Abstract:Power Doppler US is unsuitable for discrimination between local breast cancer recurrence and fibrosis. Although the SWE score and SWE maximum elasticity can make this discrimination, the use of these methods to determine biopsy may lead to poorer clinical outcomes than the current practice of performing biopsies of all suspicious masses.
“…However, evidence regarding the value of SWE in differentiating benign postoperative changes in the breast from local carcinoma recurrences is scarce. A PubMed search performed in October 2019 resulted in only one study that investigated the sensitivity and specificity of SWE in suspected recurrence of breast carcinoma [19]. This study included 29 patients with 32 masses and although it was shown that SWE can discriminate between benign and malignant lesions, it was not recommended to perform biopsies based on SWE results only.…”
Purpose To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma.
Materials and Methods SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2 mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy.
Results Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had Elmax values ranging from 128 to 199 kPa, and 50 % of benign lesions had Elmax values ranging from 65 to 169 kPa. The cut-off value of 171.2 kPa for Elmax shows a sensitivity of 59 % and specificity of 78.4 % for carcinoma recurrence, area under the curve 0.706 (CI95 % 0.6–0.81), P = 0.001. In univariate logistic models, restricted diffusion and stiffness on SWE, Elmax > 171.2 kPa, were shown as significant recurrence predictors. In the multivariate model, restricted diffusion remains significant independent recurrence predictor. With a recurrence prevalence of 43 %, the test sensitivity is 95 % (CI95 % 81–99 %) and the specificity is 75 % (CI95 % 60–85 %).
Conclusion Stiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.
“…However, evidence regarding the value of SWE in differentiating benign postoperative changes in the breast from local carcinoma recurrences is scarce. A PubMed search performed in October 2019 resulted in only one study that investigated the sensitivity and specificity of SWE in suspected recurrence of breast carcinoma [19]. This study included 29 patients with 32 masses and although it was shown that SWE can discriminate between benign and malignant lesions, it was not recommended to perform biopsies based on SWE results only.…”
Purpose To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma.
Materials and Methods SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2 mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy.
Results Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had Elmax values ranging from 128 to 199 kPa, and 50 % of benign lesions had Elmax values ranging from 65 to 169 kPa. The cut-off value of 171.2 kPa for Elmax shows a sensitivity of 59 % and specificity of 78.4 % for carcinoma recurrence, area under the curve 0.706 (CI95 % 0.6–0.81), P = 0.001. In univariate logistic models, restricted diffusion and stiffness on SWE, Elmax > 171.2 kPa, were shown as significant recurrence predictors. In the multivariate model, restricted diffusion remains significant independent recurrence predictor. With a recurrence prevalence of 43 %, the test sensitivity is 95 % (CI95 % 81–99 %) and the specificity is 75 % (CI95 % 60–85 %).
Conclusion Stiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.
“…Es gibt jedoch nur wenige Belege für den Stellenwert der SWE bei der Differenzierung zwischen gutartigen postoperativen Mammaveränderungen und malignen Lokalrezidiven. Eine im Oktober 2019 durchgeführte PubMed-Literatursuche ergab nur eine Studie, in der die Sensitivität und Spezifität der SWE bei Rezidivverdacht eines Mammakarzinoms untersucht wurde 19 . Diese Studie umfasste 29 Patienten mit 32 Raumforderungen, und obwohl gezeigt wurde, dass die SWE zwischen benignen und malignen Läsionen differenzieren konnte, wurde nicht empfohlen, Biopsien allein auf Grundlage der SWE-Ergebnisse vorzunehmen.…”
Zusammenfassung
Ziel Es soll untersucht werden, ob der Second-Look-US mittels Scherwellen-Elastografie (SWE) nützlich ist, um zwischen benignen und malignen Veränderungen in der postoperativen Brust nach der operativen Therapie des Mammakarzinoms zu differenzieren.
Material und Methoden SWE und die damit verbundenen sonografischen Merkmale wurden bei 90 Patientinnen mit Anamnese einer operativen Therapie des Mammakarzinoms und einer bei der MRT-Nachuntersuchung entdeckten verdächtigen Läsion überprüft. Ein einziger erfahrener Radiologe führte alle Second-Look-US-Untersuchungen mit SWE-Messungen durch, indem er eine kreisförmige Region of Interest von 2 mm Durchmesser über dem steifsten Teil der Läsion legte. Gewebeproben für die histopathologische Untersuchung wurden dabei durch Stanzbiopsie entnommen.
Ergebnisse Von 90 Läsionen erwiesen sich 39 als maligne in der histopathologischen Untersuchung. Von den malignen Läsionen zeigten 50 % Elmax-Werte im Bereich von 128 bis 199 kPa, und 50 % der benignen Läsionen hatten Elmax-Werte von 65 bis 169 kPa. Ein Cut-off-Wert von 171,2 kPa für Elmax zeigt eine Sensitivität von 59 % und eine Spezifität von 78,4 % für das Karzinomrezidiv und eine AUC von 0,706 (95 %-KI 0,6–0,81; p = 0,001). In univariaten logistischen Modellen erwiesen sich eingeschränkte Diffusion und Steifigkeit bei SWE, Elmax > 171,2 kPa, als signifikante Rezidiv-Prädiktoren. Im multivariaten Modell bleibt die eingeschränkte Diffusion ein signifikanter unabhängiger Rezidiv-Prädiktor. Bei einer Rezidiv-Prävalenz von 43 % liegt die Testsensitivität bei 95 % (95 %-KI 81–99 %) und die Spezifität bei 75 % (95 %-KI 60–85 %).
Schlussfolgerung Steifere Läsionen in der postoperativen Brust sollten im Second-Look-Ultraschall als suspekt angesehen werden. SWE kann eine hilfreiche Methode zur Identifizierung maligner Läsionen sein, insbesondere im Zusammenhang mit einer eingeschränkten Diffusion in der MRTUntersuchung. Die Steifigkeit der Läsion sollte jedoch nicht als unabhängiger Prädiktor für die Läsionsmalignität in der postoperativen Brust angesehen werden, da in der SWE benigne Veränderungen steif, Karzinomrezidive hingegen weich erscheinen können.
“…Nosso valor de corte para Vmax é maior do que aquele encontrado na maioria dos estudos publicados, que varia de 2.03 a 4.5 38,48,49,55,56 , mas semelhante ao encontrado por Golatta e colaboradores 37 Dentre os estudos utilizando a tecnologia SSI, os resultados quanto ao melhor parâmetro a ser utilizado são divergentes: Emax para alguns autores [40][41][42]62,63 , Eratio para outros 43,61 O único estudo publicado até o momento avaliando a aplicabilidade da elastografia VTIQ como método complementar na avaliação de recidivas demonstrou que a elastografia auxilia na identificação de nódulos malignos. Entretanto, deixar de realizar a biópsia em caso de suspeita de recidiva pode levar a desfechos ruins e piorar o prognóstico das pacientes 66 . Dessa forma, considerando também os aspectos clínicos, em que as duas suspeitas de recidiva teriam sido biopsiadas, apenas um caso de CDIS dentro de um fibroadenoma não teria sido diagnosticado (0.4% de todos os casos de câncer).…”
pelas lições de saber, pela confiança, dedicação e orientação constantes, imprescindíveis para a realização desta tese; Ao Prof. Dr. Rodrigo Menezes Jales, pela concepção do tema deste trabalho, pela orientação incansável e por ter me auxiliado a trilhar esse caminho; Aos meus pais, Lílian e Gustavo, e ao meu irmão, Rodrigo, pelo amor, apoio e motivação incondicionais e por serem meu grande alicerce; À Livia Conz, pela parceria e amizade, sempre presente durante todo o meu caminho em São Paulo e Campinas; Aos pacientes que participaram desse estudo e todos àqueles que estiveram na minha jornada e formação como médica, meu eterno agradecimento.
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