Does ARFI elastography complement B-mode ultrasonography in the radiological diagnosis of idiopathic granulomatous mastitis and invasive ductal carcinoma?

Abstract

Background Idiopathic granulomatous mastitis (IGM) is a chronic, unpleasant autoimmune inflammatory condition and is clinically and radiologically often confused with breast malignancy. Purpose To investigate the contributions of qualitative and quantitative aspects of acoustic radiation force impulse (ARFI) elastography to the differential diagnosis between IGM and invasive ductal carcinoma (IDC) in the breast. Material and Methods Ninety-four women with IDC and 39 with IGM were included in the study. Shear wave velocity (SWV) was calculated for all lesions using quantitative elastography. Next, each lesion’s correspondence on qualitative elastographic images to those on the B-mode images was evaluated: pattern 1, no findings on elastography images; pattern 2, lesions that were bright inside; pattern 3, lesions that contained both bright and dark areas; and pattern 4, lesions that were dark inside. Pattern 4 was subdivided into 4a (dark area same size as lesion) and 4b (dark area larger than lesion size). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results The mean SWV based on ARFI elastography was 3.78 ± 1.26 m/s for IGM and 5.34 ± 1.43 m/s for IDC lesions ( P < 0.05). Based on qualitative ARFI elastography, IDC lesions were mostly classified as pattern 4b, while IGM lesions were mostly classified as pattern 1 or 2 ( P = 0.01). Evaluation of both the qualitative and quantitative aspects of ARFI elastography yielded a sensitivity of 89% and specificity of 84%. Conclusion ARFI elastography may facilitate the differential diagnosis between IGM and IDC.

Clinical, Histopathological, Imaging, and Treatment Perspectives of Inflammatory Granulomatous Mastitis: Review of the Literature

“…This method allows a more objective and quantitative evaluation of breast lesion, specifically differentiating benign from malignant masses. A recent study by Toprak et al 31 investigating the qualitative and quantitative role of SWE in differentiating IGM from invasive ductal carcinoma (IDC), found sensitivity and specificity of 89% and 84%, respectively. 31 …”

“…A recent study by Toprak et al 31 investigating the qualitative and quantitative role of SWE in differentiating IGM from invasive ductal carcinoma (IDC), found sensitivity and specificity of 89% and 84%, respectively. 31 …”

Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches

“…The extramammary manifestations includes erythema nodosum and regional lymphadenopathy, present in a quarter of patients ( 18 ). Ultrasound, as an imaging modality, is commonly used for diagnosis of IGM, indicating irregular hypoechoic masses, multiple hypoechoic masses, parenchymal heterogeneity, or heterogeneous echogenic areas on ultrasonographic examination ( 19 ). The common mammographic features are focal or diffuse asymmetric density ( 20 ), while magnetic resonance imaging is not routinely utilized in the evaluation of IGM ( 9 ).…”

Differential expression profiles of miRNA in granulomatous lobular mastitis and identification of possible biomarkers

“…The main manifestations of GLM are palpable breast lumps, swelling and pain on one or both sides of the breast, which may be accompanied by skin blushes, inversion of the nipple, mammary duct fistula, arthritis and fever ( 2 ). Radiological examination of GLM is not specific and it may be easily confused with breast cancer (BC) ( 3 ). Pathological examination is the gold standard for GLM diagnosis.…”