Second-Look-Ultraschall mittels Scherwellen-Elastografie bei Verdacht auf lokoregionales Rezidiv des Mammakarzinoms im MRT

Zusammenfassung

Ziel Es soll untersucht werden, ob der Second-Look-US mittels Scherwellen-Elastografie (SWE) nützlich ist, um zwischen benignen und malignen Veränderungen in der postoperativen Brust nach der operativen Therapie des Mammakarzinoms zu differenzieren.

Material und Methoden SWE und die damit verbundenen sonografischen Merkmale wurden bei 90 Patientinnen mit Anamnese einer operativen Therapie des Mammakarzinoms und einer bei der MRT-Nachuntersuchung entdeckten verdächtigen Läsion überprüft. Ein einziger erfahrener Radiologe führte alle Second-Look-US-Untersuchungen mit SWE-Messungen durch, indem er eine kreisförmige Region of Interest von 2 mm Durchmesser über dem steifsten Teil der Läsion legte. Gewebeproben für die histopathologische Untersuchung wurden dabei durch Stanzbiopsie entnommen.

Ergebnisse Von 90 Läsionen erwiesen sich 39 als maligne in der histopathologischen Untersuchung. Von den malignen Läsionen zeigten 50 % El_max-Werte im Bereich von 128 bis 199 kPa, und 50 % der benignen Läsionen hatten El_max-Werte von 65 bis 169 kPa. Ein Cut-off-Wert von 171,2 kPa für El_max zeigt eine Sensitivität von 59 % und eine Spezifität von 78,4 % für das Karzinomrezidiv und eine AUC von 0,706 (95 %-KI 0,6–0,81; p = 0,001). In univariaten logistischen Modellen erwiesen sich eingeschränkte Diffusion und Steifigkeit bei SWE, El_max > 171,2 kPa, als signifikante Rezidiv-Prädiktoren. Im multivariaten Modell bleibt die eingeschränkte Diffusion ein signifikanter unabhängiger Rezidiv-Prädiktor. Bei einer Rezidiv-Prävalenz von 43 % liegt die Testsensitivität bei 95 % (95 %-KI 81–99 %) und die Spezifität bei 75 % (95 %-KI 60–85 %).

Schlussfolgerung Steifere Läsionen in der postoperativen Brust sollten im Second-Look-Ultraschall als suspekt angesehen werden. SWE kann eine hilfreiche Methode zur Identifizierung maligner Läsionen sein, insbesondere im Zusammenhang mit einer eingeschränkten Diffusion in der MRTUntersuchung. Die Steifigkeit der Läsion sollte jedoch nicht als unabhängiger Prädiktor für die Läsionsmalignität in der postoperativen Brust angesehen werden, da in der SWE benigne Veränderungen steif, Karzinomrezidive hingegen weich erscheinen können.

Abstract

Purpose To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma.

Materials and Methods SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2 mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy.

Results Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had El_max values ranging from 128 to 199 kPa, and 50 % of benign lesions had El_max values ranging from 65 to 169 kPa. The cutoff value of 171.2 kPa for El_max shows a sensitivity of 59 % and specificity of 78.4 % for carcinoma recurrence, area under the curve 0.706 (CI95 % 0.6–0.81), P = 0.001. In univariate logistic models, restricted diffusion and stiffness on SWE, El_max > 171.2 kPa, were shown as significant recurrence predictors. In the multivariate model, restricted diffusion remains significant independent recurrence predictor. With a recurrence prevalence of 43 %, the test sensitivity is 95 % (CI95 % 81–99 %) and the specificity is 75 % (CI95 % 60–85 %).

Conclusion Stiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.

Key words

mamma - sonoelastografie - karzinom - rezidiv

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