclusion criteria. All solid masses identified on grey scale imaging were subjected to strain elastography. Elastographic findings were represented in both strain score and strain ratio. Comparison of diagnostic performance with histological findings as the gold standard for all detected solid masses was done. Fisher’s exact test and receiver operating characteristics curves were applied for statistical analysis to look for any significant differences between the diagnostic performance of strain score and strain ratio.ResultsOut of the 118, three patients did not attend for all the examinations and three biopsy results were misplaced therefore analysis was done for 112 subjects. The sensitivity, specificity, positive predictive value and negative predictive value of elasticity strain (Ueno) score were 0.86, 0.96, 0.89 and 0.96 respectively. For the strain ratio the values were 0.93, 0.96, 0.90 and 0.96 respectively. Fisher’s exact test P values comparing the sensitivity and specificity were 0.69 and 1.00 respectively not considered significant at p 0.05 levels. The areas under the curve (AUCs) from the receiver operating characteristic (ROC) curves were 0.972 and 0.976 for strain score and ratio respectively with a strong Pearson’s correlation coefficient, r 0.79 indicating a high diagnostic accuracy for both methods but no statistically significant difference in performance.ConclusionSemiquantitative ultrasound elastography has good diagnostic accuracy in differentiating benign and malignant breast solid lesions and there is no statistically significant difference between strain score and strain ratio in sensitivity, specificity and accuracy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0070-8) contains supplementary material, which is available to authorized users.

Background Elastography is an addition to grey-scale ultrasonic examination that has gained substantial traction within the last decade. Strain ratio (SR) has been incorporated as a semiquantitative measure within strain elastography, thus a potential imaging biomarker. The World Federation for Ultrasound in Medicine and Biology (WFUMB) published guidelines in 2015 for breast elastography. These guidelines acknowledge the marked variance in SR cut-off values used in differentiating benign from malignant lesions. The objective of this review was to include more recent evidence and seek to determine the optimal strain ratio cut off value for differentiating between benign and malignant breast lesions. Methods Comprehensive search of MEDLINE and Web of Science electronic databases with additional searches via Google Scholar and handsearching set from January 2000 to May 2020 was carried out. For retrieved studies, screening for eligibility, data extraction and analysis was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) Statement guidelines of 2018. Quality and risk of bias assessment of the studies were performed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results A total of 424 articles, 412 from electronic database and 12 additional searches were retrieved and 65 studies were included in the narrative synthesis and subgroup analysis. The overall threshold effect indicated significant heterogeneity among the studies with Spearman correlation coefficient of Logit (TPR) vs Logit (FPR) at − 0.301, p-value = 0.015. A subgroup under machine model consisting seven studies with 783 patients and 844 lesions showed a favourable threshold, Spearman’s correlation coefficient,0.786 (p = 0.036). Conclusion From our review, currently the optimal breast SR cut-off point or value remains unresolved despite the WFUMB guidelines of 2015. Machine model as a possible contributor to cut-off value determination was suggested from this review which can be subjected to more industry and multi-center research determination.

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COVID-19 is a rapidly growing pandemic that has grown from a few cases in Wuhan, China to millions of infections and hundreds of thousands of deaths worldwide within a few months. Sub-Saharan Africa is not spared. Radiology has a key role to play in the diagnosis and management of COVID-19 as literature from Wuhan and Italy demonstrates. We therefore share some critical knowledge and practice areas for radiological suspicion and diagnosis. In addition, emphasis on how guarding against healthcare acquired infections (HAIs) by applying “red” and “green” principle is addressed. Given that pandemics such as COVID-19 can worsen the strain on the scantily available radiological resources in this region, we share some practical points that can be applied to manage these precious resources also needed for other essential services. We have noted that radiology does not feature in many main COVID-19 guidelines, regionally and internationally. This paper therefore suggests areas of collaboration for radiology with other clinical and management teams. We note from our local experience that radiology can play a role in COVID-19 surveillance.

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