Value of Sonographic Bidirectional Arterial Flow Combined With Elastography for Diagnosis of Breast Imaging Reporting and Data System Category 4 Breast Masses

Liu, Da; Huang, Ying; Tian, Dan; Yin, Jie; Deng, Lei

doi:10.7863/ultra.35.5.759

Cited by 6 publications

(9 citation statements)

References 30 publications

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“…The presence of BAF was found to have sensitivity of 72.73 per cent and specificity of 64.71 per cent. Our values were slightly different from the results obtained in the study conducted in 116 BI-RADS category 4 lesions by Liu et al 14 who obtained sensitivity of 64.9 per cent, specificity of 98.7 per cent. This disparity could be due to the small sample size used in the present study.…”

Section: Discussioncontrasting

confidence: 99%

“…at least three positive variables out of eight variables). The diagnostic performance of the combined method was found to have high sensitivity (100%), specificity (76.47%), PPV (89.19%), NPV (100%) and accuracy (92%) in tandem with proposing the combined use of elastography and Doppler to increase the diagnostic performance 13 14 26 27 .…”

Section: Discussionmentioning

confidence: 99%

“…Hypervascularisation (two or more circumferential or central vessels or penetrating vessel in mass), a penetrating vessel in the mass, branching and disordered course of vessels and RI >0.85 were considered as probable malignant criteria by Elkharbotly and Farouk 13 . A novel Doppler sign-bidirectional arterial flow (BAF) was evaluated by Liu et al 14 in 2015 for differentiating BI-RADS category 4 masses. It is defined as the occurrence of two vessels with different arterial blood flow directions within the same breast mass, as indicated by red and blue colours on colour and spectral Doppler study.…”

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Novel approach in the evaluation of ultrasound BI-RADS 3 & 4 breast masses with a combination method of elastography & Doppler

et al. 2021

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Background & objectives : Ultrasound BI-RADS categories 3 and 4 constitute those breast masses which cannot be confidently classified as benign or malignant, owing to their morphological characteristics. These masses are further managed by follow up and biopsy, respectively. This study aims to evaluate the role of strain elastography and Doppler in better characterization of these sonographically indeterminate breast masses as benign or malignant. Methods : Fifty female patients with ultrasound BI-RADS 3 or 4 were evaluated with strain elastography and color Doppler including spectral analysis. Eight variables were assessed by elastography and Doppler, including a new phenomenon called bidirectional arterial flow (BAF). The findings were correlated with the gold standard diagnostic method of histopathology/cytology. Based on findings of combined elastography and Doppler method, the initial ultrasound BI-RADS categories of masses were re-categorized by up-gradation or down-gradation. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value and receiver operating characteristic (ROC) curves were used to estimate the diagnostic performance of the combination method. Results : Using ROC analysis, the positivity of ≥3 among the total eight variables correlated with malignancy on histopathology. Sensitivity, specificity and accuracy of the combination method using cut-off score ≥3 ( i.e . at least three out of the eight parameters in the combination method being positive) for the prediction of malignancy was 100, 76.47 and 92 per cent, respectively, with the area under curve being 0.967. In addition, BAF was found predictive of malignancy with a diagnostic accuracy of 70 per cent. Interpretation & conclusions : This non-invasive, cheaper and readily accessible combination method of strain elastography and Doppler imaging can improve the diagnostic characterization of sonographically indeterminate breast masses and may obviate the need of magnetic resonance imaging and unnecessary biopsies, thus proving helpful in resource-poor countries.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

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Novel approach in the evaluation of ultrasound BI-RADS 3 & 4 breast masses with a combination method of elastography & Doppler

et al. 2021

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“…To reduce the number of false-positive cases, elastography has been introduced as an additional diagnostic tool to B-mode US which helps clinicians decide whether or not to perform biopsy on USdetected lesions (6)(7)(8)(9)(10)(11)(12)(13). Several studies have evaluated the additional value of elastography in downgrading BI-RADS category 4a lesions detected on US and its effect on reducing the number of unnecessary biopsies being performed (11)(12)(13)(14)(15)(16). In one small series study, none of the BI-RADS category 4a lesions detected on US with soft elastography features was malignant; therefore, they could be managed with follow-up instead of biopsy (11).…”

Section: Introductionmentioning

confidence: 99%

“…In one small series study, none of the BI-RADS category 4a lesions detected on US with soft elastography features was malignant; therefore, they could be managed with follow-up instead of biopsy (11). Other studies also showed that elastography increased specificity when downgrading BI-RADS category 4a lesions and that its addition allowed patients to avoid unnecessary benign biopsies (12)(13)(14)(15)(16). However, biopsy is currently performed for all BI-RADS category 4a breast lesions in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors

et al. 2018

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Background Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions. Purpose To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women. Material and Methods Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors. Results Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography ( P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography ( P = 0.390). Conclusion In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.

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Advances in Breast Ultrasound

Eghtedari

Yang

2016

Curr Radiol Rep

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Value of Sonographic Bidirectional Arterial Flow Combined With Elastography for Diagnosis of Breast Imaging Reporting and Data System Category 4 Breast Masses

Abstract: Bidirectional arterial flow evaluation, when combined with elastography, could potentially improve diagnostic accuracy for BI-RADS category 4 breast masses.

Cited by 6 publications

References 30 publications

Novel approach in the evaluation of ultrasound BI-RADS 3 & 4 breast masses with a combination method of elastography & Doppler

Novel approach in the evaluation of ultrasound BI-RADS 3 & 4 breast masses with a combination method of elastography & Doppler

Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors

Advances in Breast Ultrasound

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