Combined use of the automated breast volume scanner and the US elastography for the differentiation of benign from malignant lesions of the breast

Abstract

BackgroundAutomated breast volume scanner (ABVS) and US elastography (UE) have been useful for the differentiation of benign and malignant lesions. However, combining these two methods applied in diagnosis of breast lesions has not yet been reported. The aim of this study is to analyze the inter-examiner reliability of ABVS and UE, and compare diagnostic performance among ABVS, UE, and the combination of these two methods.MethodsForty-one patients (forty-six lesions) underwent both ABVS and UE examinations. ABVS images were acquired by medial and lateral scans for each breast and classified a BI-RADS category based on the distribution, size, shape, echogenicity and microcalcification of the lesions. UE images were assigned an elasticity score according to the distribution of strain induced by light compression. Kappa statistics was used to examine the reproducibility between examiners with ABVS and UE, and the concordance between pathology and ABVS, UE, and the combination of these two methods. χ2 test was used to compare diagnostic performance among these three methods.Two examiners blinded to the patients’ history evaluated the results of breast imaging independently.ResultsInter-examiner reliability with ABVS (κ = 0.62, 95% confidence interval (CI): 0.44-0.80) and UE (κ = 0.65, 95% CI: 0.48-0.82) was substantial. With respect to the pathology results, the inter-rater coefficient of concordance was κ = 0.81 (95% CI: 0.64-0.98) for ABVS, κ = 0.77 (95% CI: 0.58-0.96) for UE, and κ = 0.90 (95% CI: 0.77-1.00) for combination of ABVS and UE. Examiner variability was reduced from UE to ABVS, and to the combination of ABVS with UE.The diagnostic accuracy, sensitivity, and specificity for the combination of ABVS and UE were 95.7% (95%CI: 84.0-99.2), 100% (95% CI: 85.9-100), and 87.5% (95% CI: 60.4-97.8), respectively. When comparing, the diagnostic performance of ABVS combined with UE was better than, or at least equal to, that of ABVS (accuracy 91.3% (95% CI: 78.3-97.2), sensitivity 100% (95% CI: 85.0-1.00), specificity 77.8% (95% CI: 51.9-92.6)) or UE (accuracy 89.1% (95% CI: 75.6-95.9), sensitivity 96.4% (95% CI: 79.8-99.8), specificity 77.8% (95% CI: 51.9-92.6)) alone, though the improvement was no statistically significance.ConclusionsBoth ABVS and UE demonstrated substantial inter-examiner reliability. With high diagnostic performance for differentiation of benign and malignant lesions in the breast, the combination of ABVS and UE are useful to improve the diagnostic accuracy and specificity.

Uterine contractility and elastography as prognostic factors for pregnancy after intrauterine insemination

“…Elastography is an ultrasound modality based on the analysis of tissue deformation induced by mechanical distortions, such as blood pulse at each heartbeat. It is now routinely used in the assessment of certain tumors (23). UCs can be assessed noninvasively by ultrasound.…”

Current status of automated breast ultrasonography

“…Several papers have reported the evaluation of the diagnostic performance of ABUS as a tool for preoperative evaluation, replacement of second-look US, and ductal carcinoma in situ (DCIS) evaluation [ 24 - 27 , 32 - 34 ]. However, the lesion detection, reliability, and interobserver concordance of ABUS need to be confirmed before the clinical application of ABUS in a diagnostic situation is considered [ 24 , 25 , 32 , 33 ].…”

“…The combined assessments of readers 1 and 2 showed a diagnostic accuracy of 79%, sensitivity of 83%, and specificity of 78%. Xu et al [ 34 ] evaluated the role of both ABUS and US elastography. They reported that both ABUS and US elastography showed substantial interobserver reliability and the combined use of ABUS and US elastography was useful in improving diagnostic accuracy and specificity [ 34 ].…”

Evaluation of Diagnostic Performance of Automatic Breast Volume Scanner Compared to Handheld Ultrasound on Different Breast Lesions: A Systematic Review

“…In 2012, the approval for the use of ABVS was granted by the U.S. Food and Drug Administration for women with dense breasts and negative mammography findings as an additional whole-breast screening method [ 13 ]. The use of ABVS for diagnostic purposes has, over the past decade, been examined by different studies [ 9 , 14 , 15 , 16 , 17 ]. Promising results have been reported in several considerably small patient-population studies [ 15 , 18 , 19 , 20 ].…”