Non-Mass Breast Lesions on Ultrasound: Feature Exploration and Multimode Ultrasonic Diagnosis

Zhang, Wenyue; Xiao, Xiaoyun; Xu, Xiaolin; Ming, Liang; Wu, Huan; Ruan, Jingliang; Luo, Baoming

doi:10.1016/j.ultrasmedbio.2018.05.005

Cited by 40 publications

(31 citation statements)

References 29 publications

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“…In a study by Zhang et al., among a total of 928 patients with US-detected breast lesions, 79 individuals had lesions recognized as NMLs, 43.7% of which were benign. 20 More recently, a study including 715 NMLs found that 53.8% of the lesions were benign. 19 In our study, palpability was not significantly associated with greater risk of malignancy among NMLs.…”

Section: Discussionmentioning

confidence: 99%

Can shear wave elastography be utilized as an additional tool for the assessment of non-mass breast lesions?

et al. 2021

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Introduction We aimed to describe shear wave elastography parameters of non-mass lesions of the breast and to assess the measures of diagnostic accuracy of shear wave elastography in the differentiation of non-mass lesions compared with conventional ultrasound, using histopathologic results as the reference standard. Methods This retrospective study included breast ultrasound-detected non-mass lesions with a confirmed pathologic diagnosis during a two-year study period. B-mode ultrasound and shear wave elastography were performed for all lesions before biopsy. Ultrasound features, shear wave elastography parameters (mean elasticity and maximum stiffness color), as well as Breast Imaging-Reporting and Data System categories were recorded for each lesion. Measures of diagnostic accuracy of ultrasound and ultrasound + shear wave elastography were also assessed. Results From a total of 567 breast lesions requiring core-needle biopsy, 49 (8.6%) were considered as non-mass lesions. Based on histopathologic reports, 32 patients (65.3%) had non-high-risk benign lesions, five (10.2%) had high-risk benign lesions, five (10.2%) had ductal carcinoma in situ, and seven (14.3%) had invasive carcinoma. There was no significant difference in patients’ age and palpability between benign and malignant lesions ( p = 0.16 and p = 0.12, respectively). Mean elasticity values and Breast Imaging-Reporting and Data System categories were significantly higher among malignant lesions compared with benign non-mass lesions (both p < 0.001). Furthermore, the addition of shear wave elastography to grayscale ultrasound increased the specificity, positive predictive value, and diagnostic accuracy. Conclusion The complementary use of shear wave elastography with conventional ultrasound might help in the differentiation of non-mass breast lesions and has the potential to decrease the frequency of unnecessary biopsies performed for benign non-mass lesions.

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Section: Discussionmentioning

confidence: 99%

Can shear wave elastography be utilized as an additional tool for the assessment of non-mass breast lesions?

et al. 2021

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“…It has been reported that both malignant and benign breast lesions can present as NMLs [10,11], accounting for about 9.2% of all breast lesions [11,24]. The features of malignant and benign lesions on conventional US overlap considerably [4,6], resulting in low diagnostic specificity (about 21-43%) [4,15,19].…”

Section: Discussionmentioning

confidence: 99%

“…The qualitative measurement index is simpler, with relatively unified standards based on strain and colour pattern [28]. Typically, the elasticity score, which involves calculating the hard area ratio, is used, as it was in three studies [11,20,29] in our meta-analysis. The cut-off values for diagnosing breast NLMs was an elasticity score of 3 in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, it is important to identify breast NMLs, because not only do some malignant entities, such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma, and invasive lobular carcinoma (ILC), manifest as NMLs, but many benign lesions, such as fibrocystic changes, inflammation, post-operative scars, and biopsy scars, also typically present as NMLs [7][8][9]. Therefore, although some conventional US features can suggest a diagnosis of breast NMLs, an accurate diagnosis is difficult because of overlapping features of malignant and benign breast NMLs [10,11]. Therefore, in order to increase the specificity of diagnosis and reduce the number of invasive biopsies, it is necessary to improve US technology.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of elastography for breast non-mass lesions: A systematic review and meta-analysis

Shen

Gao

et al. 2021

European Journal of Radiology

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This systematic review and meta-analysis aimed to evaluate the diagnostic performance of ultrasound elastography in the differentiation of benign and malignant breast non-mass lesions (NMLs). Methods: PubMed, Cochrane Library, and Embase databases were searched for eligible studies up to end of June 2021. The diagnostic performance of elastography for NMLs was investigated using pooled sensitivity and specificity, likelihood ratio, diagnostic odds ratio (DOR), post-test probability, and the area under hierarchical summary receiver operating characteristic curve (HSROC). Results: Eleven studies involving 812 NMLs (malignant 414) were included. The pooled sensitivity, specificity, DOR, positive likelihood ratio, and negative likelihood of elastography for the differentiation of benign and malignant breast NMLs were 79% (95 %CI: 71-85), 86% (95 %CI: 79-91), ), and 0.24 (95 %CI: 0.17-0.34), respectively. No significant publication bias existed. The area under the HSROC curve was 90% (95 %CI: 87-92). Fagan plots demonstrated good clinical utility. However, substantial heterogeneity existed. Country, measurement index, and number of lesions served as potential sources of heterogeneity. Conclusions:The results of this study suggest that elastography has high diagnostic accuracy in differentiating between malignant and benign NMLs. Elastography can be a feasible and non-invasive tool for breast NMLs.

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“…There is no standardized guideline for the interpretation and management of non-mass-like lesions, and thus it is currently dependent on operator experience and judgement in individual clinical setting [9]. Recently, attempts to discriminate between benign or malignant non-mass-like lesions based on a combined analysis of B-mode, color Doppler US, strain, or shear wave elastography have consistently demonstrated improved diagnostic performances [10–13]. Non-mass-like lesions are known to reflect a broad spectrum of breast pathologies including benign, high-risk, and malignant lesions [14].…”

Section: Discussionmentioning

confidence: 99%

Sonographic Features of Flat Epithelial Atypia Manifesting as a Non-Mass-Like Lesion: A Case Report

Kim

2019

Am J Case Rep

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Patient: Female, 47Final Diagnosis: Flat epithelial atypia of the breastSymptoms: —Medication: —Clinical Procedure: —Specialty: RadiologyObjective:Rare diseaseBackground:The incidence of flat epithelial atypia of the breast has been increasing owing to the increasing use of ultrasonography (US) and US-guided core needle biopsy. However, reports describing the sonographic features of flat epithelial atypia are fewer than those on its mammographic features.Case Report:A 47-year-old female had a regular 6 month-interval follow-up US for multiple bilateral breast masses detected on US. A new focal non-mass-like lesion measuring 2 cm in maximum diameter was noted in the 10 o’clock direction of the right breast on the follow-up US. Mammography was not performed during the follow-up period. The patient had no breast symptoms and no family history of breast cancer or other pertinent medical history. US-guided 14-gauge core needle biopsy yielded a pathological diagnosis of flat epithelial atypia without upgrade to malignancy, and this was further confirmed after complete excision of the non-mass-like lesion.Conclusions:Flat epithelial atypia can present as a focal non-mass-like lesion on US, which has not been reported previously.

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Non-Mass Breast Lesions on Ultrasound: Feature Exploration and Multimode Ultrasonic Diagnosis

Cited by 40 publications

References 29 publications

Can shear wave elastography be utilized as an additional tool for the assessment of non-mass breast lesions?

Can shear wave elastography be utilized as an additional tool for the assessment of non-mass breast lesions?

Diagnostic performance of elastography for breast non-mass lesions: A systematic review and meta-analysis

Sonographic Features of Flat Epithelial Atypia Manifesting as a Non-Mass-Like Lesion: A Case Report

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