Sonobreast: Predicting Individualized Probabilities of Malignancy in Solid Breast Masses with Echographic Expression

Abstract

To create an individualized predictive tool for the risk of malignancy in solid breast masses, based on echographic and clinical characteristics. Research Ethics Committee approval and informed consent were obtained. This multi-center study included 1,403 solid breast masses prospectively. Each ultrasound feature was analyzed and compared with the definitive diagnosis. The ultrasound results, women's ages and family histories of breast cancer were included in a multivariate logistic regression model. Among the 1,403 lesions included in the study, 1,390 (99.1%) had a conclusive diagnosis: 343 malignant tumors (24.7%), and 1,047 benign masses (75.3%). The odds ratio (and confidence interval) for breast malignancy for each variable included in the model, as calculated by multivariate analysis, were as follows: irregular shape/noncircumscribed margins, 16.02 (7.75-33.09); heterogeneous echo texture, 4.50 (2.42-8.23); vertical orientation (not parallel to the skin), 2.23 (1.04-4.75); anterior echogenic rim, 2.62 (1.09-6.31); posterior shadowing, 2.38 (1.23-4.62); age more than 40 years, 2.19 (1.26-3.81); positive first-degree family history (mother, sister or daughter), 7.50 (2.65-21.18). There was no advantage in including the presence of internal vascularity, presence of thickened Cooper's ligaments or size of the mass, in the model. The predictive tool was named SONOBREAST and it is freely available for medical purposes on the internet site: http://www.sonobreast.com. The probability of malignancy in breast masses can be specified based on their ultrasound features, the woman's age and the family history of breast cancer.

Can Cut-Off-Values for Tumor Size or Patient Age in Breast Ultrasound Reduce Unnecessary Biopsies or is it all About Bi-rads?– A Retrospective Analysis of 763 Biopsied T1-Sized Lesions

“…Although we found statistically significant correlations between malignancy rate and tumor size and patient age respectively in the binary logistic regression analysis, it was not possible to establish a cut-off-value for those criteria while retaining an acceptable sensitivity and specificity. Paulinelli et al did not find any tumor size that could be significant in the multivariate analyses, but did find an increasing risk of malignancy with increasing age (ROC giving a sensitivity of 84.5 %, a specificity of 64.5 % and an overall accuracy of 74.5 % for the age of 40) [11]. We found that the combination of oval/round shape and circumscribed margin without echogenic rim ( = circumscribed margin in the 5th edition of the ACR BIRADS ® Atlas) [8] was the most reliable to predict a benign outcome with a negative predictive value (NPV) of 99.1 %.…”

“…In this study we wanted to analyze the influence of lesion size alone and in combination with patient age to find a "rule of thumb" for the combined mammography-ultrasound screening setting. We did not try to establish a new kind of prediction model like other authors have designed [11]. Instead we assessed whether it was possible to recommend a cut-off value for size (and/or age), under which it is reasonable to obviate a needle biopsy.…”

Association of sonographic features and molecular subtypes in predicting breast cancer disease outcomes

“…23 It was normally interpreted as high proliferation which led to expansive growth against peripheral tissues 24 and thus was always considered as a risk sign for BC. 25,26 Meanwhile, studies have also manifested that vertical orientation was significantly associated with more invasive proportion of tumor 27 and higher level of clinical risk in BC. 28 However, evidence concerning vertical orientation and clinical outcomes in BC was inconsistent.…”

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“…The field of ethics studies the principles of right and wrong [20,21] in the field of medicine refers to the ethics between the doctor-patient relationship, including all general responsibilities towards the patient [22]. Medical ethics includes four principles: Respect for autonomy, beneficence, non-maleficence, and justice [23].…”