Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring

Abstract

There has been controversy regarding the accuracy of breast ultrasound elastography (USE) compared to conventional B-mode Ultrasound (USB). The purpose of this study was to conduct a direct comparative effectiveness analysis of USB versus USE or their combination in differentiating breast lesions through systematically reviewing recent literature. An extensive literature search of PubMed and other medical and general purpose databases from inception through August 2011 was conducted. Published studies that reported a direct comparison of the diagnostic performance of USE, using elasticity score versus USB, using breast imaging reporting and data system (BIRADS) for characterization of focal breast lesions were included. Summary diagnostic performance measures were assessed for each of the tests and their combination using bivariate generalized linear mixed modeling. The two tests were combined as: (1) conjunctive, where the outcome of the combination of tests is positive only if both test results are positive; (2) disjunctive, where the outcome of a combination of tests is negative only if both tests are negative. Twenty nine studies provided relevant information on 5,511 breast masses (2,065 cancers, 3,446 benign lesions). Sensitivity of USB, USE, and their conjunctive and disjunctive combinations were 96% (95% credible interval (CrI), 93-98%), 79% (95% CrI, 74-83%), 73% (95% CrI, 67-78%), and 99% (95% CrI, 98-99%), respectively. Specificity of USB, USE, and their conjunctive and disjunctive combinations were 70% (95% CrI, 55-83%), 88% (95% CrI, 82-92%), 97% (95% CrI, 95-99%), and 56% (95% CrI, 43-69%), respectively. The application of USE as a single test is not superior to USB alone. However, in low risk patients it is recommended to perform an USE following a positive USB result to decrease the rate of unnecessary biopsies.

Elastography Complements Ultrasound as Principle Modality in Breast Lesion Assessment

“…By combining BI-RADS classification with TS and SR, specificity, PPV and NPV increased. This is in line with other published data [2,23,24] .…”

“…These findings are in line with the sensitivity and specificity of 96% (56-100%) and 70% (21-99%), respectively, reported by Sadigh et al [2] in their meta-analysis. For TS, our study reveals a sensitivity of 39%, which is lower than the average 79% reported by Sadigh et al [2] , although 39% is still within the range they observed (35-97%). Our values for TS specificity were more similar to theirs, with 94% in our study compared to 88% (70-99%) in theirs.…”

“…Nevertheless, to avoid unnecessary breast biopsies, investigators seek to improve breast cancer diagnosis with new US modalities such as real-time elastography (RTE), where differences in tissue stiffness are probed at the macroscopic scale [1,2] . More recently, indentation-type atomic force microscopy has emerged as a novel diagnostic tool that enables investigators to map the stiffness of fresh breast biopsy specimens at nanoscale resolution [3] .…”

Evaluation of Real-Time Tissue Sono-elastography in the Assessment of 214 Breast Lesions: Limitations of This Method Resulting from Different Histologic Subtypes, Tumor Size and Tumor Localization

“…Its diagnostic power has been reported in several publications (Farrokh et al 2011;Wojcinski et al 2010). A recent meta-analysis of 5511 lesions indicated that elastography has a sensitivity of 79% and a specificity of 88% when the Tsukuba elasticity score is used (Sadigh et al 2012). Several studies have reported that B-mode ultrasound has a higher sensitivity and a lower specificity than elastography.…”

Characterization of Focal Breast Lesions by Means of Elastography

“…Quantifiable results can also be reproducibly represented. In 2012 Sadigh et al conducted a first large metaanalysis regarding the use of ultrasound elastography (USE) for the differentiation of focal breast lesions compared to B-mode imaging (USB) and the combination of the two methods (dependent and independent) [44,45]. It was shown on the basis of 5,511 breast lesions that elastography alone increases the specificity from 70 % (USB) to 88 % (USE) but came at the price of a partially reduced sensitivity (96 % vs. 79 %), while the number of correct classifications did not differ significantly.…”