Characterization of Focal Breast Lesions by Means of Elastography

Abstract

Purpose: The modern method of sonoelastography of the breast is used for differentiating focal lesions. This review gives an overview of the different techniques available and discusses their roles in the routine clinical setting. Materials and Methods: The presented techniques include compression or vibration elastography as well as shear wave elastography. Descriptions of the methods are supplemented by a discussion of the clinical role of each technique based on the most recent literature. We discuss by outlining two recent experimental approaches ? MRI and tomosynthesis elastography. Results: Currently available data suggest that elastography is an important supplementary tool for the differentiation of breast tumors under routine clinical conditions. The specificity improves with the immediate availability of additional diagnostic information using real-time techniques and/or the calculation of strain ratios (SR). Elastography is especially helpful in women with involuted breasts for differentiating BI-RADS-US 3 and 4 lesions and for evaluating very small cancers without the typical imaging features of malignancy. Here, elastography techniques are highly specific, while the sensitivity decreases compared to B-mode ultrasound. SR calculation is especially helpful in women who have a high risk of breast cancer and high pretest likelihood. Conclusion: B-mode ultrasound is still the first-line method for the initial evaluation of the breast. If suspicious findings are detected, elastography with or without SR calculation is the most crucial supplementary tool. Key Points: Citation Format:

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016

“…Women with BRCA1/2 mutations should also be offered non directive counselling for the uptake of primary preventive measures (e.g. riskreducing bilateral salpingooophorectomy at around 40 years of age, riskreducing bilateral mastectomy, or medical prevention with tamoxifen, raloxifen, or an aro matase inhibitor) in addition to participation in a surveillance/ ing Report and Data System (BIRADS) III lesions and in measuring the true size of breast cancer lesions [17]. According to a recent metaanalysis, the reexcision rate is not reduced but the initial and total rate of mastectomy is in creased if a preoperative breast MRI is performed compared with no preoperative breast MRI [18,19].…”

Strain Elastography of Breast and Prostata Cancer: Similarities and Differences

“…Additionally, USE has difficulty differentiating between postoperative scarring and tumor recurrence, since in both cases there is reduced tissue elasticity. In this instance contrast-enhanced MRI is superior to USE [17,28].…”

“…Since USE represents an additive to B-mode sonography, false-negative changes play a reduced role in the detection of breast cancer. Most false-negative changes are found, for example, in phyllodes tumors with a soft center, mucoid breast carcinomas and carcinomas with large central necrosis [5,17,26,27]. In a B-mode image, both entities are shown as suspicious.…”

“…This contrasts with prostate cancer, since non-hypoechoic carcinomas are frequently encountered [15,16]. This ultimately results in the B-mode image being used as a search modality for breast cancer, and USE used only for additional evaluation/risk assessment [17]. For prostate cancer, USE is superior to the B-mode image with respect to detection, and the B-mode image itself is only included in elastography scoring [18,19].…”

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2014

“…Elastography is a US-based method and has some advantages in diminishing the rate of Breast Imaging Report and Data System (BI-RADS) III lesions and in measuring the true size of breast cancer lesions [17]. …”