Quantitative evaluation of tissue stiffness around lesion by sound touch elastography in the diagnosis of benign and malignant breast lesions

Abstract

The purpose of our study is to assess the diagnostic performance of quantitative evaluation of tissue stiffness around lesion by Sound Touch Elastography (STE) in distinguishing between benign and malignant breast lesions. A total number of 160 breast lesions from 160 female patients were examined by STE. Resona 7 was equipped with "shell" function to measure elastic modulus values of tissue in the region of surrounding lesion quantitatively. The contours of the lesion were required to be delineated. The elastic modulus values of tissue in the region of 1mm, 2mm, and 3mm outside the boundary were acquired. The elastic modulus values included maximum elastic modulus (E max), mean elastic modulus (E mean), minimum elastic modulus (E min), and elastic modulus standard deviation (E sd). All lesions were confirmed by histopathology. We compared the differences of the above elastic modulus values between benign and malignant groups. Receiver operating characteristic (ROC) curve was drawn with the histological diagnostic results as the gold standard. Sensitivity and specificity were calculated to evaluate the diagnostic performance of STE. Operator consistency was also analyzed. Among the 160 lesions, 100 (62.5%) were benign and 60 (37.5%) were malignant. In the region of 1mm, 2mm, and 3mm surrounding the lesion, E max , E mean , and E sd of malignant group were significantly higher than those of the benign group (all P<0.05). When the "shell" was 3mm, E max had the highest AUROC value (AUROC = 0.998). Regarding the measurement of elastic modulus values, all the intra-class correlation coefficient (ICC) values of the inter-operator consistency were greater than 0.75 for E max , E mean , and E sd. Therefore, quantitative evaluation of tissue stiffness around lesion by STE has the potential to distinguish between benign and malignant breast lesions.

Diagnostic performance of elastography for breast non-mass lesions: A systematic review and meta-analysis

“…Consequently, in a clinical context, these lesions require biopsy [22,25]. Recently, some studies [19,26,27] have reported that UE, which can detect differences in stiffness between normal breast tissue and NMLs, can facilitate characterization of breast NMLs [19,27] and thereby avoid 46-87.5% of benign biopsies [21]. Thus, it can offer an excellent method for diagnosing breast NMLs.…”

Methods for Studying Endometrial Pathology and the Potential of Atomic Force Microscopy in the Research of Endometrium

“… The differentiation of cancerous lesions based on elasticity measurements. Elastic modulus (E) of benign and malignant breast lesions determined by the sound touch elastography (STE) technique [ 68 ]. …”

The Mechanical Microenvironment in Breast Cancer

“…Indeed, breast carcinomas are characterized as being more stiff than glandular tissue [ 134 ]. This has led to new clinical technologies that show that stiffness evaluated by ultrasound-based sound touch elastography may aid breast cancer diagnosis [ 164 ] while stiffness measured by ultrasound-based shear wave elastography may provide prognostic value [ 165 , 166 ]. The effects and underlying mechanisms of stiffness on normal mammary tissue and tumors have been studied in greater detail and will be discussed further.…”

“…High average stiffness measured in vivo by shear wave elastography range is seen in human lobular (181 ± 67 kPa) and ductal tumors (139 ± 56 kPa) and stiffness increases with tumor grade (benign lesions defined as < 50 kPa, Grade 1 = 88 ± 62 kPa, Grade 2 = 143 ± 55 kPa, Grade 3 = 147 ± 58 kPa) [ 166 ]. Stiffness measured by sound touch elastography showed high average stiffness in malignant lesions (40.85 kPa) over benign lesions (19.02 kPa) [ 164 ]. Supersonic shear imaging was able to distinguish stiffness differences between fat, dense tissue, benign lesions and malignant lesions (3, 45, <80, and >100 kPa, respectively) [ 169 ].…”

“…Supersonic shear imaging was able to distinguish stiffness differences between fat, dense tissue, benign lesions and malignant lesions (3, 45, <80, and >100 kPa, respectively) [ 169 ]. Interestingly, there is typically higher stiffness in the periphery or edges of the tumors (known as the “stiff rim”) [ 164 , 166 , 170 ]. Many other reports using ultrasound-based techniques also find stiffness in breast cancer [ 171 , 172 , 173 , 174 , 175 ].…”