Impact of Strain Elastography on BI-RADS classification in small invasive lobular carcinoma

Abstract

Aims: The purpose of this study was to determine the impact of strain elastography (SE) on the Breast Imaging Reporting Data System (BI-RADS) classification depending on invasive lobular carcinoma (ILC) lesion size.Materials and methods: We performed a retrospective analysis on a sample of 152 female subjects examined between January 2010 – January 2017. SE was performed on all patients and ILC was subsequently diagnosed by surgical or ultrasound-guided biopsy. BI-RADS 1, 2, 6 and Tsukuba BGR cases were omitted. BI-RADS scores were recorded before and after the use of SE. The differences between scores were compared to the ILC tumor size using nonparametric tests and logistic binary regression. We controlled for age, focality, clinical assessment, heredo-collateral antecedents, B-mode and Doppler ultrasound examination. An ROC curve was used to identify the optimal cut-off point for size in relationship to BI-RADS classificationdifference using Youden’s index.Results: The histological subtypes of ILC lesions (n=180) included in the sample were luminal A (70%, n=126), luminal B (27.78%, n=50), triple negative (1.67%, n=3) and HER2+ (0.56%, n=1). The BI-RADS classification was higher when SE was performed (Z=- 6.629, p<0.000). The ROC curve identified a cut-off point of 13 mm for size in relationship to BI-RADS classification difference (J=0.670, p<0.000). Small ILC tumors were 17.92% more likely to influence BI-RADS classification (p<0.000).Conclusions: SE offers enhanced BI-RADS classification in small ILC tumors (<13 mm). Sonoelastography brings added value to B-mode breast ultrasound as an adjacent to mammography in breast cancer screening.

Analysis of the accuracy of ultrasound elastography and BI-RADS classification of breast masses located within the superficial fat layer of the glands

“…The BI-RADS classification can be downgraded if elastography shows a soft mass, and the BI-RADS classification can be upgraded if elastography shows a hard mass (16)(17)(18)(19). This study shows that ultrasound elastography can easily misdiagnose benign masses as malignant.…”

“…Ultrasound elastography can be used to assess the stiffness of breast masses, and many studies have reported that it can improve the accuracy of ultrasound in distinguishing benign from malignant breast tumors (10)(11)(12)(13)(14)(15). Studies have shown that ultrasound elastography can be used to upgrade or downgrade the ultrasound BI-RADS classification of breast tumors (16)(17)(18)(19). Ultrasound elastography features of breast masses have been incorporated into the latest version of BI-RADS (20).…”

Medical Diagnostic Tests: A Review of Test Anatomy, Phases, and Statistical Treatment of Data

“…Different metrics are used to choose the cutoff for the optimum Se and Sp, such as Youden's index ( J , maximum), d 2 ((1 − Se) 2 + (1 − Sp) 2 , minimum), the weighted number needed to misdiagnose (maximum, considered the pretest probability and the cost of a misdiagnosis) [172], and Euclidean index [173]. The metrics used to identify the best cutoff value are a matter of methodology and are not expected to be reported as a result (reporting a J index of 0.670 for discrimination in small invasive lobular carcinoma [174] is not informative because the same J could be obtained for different values of Se and Sp: 0.97/0.77, 0.7/0.97, 0.83/0.84, etc.). Youden's index has been reported as the best metric in choosing the cutoff value [173] but is not able to differentiate between differences in sensitivity and specificity [175].…”

The role of imaging techniques in the diagnosis, staging and choice of therapeutic conduct in pregnancy associated breast cancer

“…Color Doppler US and elastography are complementary to the basic US examination and provide important details which serve to refine the diagnosis [18,19] (fig 2, 3).…”