Elastographic Evaluation of Indeterminate Breast Masses on Ultrasound

Abstract

Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound.

Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis.

Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20–85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values ​​of the malignant lesions were statistically higher when compared with the subcutaneous tissue or the adjacent fibroglandular tissue. The analysis of the receiver operating characteristic (ROC) curves for these two semiquantitative methods showed that both are considered satisfactory, with an area under the curve above 0.75 and statistical significance (p < 0.0001). The best results were obtained when using the findings of combined conventional ultrasound and qualitative elastography, with 100% sensitivity and 63.2% specificity.

Conclusions Elastography can be a useful complementary method, increasing the specificity and diagnostic accuracy of conventional ultrasound for the diagnosis of breast cancer in patients with indeterminate breast lesions.

Resumo

Objetivo Avaliar a acurácia diagnóstica da elastografia para identificação do câncer de mama em pacientes com lesões indeterminadas por ultrassom.

Métodos Estudo prospectivo, descritivo, com pacientes com lesões mamárias indeterminadas no ultrassom e indicação de biópsia percutânea ou cirúrgica. A elastografia foi avaliada por análise qualitativa e dois métodos de análise semiquantitativa.

Resultados Avaliamos 125 pacientes do sexo feminino com 159 lesões, com média de idade de 47 anos, variando de 20 a 85 anos. O ultrassom mostrou ser um método com boa sensibilidade (98,1%), mas com menor especificidade (40,6%). Na elastografia da análise qualitativa, a especificidade e acurácia foram de 80,2% e 81,8%, respectivamente. A dimensão média das lesões não mostrou diferença na classificação por elastografia. Para a elastografia semiquantitativa, os valores médios das lesões malignas foram estatisticamente maiores quando comparados ao tecido subcutâneo ou fibroglandular adjacente. A análise das curvas ROC para estes dois métodos semiquantitativos mostrou que ambos são considerados satisfatórios, com área abaixo da curva acima de 0,75 e significância estatística (p < 0,0001). Os melhores resultados foram obtidos com os achados de ultrassonografia combinada convencional e elastografia qualitativa, com sensibilidade de 100% e especificidade de 63,2%.

Conclusões A elastografia pode ser um método complementar útil, aumentando a especificidade e a precisão diagnósticas do ultrassom convencional para o diagnóstico de câncer de mama em pacientes com lesões mamárias indeterminadas.

Keywords

breast neoplasms - mammary ultrasonography - elastography - lesions

Palavras-chave

neoplasias da mama - ultrassonografia mamária - elastografia - lesões

• References

• 1 Wojcinski S, Boehme E, Farrokh A, Soergel P, Degenhardt F, Hillemanns P. Ultrasound real-time elastography can predict malignancy in BI-RADS®-US 3 lesions. BMC Cancer 2013; 13 (01) 159
• 2 Zhi H, Xiao XY, Ou B. , et al. Could ultrasonic elastography help the diagnosis of small (≤2 cm) breast cancer with the usage of sonographic BI-RADS classification?. Eur J Radiol 2012; 81 (11) 3216-3221
• 3 Lee JH, Kim SH, Kang BJ. , et al. Role and clinical usefulness of elastography in small breast masses. Acad Radiol 2011; 18 (01) 74-80
• 4 Balleyguier C, Ciolovan L, Ammari S. , et al. Breast elastography: the technical process and its applications. Diagn Interv Imaging 2013; 94 (05) 503-513
• 5 Barr RG. Sonographic breast elastography: a primer. J Ultrasound Med 2012; 31 (05) 773-783
• 6 Ricci P, Maggini E, Mancuso E, Lodise P, Cantisani V, Catalano C. Clinical application of breast elastography: state of the art. Eur J Radiol 2014; 83 (03) 429-437
• 7 Yerli H, Yılmaz T, Ural B, Gülay H. The diagnostic importance of evaluation of solid breast masses by sonoelastography. Ulus Cerrahi Derg 2013; 29 (02) 67-71
• 8 Yoon JH, Kim MH, Kim EK, Moon HJ, Kwak JY, Kim MJ. Interobserver variability of ultrasound elastography: how it affects the diagnosis of breast lesions. AJR Am J Roentgenol 2011; 196 (03) 730-736
• 9 Chang JM, Won JK, Lee KB, Park IA, Yi A, Moon WK. Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol 2013; 201 (02) W347-56
• 10 Itoh A, Ueno E, Tohno E. , et al. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006; 239 (02) 341-350
• 11 Kumm TR, Szabunio MM. Elastography for the characterization of breast lesions: initial clinical experience. Cancer Contr 2010; 17 (03) 156-161
• 12 Goddi A, Bonardi M, Alessi S. Breast elastography: A literature review. J Ultrasound 2012; 15 (03) 192-198
• 13 Carlsen JF, Ewertsen C, Lönn L, Nielsen MB. Strain elastography ultrasound: an overview with emphasis on breast cancer diagnosis. Diagnostics (Basel) 2013; 3 (01) 117-125
• 14 Thomas A, Degenhardt F, Farrokh A, Wojcinski S, Slowinski T, Fischer T. Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol 2010; 17 (05) 558-563
• 15 Schaefer FKW, Heer I, Schaefer PJ. , et al. Breast ultrasound elastography--results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol 2011; 77 (03) 450-456
• 16 Tan SM, Teh HS, Mancer JFK, Poh WT. Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography--a clinical approach. Breast 2008; 17 (03) 252-257
• 17 Tardivon A, El Khoury C, Thibault F, Wyler A, Barreau B, Neuenschwander S. [Elastography of the breast: a prospective study of 122 lesions]. J Radiol 2007; 88 (5 Pt 1): 657-662
• 18 Thomas A, Fischer T, Frey H. , et al. Real-time elastography--an advanced method of ultrasound: First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 2006; 28 (03) 335-340
• 19 Cho N, Moon WK, Park JS, Cha JH, Jang M, Seong MH. Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol 2008; 9 (02) 111-118
• 20 Barr RG, Nakashima K, Amy D. , et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast. Ultrasound Med Biol 2015; 41 (05) 1148-1160
• 21 Farrokh A, Wojcinski S, Degenhardt F. [Diagnostic value of strain ratio measurement in the differentiation of malignant and benign breast lesions]. Ultraschall Med 2011; 32 (04) 400-405
• 22 Zhou J, Zhou C, Zhan W, Jia X, Dong Y, Yang Z. Elastography ultrasound for breast lesions: fat-to-lesion strain ratio vs gland-to-lesion strain ratio. Eur Radiol 2014; 24 (12) 3171-3177
• 23 Stachs A, Hartmann S, Stubert J. , et al. Differentiating between malignant and benign breast masses: factors limiting sonoelastographic strain ratio. Ultraschall Med 2013; 34 (02) 131-136
• 24 Fleury EdeF, Assunção-Queiros MdoC, Roveda Jr D. Breast carcinomas: variations in sonoelastographic appearance. Breast Cancer (Dove Med Press) 2014; 6: 135-143
• 25 Chang JM, Moon WK, Cho N, Kim SJ. Breast mass evaluation: factors influencing the quality of US elastography. Radiology 2011; 259 (01) 59-64
• 26 Raza S, Odulate A, Ong EMW, Chikarmane S, Harston CW. Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med 2010; 29 (04) 551-563