Breast Disease: Clinical Application of US Elastography for Diagnosis

Itoh, Ako; Ueno, Ei; Tohno, Eriko; Kamma, Hiroshi; Takahashi, Hideto; Shiina, Tsuyoshi; Yamakawa, Makoto; Matsumura, Takeshi

doi:10.1148/radiol.2391041676

Cited by 1,501 publications

(1,427 citation statements)

References 9 publications

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“…Ultrasound elastography was initially used with good results in the characterization of breast nodules [3,4]. Breast tissue can be uniformly compressed without difficulty, and this feature facilitates the visualization of areas with altered consistency.…”

Section: Discussionmentioning

confidence: 99%

The role of sonoelastography in the differential diagnosis of neck nodules

Rubaltelli

Stramare

Tregnaghi

et al. 2009

Journal of Ultrasound

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KEYWORDSTechnology assessment; Thyroid; Tumor.Abstract Sonoelastography is an imaging technique that provides information on tissue elasticity. Its use as a diagnostic procedure is based on the premise that pathological processes like cancer alter the physical characteristics of the involved tissue. Ultrasonographic studies of the neck can reveal the nonpalpable thyroid nodules, but the nature of these lesions generally has to be established on the basis of FNAB findings. In our hands, sonoelastography displayed a diagnostic accuracy of 86.2% in identifying thyroid nodule malignancy, with positive and negative predictive values (PPV and NPV) of 64% and 94.5%, respectively. In the study of cervical lymph nodes, the results were less impressive (sensitivity 75%, specificity 80%, accuracy 77%, PPV 80%, NPV 70%), but the information obtained with this technique can in our opinion be a useful adjunct to sonographic findings. Indeed, in 5 lymph nodes with sonographic features consistent with malignancy, sonoelastography revealed diffuse elasticity that was indicative of benign disease, which was confirmed by pathological studies. Other nodular lesions of the neck can also be evaluated with sonoelastography, including enlarged parotid glands, but the data in the literature are too limited to allow hypotheses on the role of this imaging modality in this field. Sonoelastography is rapid and simple to perform, and it appears to be a potentially useful tool for the differential diagnosis of neck nodules. This is particularly true of thyroid nodules. Our experience with these lesions indicates that diffuse elasticity is strongly correlated with benign disease. If this finding is confirmed in larger studies, sonoelastography might be used to identify thyroid nodules that do not require immediate biopsy.Sommario L'elastosonografia è una tecnica di imaging che fornisce informazioni relative alla elasticità dei tessuti e che può essere utilizzata nella pratica clinica basandosi sul presupposto che i processi patologici, come il cancro, inducono modificazioni della caratteristiche fisiche dei tessuti ammalati. Lo studio ecografico della loggia cervicale permette di individuare formazioni nodulari non palpabili all'interno della tiroide, tuttavia l'accuratezza diagnostica di questa tecnica è scarsa e per tale motivo il ricorso alla FNAB è spesso necessario. Nella nostra esperienza l'elastosonografia ha dimostrato, nella diagnosi differenziale dei nodi tiroidei, un'accuratezza diagnostica del 86,2% con VPN 94,5% e VPP 64%. Nello studio dei linfonodi cervicali i risultati ottenuti sono meno brillanti (sensibilità, specificità e accuratezza rispettivamente del 75%, 80% e 77% con VPP e VPN di 80% e 70%), ma riteniamo che le informazioni ottenibili possono in molti casi essere utili per integrare i dati ecografici; in particolare in 5 casi di linfonodi con caratteristiche morfo-strutturali indicative di malignità, l'elastosonografia ha dimostrato un pattern di completa elasticità, riconoscendo la natura benigna confermata dalle succes...

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Section: Discussionmentioning

confidence: 99%

The role of sonoelastography in the differential diagnosis of neck nodules

Rubaltelli

Stramare

Tregnaghi

et al. 2009

Journal of Ultrasound

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“…In the absence of validated criteria for the testes, we applied the five‐point scale according to Itoh et al . (2006), Rago et al . (2007, 2010), and Hong et al .…”

Section: Methodsmentioning

confidence: 99%

Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non‐palpable testicular lesions

et al. 2016

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SummaryThe purpose of this study was to evaluate prospectively the accuracy of qualitative and strain ratio elastography (SE) in the differential diagnosis of non‐palpable testicular lesions. The local review board approved the protocol and all patients gave their consent. One hundred and six patients with non‐palpable testicular lesions were consecutively enrolled. Baseline ultrasonography (US) and SE were correlated with clinical and histological features and ROC curves developed for diagnostic accuracy. The non‐palpable lesions were all ≤1.5 cm; 37/106 (34.9%) were malignant, 38 (35.9%) were benign, and 31 (29.2%) were non‐neoplastic. Independent risk factors for malignancy were as follows: size (OR 17.788; p = 0.002), microlithiasis (OR 17.673, p < 0.001), intralesional vascularization (OR 9.207, p = 0.006), and hypoechogenicity (OR, 11.509, p = 0.036). Baseline US had 89.2% sensitivity (95% CI 74.6–97.0) and 85.5% specificity (95% CI 75.0–92.8) in identifying malignancies, and 94.6% sensitivity (95% CI 86.9–98.5) and 87.1% specificity (95% CI 70.2–96.4) in discriminating neoplasms from non‐neoplastic lesions. An elasticity score (ES) of 3 out of 3 (ES3, maximum hardness) was recorded in 30/37 (81.1%) malignant lesions (p < 0.001). An intermediate score of 2 (ES2) was recorded in 19/38 (36.8%) benign neoplastic lesions and in 22/31 (71%) non‐neoplastic lesions (p = 0.005 and p = 0.001 vs. malignancies). None of the non‐neoplastic lesions scored ES3. Logistic regression analysis revealed a significant association between ES3 and malignancy (χ2 = 42.212, p < 0.001). ES1 and ES2 were predictors of benignity (p < 0.01). Overall, SE was 81.8% sensitive (95% CI 64.8–92.0) and 79.1% specific (95% CI 68.3–88.4) in identifying malignancies, and 58.6% sensitive (95% CI 46.7–69.9) and 100% specific (95% CI 88.8–100) in discriminating non‐neoplastic lesions. Strain ratio measurement did not improve the accuracy of qualitative elastography. Strain ratio measurement offers no improvement over elastographic qualitative assessment of testicular lesions; testicular SE may support conventional US in identifying non‐neoplastic lesions when findings are controversial, but its added value in clinical practice remains to be proven.

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“…RTE can be performed using conventional US equipment with dedicated software, and this method assesses the relative elasticity of the tissues in a specific area of interest (the RTE-box) creating an elastogram that is superimposed to the US image and updated in real-time at a frequency of 10e15 Hz [10,22].…”

Section: Elastographic Imagingmentioning

confidence: 99%

“…scirrhous carcinoma) or infiltration of the intraductal component (e.g. ductal carcinoma in situ) [10]. There are of course exceptions, e.g.…”

Section: The Basic Principles Of Elastography and Related Reportsmentioning

confidence: 99%

Breast elastography: A literature review

Goddi¹,

Bonardi

Alessi

2012

Journal of Ultrasound

141

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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Breast Disease: Clinical Application of US Elastography for Diagnosis

Abstract: For assessing breast lesions, US elastography with the proposed imaging classification, which was simple compared with that of the Breast Imaging Recording and Data System classification, had almost the same diagnostic performance as conventional US.

Cited by 1,501 publications

References 9 publications

The role of sonoelastography in the differential diagnosis of neck nodules

The role of sonoelastography in the differential diagnosis of neck nodules

Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non‐palpable testicular lesions

Breast elastography: A literature review

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