Sonoelastography in the Diagnosis of Malignant and Benign Breast Lesions: Initial Clinical Experiences

Abstract

Zusammenfassung ! Ziel: Ziel der prospektiven Untersuchung war es, Ultraschall-Elastografie, B-Bild-Sonografie und Mammografie hinsichtlich ihrer Aussagekraft zur Dignität von Herdbefunden zu vergleichen. Weiterhin wurde untersucht, ob sich die Ergebnisse in der Gruppe palpabler Befunde von denen in der Gruppe nicht palpabler Befunde unterscheiden. Material und Methoden: Es wurden 97 histologisch ungesicherte Herdbefunde (66 benigne, 31 maligne) untersucht. Sensitivität, Spezifität, positiv (PPW) und negativ prädiktiver Wert (NPW) und Effizienz wurden berechnet. Die Wertigkeit der Elastografie wurde zusätzlich in der Gruppe palpabler Befunde und in der Gruppe nicht palpabler Befunde getrennt betrachtet und verglichen. Ergebnisse: Die Sonografie erreichte eine Sensitivität von 97 % und eine Spezifität von 82 % (PPW 71 %, NPW 98 %, Effizienz 87 %) bzw. 84 % und 89 % für die Mammografie (PPW 79 %, NPW 92 %, Effizienz 88 %). Die Sensitivität der Elastografie lag bei 71 %, die Spezifität bei 48 % (PPW 39 %, NPW 78 %, Effizienz 56 %). Die Kombination aus Sonografie und Elastografie brachte eine Sensitivität von 100 % und eine Spezifität von 38 % (PPW 43 %, NPW 100 %, Effizienz 58 %). Sensitivität und Spezifität waren zwischen den Gruppen der palpablen und nicht palpablen Befunden nicht signifikant unterschiedlich. Schlussfolgerung: Die Elastografie stellt ein klinisch einfach anwendbares Diagnoseverfahren dar. Die Effizienz der Methode in der alleinigen Anwendung zeigt keine Vorteile gegenüber alternativen Methoden. In Kombination mit der B-Bild-Sonografie aber wurde deren Sensitivität auf Kosten der Spezifität gesteigert. Abstract !Purpose: This prospective study aimed to compare sonoelastography, B-mode ultrasonography, and mammography in terms of their ability to distinguish benign from malignant breast lesions. We also assessed how the diagnostic value of sonoelastography differs between palpable and clinically occult lesions. Materials and Methods: Evaluation revealed a total of 97 lesions (66 benign; 31 malignant) without histological confirmation at the time of the initial examination. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) as well as efficiency were calculated. These parameters were separately assessed for palpable lesions and for non-palpable lesions. We subsequently compared these results. Results: Sonography had a sensitivity of 97% and a specificity of 82% (PPV: 71 %, NPV: 98 %, efficiency: 87%). For mammography, the respective figures were 84 % and 89 % (PPV: 79%, NPV: 92%, efficiency: 88 %). Sonoelastography had a sensitivity of 71 % and a specificity of 48 % (PPV: 39%, NPV: 78 %, efficiency: 56 %). The combination of sonography and sonoelastography yielded a sensitivity of 100 % and a specificity of 38% (PPV: 43%, NPV: 100 %, efficiency: 58%). The sensitivity and specificity were not statistically different between the groups of palpable and non-palpable lesions. Conclusion: Sonoelastography is easily performed and not very time-consuming. Used by itself, the met...

Three Cases of Adenomyoepithelioma: An Unusual Breast Neoplasm

“…Malignant lesions have a harder structure than benign lesions, and therefore are less elastic due to increased fibrosis and desmoplastic reaction in their structure. When used in conjunction with B-mode US, the latter's sensitivity was increased [7]. AME often has a benign clinical course; however, malignant transformation can rarely develop from one or both cellular components [8].…”

Correlation of Tumoral Prognostic Factors by Sonoelastography Score in Patients to be Operated Due to Breast Cancer

“…In recent years, researches have been performed on the use of the elastography technique on discrimination of malignant and benign bulks [14][15][16]. But no study searching the existence of predictive power of prognosis and relation with tumoral prognostic factors of this technique is found in the literature.…”

Breast Sonography – 2D, 3D, 4D Ultrasound or Elastography?

“…Using scores 1-3 for benign and scores 4 and 5 for malignant lesions, elasticity showed a sensitivity of 87% and a specificity of 90%. In the publication of Hatzung et al [30], the same score system was applied, but they found the highest sensitivity for elastography using scores 1 and 2 for benign and scores 3-5 for malignant lesions. The sensitivity was 71%, the specificity 48%, the ppv 39%, and the npv 78%.…”

“…In most of the publications, elasticity is not studied as a stand-alone feature. It is used as a complementary technology to B-mode imaging [22,30]. Based on the literature, the sensitivity of B-mode breast US varies from 57% to 97% and the specificity from 60% to 90%.…”

“…Education, experience, and technical equipment can be improved by teaching and using modern US systems. A state-of-the-art breast US unit combined with experienced investigators offers high sensitivity of 97%, specificity of 82%, a positive predictive value (ppv) of 71%, and a negative predictive value (npv) of 78% [30]. To analyze breast lesions with B-mode imaging means to collect mosaic stones and to put them together as a basis for the decision on BI-RADS 2 or 3, which means that no needle biopsy is necessary, or BI-RADS 4 or 5, with the typical consequence of core needle or vacuum aspiration biopsies [31][32][33][34][35][36].…”