Ultrasound real-time elastography can predict malignancy in BI-RADS®-US 3 lesions

Wojcinski, Sebastian; Boehme, Esther; Farrokh, André; Soergel, Philipp; Degenhardt, F; Hillemanns, Peter

doi:10.1186/1471-2407-13-159

Cited by 40 publications

(39 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thereby, the subgroup of lesions that has a very low risk (<2%) of being malignant, namely BI-RADS 3, can be separated from the higher risk groups and short-interval follow-up can be offered instead of biopsy. Although cancer incidence among BI-RADS 3 masses is reported to be independent of larger size, advanced age, and palpability, in our practice and in many others, patients with these features are referred for biopsy instead of follow-up (17)(18)(19). In our limited study, none of the probably benign masses that were referred for biopsy due to such relative risk factors took a malignant diagnosis.…”

Section: Discussionmentioning

confidence: 67%

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

T he Breast Imaging Reporting and Data Systems (BI-RADS) lexicon (1) of AmericanCollege of Radiology (ACR) provides an efficient and standardized assessment and management of breast lesions. It also stratifies breast cancer risk for a given lesion by classifying them into categories 1 through 5 according to the degree of suspicion.According to this system, solid masses with a circumscribed margin, oval shape (including those with two or three gentle lobulations) and parallel orientation on ultrasonography (US) exam are classified as BI-RADS 3. These types of masses are commonly seen at diagnostic and screening examinations. In this category malignancy is highly unlikely (less than 2%) and a short interval follow-up is recommended (1). However, up to one-third of such masses undergo biopsy mainly because of radiologist, referring clinician, or patient concern about the substantial risk of malignancy (2-4). Many BI-RADS 3 masses are traditionally referred for biopsy if they are palpable, large in size, patient is of advanced age or has a positive family history for breast cancer.The BI-RADS 4 assessment is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. This category is largely indeterminate and highly variable in outcome. Breast lesions in this category carry 2% to 95% risk for malignancy (1). Thus, almost all recommendations for breast biopsies come from assessments made using this category. According to BI-RADS classification; category 4 is subgrouped as 4A, 4B, and 4C to better inform the clinicians, pathologists, and patients of the degree of concern. However, the criteria for distinguishing among these subcategories have not been well delineated. BI-RADS 4A designates lesions with a low suspicion for malignancy. In this group, a benign pathologic diagnosis is expected and considered concordant (1). Studies of several institutions by the use of their internal criteria revealed positive predictive value (PPV) of 7%-9% for 4A lesions, and more than 50% of the suspicious lesions fall into this category. On the other hand, BI-RADS 4B and 4C 287From the Department of Radiology (S.K.  sibel_ozy@ yahoo.com) Karadeniz Technical University, School of Medicine, Trabzon, Turkey. BREAST IMAGING ORIGINAL ARTICLE PURPOSE We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates. METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging charact...

show abstract

Section: Discussionmentioning

confidence: 67%

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…Primary breast cancer and other metastatic disease to the breast are most often more stiff than the surrounding tissue on sonoelastography. [5][6][7]18 Several parameters have been used to predict malignancy when using US elastography. E/B ratio, the comparison of the lesion size on elastography to B-mode US, has been used to predict malignancy, with E/B ratios greater than 1 favoring malignancy.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

“…In the recent years, elastography has proven to be an effective additional imaging modality when studying breast cancer, particularly primary breast cancer. [5][6][7] Gkali et al 8 reported a case of primary non-Hodgkins lymphoma of the breast that demonstrated increased stiffness on strain elastography. However, Barr et al 9 has reported a case of breast lymphoma that was soft on both SE and SWE.…”

mentioning

confidence: 98%

Sonoelastography of Breast Lymphoma

Sousaris¹,

Barr²

2016

Ultrasound Quarterly

View full text Add to dashboard Cite

Breast lymphomas only account for approximately 0.15% of malignant breast carcinomas. Half of these are primary lymphomas, and the other half are metastatic to the breast. Ultrasound elastography has been proven to aid in the diagnosis of breast lesions as malignant or benign, with malignancy appearing stiffer compared with normal breast tissue. However, in this study, we review the findings of breast lymphoma on strain and shear wave ultrasonography. Lymphoma appears drastically different on sonoelastography than primary breast cancers, and it could easily be interpreted as benign. Therefore, the unique imaging findings in addition to the patient's clinical history are important in differentiating lymphoma of the breast from other possible diagnoses.

show abstract

“…The difference in specificity was most probably caused by false negative results in the color map mode: borderline lesions that are too hard to be a plain ES=3 score on the color map, but not hard enough for a score of 4. Some authors have stated that benefits of the RTE technique are seen in cases that have benign US characteristics, are classified as BI-RADS -US 3, and show increased hardness on elastography [30] and thus are reclassified in the BI-RADS -US 4 category [31].…”

Section: Discussionmentioning

confidence: 99%

Qualitative strain elastography – strain ratio evaluation - an important tool in breast cancer diagnostic

et al. 2016

View full text Add to dashboard Cite

Aims: To assess the quality of real time elastography as a differential diagnosis tool for breast nodules and to compare it with standard ultrasonography. Material and methods: In this prospective study we enrolled 174 patients in which 174 dominant breast nodules were considered for the final diagnosis. The results of ultrasonography and real time elastography, both qualitative and quantitative, were compared with pathology findings from the biopsy specimens. Results: Pathology examinations determined 102 nodules were benign and 72 malignant. Qualitative elastography had a better diagnostic performance (82.4% sensitivity and 81.9% specificity) than ultrasonography plus Doppler evaluation (70.3% sensitivity and 73.5% specificity). Quantitative elastography, assessed using the fat-to-lesion ratio, was a good discriminant for malignancy (AUROC = 0.93, p < 0.001). Our results pointed to an optimal threshold for malignancy of > 4.88; by using this threshold, the diagnostic reliability of the fat-to-lesion ratio was better than both ultrasonography and qualitative elastography (86.5% sensitivity and 90.4% specificity). Conclusion: Real time elastography is superior to ultrasonography in diagnosing malignant breast nodules. The evaluation of nodules using a fat-to-lesion ratio was a better discriminant for malignancy than qualitative elastography.

show abstract

Ultrasound real-time elastography can predict malignancy in BI-RADS®-US 3 lesions

Cited by 40 publications

References 21 publications

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Sonoelastography of Breast Lymphoma

Qualitative strain elastography – strain ratio evaluation - an important tool in breast cancer diagnostic

Contact Info

Product

Resources

About