The Utility of the "Bull's-Eye" Artifact on Breast Elasticity Imaging in Reducing Breast Lesion Biopsy Rate

Barr, Richard G.; Lackey, Amanda E.

doi:10.1097/ruq.0b013e31822a9c75

Cited by 41 publications

(34 citation statements)

References 18 publications

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“…Non-viscous fluids are incompressible, and simple cysts should therefore not display signals of deformability at RTE; however, artifacts may produce a typical "tri-stratified" or "target" pattern according to the type of algorithm used by the equipment [14,32]. In some cysts an acoustic "streaming" effect is obtained in response to ARFI [33].…”

Section: The Basic Principles Of Elastography and Related Reportsmentioning

confidence: 99%

Breast elastography: A literature review

Goddi¹,

Bonardi

Alessi

2012

Journal of Ultrasound

138

129

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KEYWORDS Sonoelastography; Breast elastography; Breast lesions.Abstract Breast elastography is a new sonographic imaging technique which provides information on breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a noninvasive evaluation of the stiffness of a lesion. Today, two technical solutions are available for clinical use: strain elastography and shear wave elastography. Initial evaluations of these techniques in clinical trials suggest that they may substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses. This article reviews the basics of this technique, how to perform the examination, image interpretation and the results of major clinical studies. Although elastography is easy to perform, training and technical knowledge are required in order to obtain images permitting a correct interpretation. This paper will highlight the technique and point out common pitfalls.Sommario L'elastosonografia mammaria è una nuova tecnica di imaging a ultrasuoni che fornisce informazioni aggiuntive sulle lesioni della mammella rispetto all'ecografia e alla mammografia. Consente una valutazione non invasiva della rigidità tessutale di una lesione. Sono attualmente disponibili due soluzioni tecniche per uso clinico: l'elastografia con strain e l'elastografia shear wave. I primi studi clinici di valutazione di queste tecniche suggeriscono che esse possano migliorare la caratterizzazione delle lesioni mammarie differenziando quelle benigne dalle maligne e riducendo in modo sostanziale il numero di biopsie per lesioni benigne. Questo articolo rivisita le basi tecniche, i criteri interpretativi delle immagini, i principali studi clinici e le possibili cause di errore. Per quanto l'elastosonografia sia di facile esecuzione, richiede tuttavia un training e delle conoscenze tecniche adeguate per ottenere immagini correttamente interpretabili. ª

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Section: The Basic Principles Of Elastography and Related Reportsmentioning

confidence: 99%

Breast elastography: A literature review

Goddi¹,

Bonardi

Alessi

2012

Journal of Ultrasound

138

129

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“…The ACRIN 6666 study had a 76% compliance rate for short interval follow-up examinations, which is comparable with that reported by Helvie et al (57) for mammography. Further prospective validation of yearly follow-up of nonpalpable US BI-RADS category 3 lesions or of the use of elastography to up-or downgrade BI-RADS category 3 and 4a lesions is warranted to assess outcomes (58)(59)(60)(61). Ideally, the positive biopsy rate of USprompted biopsies can be substantially increased while maintaining the cancer detection rate.…”

Section: Breast Imaging: Probably Benign Lesions At Screening Breast mentioning

confidence: 99%

Probably Benign Lesions at Screening Breast US in a Population with Elevated Risk: Prevalence and Rate of Malignancy in the ACRIN 6666 Trial

Barr¹,

Zhang²,

Cormack³

et al. 2013

Radiology

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Purpose:To prospectively validate predefined breast ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) category 3 criteria in a multicenter setting in an elevated-risk population. Materials andMethods:The American College of Radiology Imaging Network 6666 database was reviewed for prospectively defined BI-RADS category 3 lesions. Patient characteristics, lesion US features at initial detection, and work-up recommendations were analyzed with descriptive statistics. Exact 95% confidence intervals (CIs) were given, where appropriate. Lesion reference standard was biopsy or a minimum of 1-year follow-up. In addition, malignancy rate for lesions that had at least 2 years of follow-up data or that had biopsy data was calculated. Results:Of 2662 : 0.3%, 1.7%) occurred in five (1.0%) of 519 participants: Five malignancies were invasive (median size, 10 mm; size range, 2-18 mm), and one was node positive. When the analysis is limited to lesions with at least 2-year follow-up or biopsy, the malignancy rate among BI-RADS category 3 lesions is 0.9% (95% CI: 0.3%, 2.0%). Three malignant BI-RADS category 3 lesions were sampled for biopsy because of a suspicious change at follow-up (two N0 lesions, one each at 6-and 12-month follow-up; one N1 lesion at 24-month follow-up), one was sampled for biopsy because of an upgrade after additional mammography (NX), one was found at mastectomy for another cancer (N0), and one was found at prophylactic contralateral mastectomy in the same patient (NX). Conclusion:As BI-RADS category 3 lesions have a low malignancy rate (0.8%; 95% CI: 0.3%, 1.7%) and only 0.1% of the cancers had suspicious changes at 6-month follow-up and only one (17%; 95% CI: 0.4%, 64%) of six malignancies were node positive at detection (24-month follow-up), a recommendation of 1-year diagnostic follow-up may be appropriate for BI-RADS category 3 lesions detected at screening US.q RSNA, 2013 Supplemental material: http://radiology.rsna.org/lookup /suppl

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“…20 In one series, 10% of complicated cysts appeared as solid masses on B-mode that could be identified as complicated cysts with this technique. If core biopsies are performed, notifying the pathologist the lesion is a complicated cyst as opposed to a solid mass will lead to better pathology/imaging correlation.…”

Section: Dovepressmentioning

confidence: 98%

“…This artifact is characterized by a white central signal within a black outer signal and a bright spot posterior to the lesion. 20 This artifact has a high predictive value for the lesion being a benign simple or complicated cyst. If there is a solid component in the cyst, it will appear as a solid lesion within the pattern.…”

Section: Physicsmentioning

confidence: 99%

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Artifacts in diagnostic ultrasound

Hindi¹,

Peterson²,

Barr³

2013

RMI

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Ultrasound artifacts are encountered daily in clinical practice and may be a source of confusion on interpretation. Some artifacts arise secondary to improper scanning techniques and may be avoidable. Other artifacts are generated by the physical limitations of the technique. Recognition of artifacts is important, as they may be clues to tissue composition and aid in diagnosis. The ability to recognize and correct potential ultrasound artifacts is important for image-quality improvement and optimal patient care. In this article, we review common ultrasound artifacts that occur in B mode, spectral and color Doppler, and elastography.

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The Utility of the "Bull's-Eye" Artifact on Breast Elasticity Imaging in Reducing Breast Lesion Biopsy Rate

Abstract: The bull's-eye artifact seen on EI on Siemens ultrasonography equipment is a promising tool in the evaluation and characterization of benign breast cysts and has the potential to significantly reduce the amount of unnecessary breast biopsy.

Cited by 41 publications

References 18 publications

Breast elastography: A literature review

Breast elastography: A literature review

Probably Benign Lesions at Screening Breast US in a Population with Elevated Risk: Prevalence and Rate of Malignancy in the ACRIN 6666 Trial

Artifacts in diagnostic ultrasound

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