Appearence of breast masses on sonoelastography with special focus on the diagnosis of fibroadenomas

Abstract

The aim of this study was to show and correlate the imaging features of breast masses, especially fibroadenomas, using sonoelastography. Two hundred thirty-five patients with 302 breast lesions referred for core needle biopsy participated in the study. All lesions appearing as solid masses on conventional US were included. Out of the included lesions (270), 115 (42.6%) corresponded to histologically confirmed fibroadenomas and 155 (57.4%) to lesions with histologically confirmed diagnoses other than fibroadenomas. These were further subdivided into fibrocystic changes, lesions with low malignancy potential, and malignant lesions. Fibroadenomas were also divided according to histological presentation into three subgroups to allow comparative study based on elastographic scores. All lesions were classified using a four-point scoring system based on ultrasound elastography imaging characteristics. Different presentations were observed for elastographic scores according to histological presentation of fibroadenomas, whereby fibroadenomas with benign characteristics tended to have elastographic classification similar to fibrocystic changes, and complex and hypercellular fibroadenomas had classifications similar to harder lesions. Fibroadenomas are generally classified as category 3 in the BI-RADS lexicon and are the most commonly found lesions in breast biopsies. Sonoelastography can provide additional information to conventional studies and be used as an auxiliary tool in assessing these masses in clinical practice.

Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions

“…In particular, sonoelastography appears especially useful in lesions classified as BI-RADS 3 at mammography and ultrasonography, in which it can confirm the diagnosis of benignity [17,18]. In our study, the higher average score (2.73±0.17) obtained in histologically benign nodules compared with other case series [8,11] is due to the fact needle biopsy was not performed on lesions classified as R1 or R2 with an ultrasonographic risk of U2, those classified as R3 and/or U3 lesions and with a sonoelastography score of S1, or on patients who opted for follow-up rather than cytological/ microhistological evaluation.…”

Assessment of breast cancer tumour size using six different methods

“…Imaging the elasticity of the lesions makes it easier to detect and characterise them, and also to estimate their size [17][18][19]. In the present study, RTE was carried out with colour coding and real-time assessment.…”

“…Most studies advocate using ultrasound as the preferred method of predicting the real histopathological tumour size, although most studies have found that ultrasound underestimates the size of breast lesions [6,8,10]. However, the published studies [6,8,[10][11][12][13][14][15][16] may not reflect current technical standards in mammography and ultrasound, as compound imaging and real-time elastography in particular, as a quite new technique in breast diagnosis, may now allow more accurate tumour size estimation [17][18][19][20][21][22][23][24]. Elastography is able to image the elasticity of soft tissues [21].…”

The importance of breast elastography added to the BI-RADS® (5th edition) lexicon classification

“…It was observed that the most indolent fibroadenomas (hypocellular with collagen) appeared softer on elastographic assessment, whereas the complex and hypercellular lesions were harder. 8 Elastography allows for an unequivocal diagnosis in complicated cysts. 9 Because of the inclusion of elastographic data in the BI-RADS ® lexicon, in this study, a large number of lesions that would have been classified as BI-RADS ® category 3 (most likely benign and soft) were reclassified as BI-RADS ® category 2 (benign).…”