Diagnostic Value of Elastography Using Acoustic Radiation Force Impulse Imaging and Strain Ratio for Breast Tumors

Abstract

PurposeThe aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone.MethodsARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch™ tissue imaging (VTI) and Virtual Touch™ tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations.ResultsAmong the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7±1.0 vs. 1.6±0.8, p<0.01), SWV (4.23±1.09 m/sec vs. 2.22±0.88 m/sec, p<0.01), and SR (5.69±1.63 vs. 2.69±1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each).ConclusionARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.

Combining Virtual Touch Tissue Imaging and BI-RADS May Improve Solid Breast Lesion Evaluation

“…Generally, benign lesions of the breast are harder than normal breast tissue but softer than malignant tumors [4][5][6]11]; however, there are exceptions. False-positive readings may be influenced by benign conditions that display poor elasticity such as scar tissue, hyperplasia, and fibroadenomas with a predominant fibrous component.…”

“…Published reports have shown that UE combined with US can reduce benign biopsies [1,3]. However, reports of the advantages and pitfalls of UE in the assessment of breast lesions have been discrepant [2,[6][7][8]. Therefore, summarization of experiences and further investigation of the role of UE in the assessment of breast lesions is necessary.…”

“…8 US and UE Examinations US and UE examinations were performed by 6 radiologists with 5-21 years of experience in US examination of the breast and 6 months' experience in UE examination of the breast. All examinations were carried out using the ACUSON S2000 TM ultrasound system (Siemens Medical Solutions) equipped with an L5 linear transducer (6)(7)(8)(9)(10)(11)(12)(13)(14). US evaluation of the breast was carried out at a frequency of 11-14 MHz at first, focusing on focal lesions.…”

Acoustic Radiation Force Impulse quantitative elastography: a new noninvasive technique for the evaluation of parotid glands. A preliminary study in controls and in patients with irradiated nasopharyngeal carcinoma.

“…Transverse and longitudinal sonograms with subsequent diameter measurements of the PG were obtained. The volume was calculated automatically by the system using the three longest diameters (measured perpendicularly) and a multiplication factor of 0.52 [16].…”

Comparison of Virtual Touch Tissue Quantification with Strain Ratio in Differentiating Malignant from Benign Cervical Lymph Nodes

“…This potentially improves the characterization of tissues and focal lesions in an objective way. VTTQ has been used in diagnosis of hepatic disease and breast lesions [8][9][10][11] , but there are few reports about VTTQ technique in LNs examination 12,13) . Thus we proposed a study to assess the VTTQ technique in differentiating malignant from benign LNs by contrasting with SR.…”