Value of shear-wave elastography in the diagnosis of symptomatic invasive lobular breast cancer

Sim, Yee Ting; Vinnicombe, Sarah; Whelehan, Patsy; Thomson, Kim; Evans, Andy

doi:10.1016/j.crad.2015.02.004

Cited by 23 publications

(17 citation statements)

References 17 publications

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“…7 SWE has the additional advantage of being equally sensitive for the detection of lobular cancers and ductal cancers, in contrast to greyscale ultrasound. 23 These data suggest that the rate of cancers having negative findings on both greyscale ultrasound and SWE will be lower than the false-negative rates of each modality alone. The practical clinical implications of our findings are substantial, for the patient and the wider National Health Service.…”

Section: Discussionmentioning

confidence: 92%

Shear-wave elastography and greyscale assessment of palpable probably benign masses: is biopsy always required?

Giannotti¹,

Vinnicombe²,

Thomson³

et al. 2016

BJR

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Objective: To establish if palpable breast masses with benign greyscale ultrasound features that are soft on shear-wave elastography (SWE) (mean stiffness ,50 kPa) have a low enough likelihood of malignancy to negate the need for biopsy or follow-up. Methods: The study group comprised 694 lesions in 682 females (age range 17-95 years, mean age 56 years) presenting consecutively to our institution with palpable lesions corresponding to discrete masses at ultrasound. All underwent ultrasound, SWE and needle core biopsy. Static greyscale images were retrospectively assigned Breast Imaging Reporting and Data System (BI-RADS) scores by two readers blinded to the SWE and pathology findings, but aware of the patient's age. A mean stiffness of 50 kPa was used as the SWE cut-off for calling a lesion soft or stiff. Histological findings were used to establish ground truth. Results:No cancer had benign characteristics on both modalities. 466 (99.8%) of the 467 cancers were classified BI-RADS 4a or above. The one malignant lesion classified as BI-RADS 3 was stiff on SWE. 446 (96%) of the 467 malignancies were stiff on SWE. No cancer in females under 40 years had benign SWE features. 74 (32.6%) of the 227 benign lesions were BI-RADS 3 and soft on SWE; so, biopsy could potentially have been avoided in this group. Conclusion: Lesions which appear benign on greyscale ultrasound and SWE do not require percutaneous biopsy or short-term follow-up, particularly in females under 40 years. Advances in knowledge: None of the cancers had benign characteristics on both greyscale ultrasound and SWE, and 32% of benign lesions were BI-RADS 3 and soft on SWE; lesions that are benign on both ultrasound and SWE may not require percutaneous biopsy or short-term follow-up.

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Section: Discussionmentioning

confidence: 92%

Shear-wave elastography and greyscale assessment of palpable probably benign masses: is biopsy always required?

Giannotti¹,

Vinnicombe²,

Thomson³

et al. 2016

BJR

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“…Here lies the importance of breast US as an adjunct in breast cancer screening. Sim et al describes 4 cases of ILC that were normal at both mammography and greyscale US, but suspicious on SWE [21].…”

Section: Discussionmentioning

confidence: 99%

“…US elastography imaging (EI) individuates benign and malignant breast lesions with high sensitivity and specificity [16][17][18][19][20]. A 2015 study concluded that shear-wave elastography (SWE) can diagnose lobular cancers that have benign findings on conventional imaging [21]. Strain elastography (SE) scores are associated with breast tumor grades [22].…”

Section: Introductionmentioning

confidence: 99%

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

Chiorean

Szep²,

Feier

et al. 2018

Med Ultrason

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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.

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“…Besides, several studies have indicated the correlation between SWE quantitative features and histologic prognostic factors—breast cancers with higher mean stiffness values at SWE had poorer prognostic features. [10,11] …”

Section: Introductionmentioning

confidence: 99%

3-Dimensional shear wave elastography of breast lesions

Chen

Chang²,

Zeng

et al. 2016

Medicine

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Color patterns of 3-dimensional (3D) shear wave elastography (SWE) is a promising method in differentiating tumoral nodules recently. This study was to evaluate the diagnostic accuracy of color patterns of 3D SWE in breast lesions, with special emphasis on coronal planes.A total of 198 consecutive women with 198 breast lesions (125 malignant and 73 benign) were included, who underwent conventional ultrasound (US), 3D B-mode, and 3D SWE before surgical excision. SWE color patterns of Views A (transverse), T (sagittal), and C (coronal) were determined. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were calculated.Distribution of SWE color patterns was significantly different between malignant and benign lesions (P = 0.001). In malignant lesions, “Stiff Rim” was significantly more frequent in View C (crater sign, 60.8%) than in View A (51.2%, P = 0.013) and View T (54.1%, P = 0.035). AUC for combination of “Crater Sign” and conventional US was significantly higher than View A (0.929 vs 0.902, P = 0.004) and View T (0.929 vs 0.907, P = 0.009), and specificity significantly increased (90.4% vs 78.1%, P = 0.013) without significant change in sensitivity (85.6% vs 88.0%, P = 0.664) as compared with conventional US.In conclusion, combination of conventional US with 3D SWE color patterns significantly increased diagnostic accuracy, with “Crater Sign” in coronal plane of the highest value.

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Value of shear-wave elastography in the diagnosis of symptomatic invasive lobular breast cancer

Cited by 23 publications

References 17 publications

Shear-wave elastography and greyscale assessment of palpable probably benign masses: is biopsy always required?

Shear-wave elastography and greyscale assessment of palpable probably benign masses: is biopsy always required?

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

3-Dimensional shear wave elastography of breast lesions

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