Elastography Complements Ultrasound as Principle Modality in Breast Lesion Assessment

Abstract

Background: The study aimed to improve breast cancer diagnosis with new ultrasound (US) modalities. We examined whether real-time elastography (RTE) complements the diagnostic performance of US. Methods: The Ethical Committee approved the study. Patients provided written informed consent and received a whole breast workup. Breast lesions were evaluated by US and RTE. Lesions were assessed by BI-RADS, Tsukuba score (TS) and strain ratio (SR). Results: The study included 164 breast lesions of which 101 were benign and 63 malignant. Women with benign lesions were predominantly premenopausal with sonographic dense breast tissue. Women with breast cancer were mostly postmenopausal, with a low sonographic density. Benign lesions had a mean TS of 2.05, which was significantly lower than the mean TS of 3.25 for malignant lesions. The SR for benign lesions (SR 1.83) was significantly smaller than for breast cancer (SR 4.83). Sensitivity and specificity was 95 and 81% for BI-RADS, 39 and 94% for TS, and 57 and 83% for SR, with a cutoff at 2.5. The combination of BI-RADS, TS and SR yielded a sensitivity of 95% and a specificity of 85%. Conclusion: Besides morphologic features revealed by US, elastic properties of breast lesions obtained by RTE can be exploited for diagnostic breast imaging.

Differentiation of Solid Breast Masses into Benign and Malignant by Using Gray Scale Ultrasonography and Strain Elastography

“…Our result showed higher specificity than Redling K (20) the reason could be higher cutoff limit of strain ratio that is 3 instead of 2.5. Subjective bias resulting from use of visual elastography score in the assessment of elastography images was avoided.…”

“…It is important to note that the strain ratio is dependent on the manufacturer of the elastography machine. According to Redling K (20) combination of BI-RADS, Tsukuba elasticity score and strain ratio gives sensitivity of 95% and a specificity of 85%.…”

Length Scale Matters: Real-Time Elastography versus Nanomechanical Profiling by Atomic Force Microscopy for the Diagnosis of Breast Lesions

“…SRs were calculated by the US system's built-in software. Based on previously published data, a cut-off SR value of 2.5 was applied to discriminate between benign and malignant lesions [ 9 ].…”

“…For example, elastography uses the stiffness differences of a mass compared to the healthy surrounding tissue for further characterization of the breast lesion. Real-time elastography (RTE) and shear wave elastography are the two modalities used in clinics as a noninvasive adjunct to breast US [ 6 – 9 ]. In RTE, external cyclic compression by the ultrasound probe leads to tissue displacement where soft areas are more readily displaced than harder areas [ 10 ].…”

“…Additional information on tissue elasticity is provided by the strain ratio (SR) between the breast lesion and adjacent fatty tissue [ 12 , 13 ]. Although elastography in combination with B-mode US improves specificity, accuracy, and positive predictive value (PPV) [ 9 , 14 , 15 ] it does not unambiguously distinguish between benign and malignant lesions.…”