Characterization of Focal Breast Lesions by Means of Elastography

Abstract

Purpose: The modern method of sonoelastography of the breast is used for differentiating focal lesions. This review gives an overview of the different techniques available and discusses their roles in the routine clinical setting.

Materials and Methods: The presented techniques include compression or vibration elastography as well as shear wave elastography. Descriptions of the methods are supplemented by a discussion of the clinical role of each technique based on the most recent literature. We discuss by outlining two recent experimental approaches – MRI and tomosynthesis elastography.

Results: Currently available data suggest that elastography is an important supplementary tool for the differentiation of breast tumors under routine clinical conditions. The specificity improves with the immediate availability of additional diagnostic information using real-time techniques and/or the calculation of strain ratios (SR). Elastography is especially helpful in women with involuted breasts for differentiating BI-RADS-US 3 and 4 lesions and for evaluating very small cancers without the typical imaging features of malignancy. Here, elastography techniques are highly specific, while the sensitivity decreases compared to B-mode ultrasound. SR calculation is especially helpful in women who have a high risk of breast cancer and high pretest likelihood.

Conclusion: B-mode ultrasound is still the first-line method for the initial evaluation of the breast. If suspicious findings are detected, elastography with or without SR calculation is the most crucial supplementary tool.

Key Points:

• Improved specificity for elastography and SR calculation.

• Significant benefits for high-risk collective (BRCA mutation).

Citation Format:

• Fischer T, Sack I, Thomas A Characterization of Focal Breast Lesions by Means of Elastography. Fortschr Röntgenstr 2013; 185: 812 – 823

Zusammenfassung

Ziel: Die moderne Methode der sonografischen Elastografie der Brustdrüse dient der Differenzierung von Herdbefunden. Diese Übersichtsarbeit beschreibt die verschiedenen Methoden und Ansätze sowie deren Nutzen im klinischen Alltag.

Material und Methoden: Sowohl die Kompressions- oder Vibrationselastografie als auch die Scherwellenelastografie werden methodisch beschrieben und ihre Wertigkeit im klinischen Alltag anhand der aktuellen Literatur belegt. Ebenfalls werden MR- und Tomosynthese-Elastografie als experimenteller Ansatz diskutiert.

Ergebnisse: Bei der derzeitigen Datenlage kann die Elastografie als wichtiges Zusatzkriterium zur Differenzierung von Mammatumoren in der Routine Einzug halten. Es zeigt sich eine Verbesserung der Spezifität bei sofortigem Informationsgewinn durch den Einsatz der Real-Time-Methode und/oder der Strain-Ratio-Kalkulation (SR). Anwendungsgebiete sind in der Trennung der Kategorie BI-RADS-US 3 und 4, insbesondere bei Brustdrüseninvolution sowie bei sehr kleinen Karzinomen ohne typische Malignitätskriterien zu sehen, wo hoch spezifische Ergebnisse erzielt werden, wenngleich die Sensitivität im Vergleich zum B-Bild abfällt. Insbesondere im Subkollektiv mit hohem Brustkrebsrisiko sollte die hohe Vor-Testwahrscheinlichkeit der SR-Kalkulation Eingang in das diagnostische Prozedere finden.

Schlussfolgerung: Suchmethode der Wahl bleibt die B-Bildsonografie, erst bei auffälligem Befund stellt die Elastografie mit und ohne SR das entscheidende Zusatzkriterium dar.

Key words

elastography - strain ratio - breast lesion - ultrasound - MRI

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