Elastographic Evaluation of Indeterminate Breast Masses on Ultrasound

Abstract

Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound. Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis. Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20-85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values of the malignant lesions were statistically higher when compared with the subcutaneous tissue or the adjacent fibroglandular tissue. The analysis of the receiver operating characteristic (ROC) curves for these two semiquantitative methods showed that both are considered satisfactory, with an area under the curve above 0.75 and statistical significance (p < 0.0001). The best results were obtained when using the findings of combined conventional ultrasound and qualitative elastography, with 100% sensitivity and 63.2% specificity. Conclusions Elastography can be a useful complementary method, increasing the specificity and diagnostic accuracy of conventional ultrasound for the diagnosis of breast cancer in patients with indeterminate breast lesions. ResumoObjetivo Avaliar a acurácia diagnóstica da elastografia para identificação do câncer de mama em pacientes com lesões indeterminadas por ultrassom. Métodos Estudo prospectivo, descritivo, com pacientes com lesões mamárias indeterminadas no ultrassom e indicação de biópsia percutânea ou cirúrgica. A elastografia foi avaliada por análise qualitativa e dois métodos de análise semiquantitativa.

Novel approach in the evaluation of ultrasound BI-RADS 3 & 4 breast masses with a combination method of elastography & Doppler

“…In a study by Brown et al 16 mammography contributed to delineation of disease extent, detection of incidental malignancies, and confirmation of benign diagnoses in women above 30 yr of age. Graziano et al 17 observed that ultrasound is a method with good sensitivity (98.1%), but with lower specificity (40.6%) in the evaluation of indeterminate breast masses. Differentiation between BI-RADS 3 and 4 by US elastography had 84 per cent sensitivity and 84 per cent specificity while dynamic contrast-enhanced MRI had 88 per cent sensitivity but only 80 per cent specificity according to a study conducted by ElSaid and Mohamed 18 .…”

Comparison of the SRmax, SRave, and color map of strain-elastography in differentiating malignant from benign breast lesions

“…The amount of included tissue is obviously different between the ROI for the lesion and that for the reference tissue. For this reason, and to maximize the comparison, we strictly selected a round-shaped ROI with an approximate average width of 2 mm, and we placed the first ROI at the hardest area that presented a blue color within the targeted lesion and the second ROI in the fat tissue that presented red color just outside of the targeted lesion at the same level (19,20). However, the sensitivity and specificity of our study were lower than in previous studies.…”

Ultrasonographic Elasticity Contrast Index of Palpable Breast Lumps

“…8 This leads to higher false positives and increased number of image guided biopsies with low cancer detection rate varying from about10-30%. 1,9,10 Various studies have shown that adding elastography to routine grey scale imaging in breast lesions increases the specificity to 85 -90 %. 5,8 Qualitative elastography has also been included in the current ACR BIRADS lexicon 2013 as an ancillary finding and the descriptors for elasticity assessment included.…”