Could ultrasonic elastography help the diagnosis of small (≤2cm) breast cancer with the usage of sonographic BI-RADS classification?

Zhi, Hui; Xiao, Xiaoyun; Ou, Bing; Zhong, Wei; Zhao, Zizhuo; Zhao, Xinbao; Yang, Huan; Luo, Baoming

doi:10.1016/j.ejrad.2012.04.016

Cited by 50 publications

(35 citation statements)

References 18 publications

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“…AUCs for shear-wave and strain elastography in breast cancer diagnosis are similar when used alongside B-mode ultrasound [32]. Elastography should be used as an adjunct to B-mode ultrasound in tumor diagnosis [38], and many new studies of strain and shear-wave elastography investigate combinations of elastography with B-mode ultrasound [39,40]. Most studies combining elastography with B-mode ultrasound use a single cutoff for assessing malignancy with stiffness measurements [32,35].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Strain and Shear-Wave Elastography in an Elasticity Phantom

Carlsen

Pedersen

Ewertsen

et al. 2015

American Journal of Roentgenology

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OBJECTIVE. The purpose of this study was to assess the diagnostic accuracy of strain and shear-wave elastography for determining targets of varying stiffness in a phantom. The effect of target diameter on elastographic assessments and the effect of depth on shear-wave velocity were also investigated. MATERIALS AND METHODS. We examined 20 targets of varying diameters (2.5-16.7 mm) and stiffnesses (8, 14, 45, and 80 kPa) with a 4-9-MHz linear-array transducer. Targets were evaluated 10 times with three different methods-shear-wave elastography, strain ratio, and strain histogram analysis-yielding 600 evaluations. AUCs were calculated for data divided between different stiffnesses. A 1.5-6-MHz curved-array transducer was used to assess the effect of depth (3.5 vs 6 cm) on shear-wave elastography in 80 scans. Mixed model analysis was performed to assess the effect of target diameter and depth. RESULTS. Strain ratio and strain histogram AUCs were higher than the shear-wave velocity AUC (p < 0.001) in data divided as 80 versus 45, 14, and 8 kPa. In data divided as 80 and 45 versus 14 and 8 kPa, the methods were equal (p = 0.959 and p = 1.000, respectively). Strain ratios were superior (p = 0.030), whereas strain histograms were not significantly better (p = 0.083) than shear-wave elastography in data divided as 80, 45, and 14 versus 8 kPa. Target diameter had an effect on all three methods (p = 0.001). Depth had an effect on shear-wave velocity (p = 0.001). CONCLUSION. The ability to discern different target stiffnesses varies between shear-wave and strain elastography. Target diameter affected all methods. Shear-wave elastography is affected by target depth.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of Strain and Shear-Wave Elastography in an Elasticity Phantom

Carlsen

Pedersen

Ewertsen

et al. 2015

American Journal of Roentgenology

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“…In a meta-analysis of 22 strain imaging studies, most of which used the 5-point Tsukuba score, the overall mean sensitivity was 83% and mean specificity was 84% for the diagnosis of malignant breast lesions 68. In a study with 370 patients with breast lesions (155 malignant) evaluated with SE using the Tsukuba score in addition to B-mode US, the BI-RADS accuracy was overall improved with increased specificity (68.3% to 87.8%) and slightly decreased sensitivity (90.3% to 83.9%) 69.…”

Section: Clinical Applications Of Ultrasound Elastographymentioning

confidence: 97%

Ultrasound Elastography: Review of Techniques and Clinical Applications

et al. 2017

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Elastography-based imaging techniques have received substantial attention in recent years for non-invasive assessment of tissue mechanical properties. These techniques take advantage of changed soft tissue elasticity in various pathologies to yield qualitative and quantitative information that can be used for diagnostic purposes. Measurements are acquired in specialized imaging modes that can detect tissue stiffness in response to an applied mechanical force (compression or shear wave). Ultrasound-based methods are of particular interest due to its many inherent advantages, such as wide availability including at the bedside and relatively low cost. Several ultrasound elastography techniques using different excitation methods have been developed. In general, these can be classified into strain imaging methods that use internal or external compression stimuli, and shear wave imaging that use ultrasound-generated traveling shear wave stimuli. While ultrasound elastography has shown promising results for non-invasive assessment of liver fibrosis, new applications in breast, thyroid, prostate, kidney and lymph node imaging are emerging.Here, we review the basic principles, foundation physics, and limitations of ultrasound elastography and summarize its current clinical use and ongoing developments in various clinical applications.

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“…Currently, ultrasonography (US) and mammography are the most frequently used non-invasive methods for detecting breast cancer [1][2][3], while Doppler techniques may be used in parallel to provide additional information [4,5] and obtain better diagnostic accuracy [6,7]. Complementary to these methods, elastography adds supplementary information regarding differences in elasticity and stiffness between different tissues [8][9][10][11]. An increase in tissue stiffness on an elastography scan is usually associated with a malignant tumor [12].…”

Section: Introductionmentioning

confidence: 99%

Qualitative strain elastography – strain ratio evaluation - an important tool in breast cancer diagnostic

et al. 2016

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Aims: To assess the quality of real time elastography as a differential diagnosis tool for breast nodules and to compare it with standard ultrasonography. Material and methods: In this prospective study we enrolled 174 patients in which 174 dominant breast nodules were considered for the final diagnosis. The results of ultrasonography and real time elastography, both qualitative and quantitative, were compared with pathology findings from the biopsy specimens. Results: Pathology examinations determined 102 nodules were benign and 72 malignant. Qualitative elastography had a better diagnostic performance (82.4% sensitivity and 81.9% specificity) than ultrasonography plus Doppler evaluation (70.3% sensitivity and 73.5% specificity). Quantitative elastography, assessed using the fat-to-lesion ratio, was a good discriminant for malignancy (AUROC = 0.93, p < 0.001). Our results pointed to an optimal threshold for malignancy of > 4.88; by using this threshold, the diagnostic reliability of the fat-to-lesion ratio was better than both ultrasonography and qualitative elastography (86.5% sensitivity and 90.4% specificity). Conclusion: Real time elastography is superior to ultrasonography in diagnosing malignant breast nodules. The evaluation of nodules using a fat-to-lesion ratio was a better discriminant for malignancy than qualitative elastography.

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Could ultrasonic elastography help the diagnosis of small (≤2cm) breast cancer with the usage of sonographic BI-RADS classification?

Abstract: USE could give BI-RADS some help in the differentiation of benign and malignant breast small lesions. The addition of elastography to BI-RADS could improve the diagnostic performance in <2 cm lesions.

Cited by 50 publications

References 18 publications

A Comparative Study of Strain and Shear-Wave Elastography in an Elasticity Phantom

A Comparative Study of Strain and Shear-Wave Elastography in an Elasticity Phantom

Ultrasound Elastography: Review of Techniques and Clinical Applications

Qualitative strain elastography – strain ratio evaluation - an important tool in breast cancer diagnostic

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