Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours

Purpose

This study was undertaken to evaluate the value of quantitative elastography in the diagnosis of breast tumours.

Materials and methods

Conventional ultrasound (US) and quantitative elastography were performed in 108 women with 114 breast lesions by two experienced radiologists, and pathological results were available in all cases. For each lesion, the maximum, mean, and minimum (min) elasticity and elasticity ratio between lesions and surrounding tissue were measured. The Breast Imaging Reporting and Data System (BI-RADS) categories were assessed with conventional US in all lesions.

Results

Malignant lesions exhibited significantly higher maximum and mean elasticity (111.57±69.29 kPa and 54.49±33.70 kPa) than did benign lesions (59.00±45.3 kPa and 36.64±26.18 kPa) (p<0.01). For maximum elasticity versus BI-RADS, performance results were sensitivity 60.9 % vs. 78.3%, specificity 85.3% vs. 98.5%, positive predictive value (PPV) 73.7% vs. 97.3 %, negative predictive value (NPV) 76.3% vs. 87.0 % and accuracy 75.4% vs. 90.3%. BI-RADS had significantly better accuracy than maximum elasticity (p<0.01). Maximum and mean elasticity of invasive ductal carcinoma (IDC) were significantly higher than those of fibroadenoma (p<0.01), whereas the difference was not statistically significant with fibroadenosis, papilloma and inflammation (p>0.01). Maximum and mean elasticity and elasticity ratio of BI-RADS 5 were all significantly higher than those of BI-RADS 3 (p<0.01). Reliability for maximum and mean elasticity were almost perfect [intraclass correlation coefficients (ICC)=0.87 and 0.79].

Conclusions

Shear-wave elastography gives quantitative elasticity information that could potentially help in breast-lesion characterisation, although it cannot replace conventional BI-RADS in the differentiation of breast lesions.     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

Comparison of automated breast volume scanning to hand-held ultrasound and mammography

Purpose

Our aim was to investigate the diagnostic potential of automated breast volume scanning (ABVS) and compare it with manual ultrasound (US) and mammography.

Patients and methods

One hundred and fifty-five patients with a total of 165 breast lesions had mammograms, manual US and an ABVS. Multiplanar reconstructions in coronal, transverse and sagittal views were reconstructed from the automated data set. After biopsy or surgery, all lesions were confirmed histologically. Data were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) classification. Detection rate, diagnostic accuracy, sensitivity, specificity and positive (PPV) and negative (NPV) predictive value of each method were analysed.

Results

Detection rate, diagnostic accuracy and mammography sensitivity were significantly lower than those of each US method (p<0.05). There were no significant differences between manual US and ABVS. When combining ABVS, US and mammography, diagnostic accuracy, sensitivity and specificity reached 96.4%, 97.1% and 95.2%, respectively. A spiculated and stellate margin in the coronal plane has a high specificity in diagnosing malignant lesions.

Conclusions

ABVS can provide additional information in the differential diagnosis of a lesion. It has significantly higher sensitivity than mammography, but it is similar to manual US and cannot be preferred to a manual US examination.     

Potential role of shear-wave ultrasound elastography for the differential diagnosis of breast non-mass lesions: preliminary report

Objectives

To report our preliminary experience with shear-wave elastography (SWE) for non-mass lesions (NMLs) in the breast and suggest a potential ancillary role of SWE for BI-RADS Category 4a NMLs in reducing the number of unnecessary benign biopsies.

Methods

A total of 310 breast lesions in 286 consecutive women who had been scheduled for US-guided automated gun biopsy or vacuum-assisted biopsy between June and December 2012 were initially included in this study. Finally, 33 women with 34 breast lesions classified as NMLs constituted our study population. Diagnostic performances of each quantitative SWE parameter were calculated. Histological diagnosis was used as a reference standard.

Results

Among the 34 breast NMLs, 22 (65 %) were benign and 12 (35 %) were malignant. E_mean value with cut-off set at 41.6 kPa had the highest Az value 0.788 (95 % CI, 0.625–0.951), showing sensitivity of 83.3 % and specificity of 68.2 %. By applying an E_mean value of 41.6 kPa or less as a criterion for downgrading soft BI-RADS category 4a NMLs to category 3 NMLs, 15 unnecessary biopsies could have been eliminated from the 19 BI-RADS category 4a lesions (79 %).

Conclusions

SWE features could increase positive predictive values and reduce unnecessary benign biopsies of category 4a NMLs.

Key points

? Ultrasound elastography is increasingly used to assess the stiffness of breast lesions ? Shear-wave elastography provides useful information about non-mass breast lesions ? Shear-wave elastography may render some biopsies of non-mass breast lesions unnecessary     

Quantitative assessment of shear-wave ultrasound elastography in thyroid nodules: diagnostic performance for predicting malignancy

Objectives

To evaluate the predictability of shear-wave ultrasound elastography (SWE) for thyroid malignancy and to compare the diagnostic performances of SWE and B-mode US.

Methods

Retrospective review of 99 patients who underwent SWE before US-guided fine-needle aspiration of thyroid nodules was performed. SWE elasticity indices of the mean (E_mean ), maximum (E_max), and minimum (E_min) of nodules were measured. Diagnostic performance of SWE was compared with that of B-mode US.

Results

Among a total of 99 nodules, 21 were papillary thyroid carcinoma (PTC) and 78 were benign. E_mean, E_max, and E_min were significantly higher in PTCs than in benign nodules (P?<?0.001). Sensitivity and specificity for predicting malignancy were 76.1 %, 64.1 % with E_max (65 kPa), 61.9 %, 76.1 % with E_min (53 kPa), and 66.6 %, 71.6 % with E_mean (62 kPa). Areas under the ROC curves (Az) of SWE values were not significantly different from those of US categories on B-mode US. However, combining E_mean and E_min with B-mode US of probably benign lesions improved the specificity (P?=?0.02, 0.007) for predicting PTC.

Conclusions

The quantitative parameter of SWE was significantly higher in PTC than in benign nodules, and combined use of quantitative SWE and B-mode US provided higher specificity for predicting malignancy.

Key Points

? Quantitative shear-wave elastography (SWE) helps differentiate benign from malignant nodules ? SWE and conventional ultrasound have comparable diagnostic performance for predicting thyroid malignancy ? Combined quantitative SWE and B-mode ultrasound is highly specific for thyroid malignancy     

Role of magnetic resonance imaging in probably benign (BI-RADS category 3) microcalcifications of the breast

Purpose

This study was undertaken to evaluate whether magnetic resonance (MR) imaging is able to rule out malignancy in the case of BI-RADS 3 microcalcifications, providing a sufficient negative predictive value (NPV) for early work-up, and to reduce unnecessary stereotactically guided vacuum-assisted biopsy (SVAB) procedures.

Materials and methods

We prospectively enrolled consecutive women with BI-RADS 3 microcalcifications, who subsequently underwent MR imaging and SVAB. The MR studies were reviewed according to the MR-BI-RADS classification system; lesions assessed as MR-BI-RADS 1 and 2 were considered negative for malignancy, categories MR-BI-RADS 3, 4 and 5 indicated malignant lesions. The presence of additional findings was recorded. Histologic analysis and follow-up were the reference standard. MR sensitivity, specificity, positive predictive value (PPV) and NPV were calculated.

Results

The final population consisted of 71 lesions. Histologic analysis showed malignancy in six cases (malignancy rate 8 %). At MR analysis, 60 (85 %) lesions were considered negative for malignancy and 11 (15 %) malignant. Additional MR imaging findings were identified in 19 (27 %) patients, all corresponding to nonmalignant lesions. MR sensitivity was 33 %, specificity 86 %, PPV 18 % and NPV 93 %.

Conclusions

Because of its relatively low NPV, MR imaging is not able to safely exclude malignancy in the case of BI-RADS 3 microcalcifications. The relatively high malignancy rate found in this study might support SVAB in the case of BI-RADS 3 microcalcifications.     

Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4

Objectives

To evaluate the diagnostic performance of shear-wave elastography (SWE) for breast cancer and to determine whether the integration of SWE into BI-RADS with subcategories of category 4 improves the diagnostic performance.

Methods

A total of 389 breast masses (malignant 120, benign 269) in 324 women who underwent SWE before ultrasound-guided core biopsy or surgery were included. The qualitative SWE feature was assessed using a four-colour overlay pattern. Quantitative elasticity values including the lesion-to-fat elasticity ratio (E_ratio) were measured. Diagnostic performance of B-mode ultrasound, SWE, or their combined studies was compared using the area under the ROC curve (AUC).

Results

AUC of E_ratio (0.952) was the highest among elasticity values (mean, maximum, and minimum elasticity, 0.949, 0.939, and 0.928; P?=?0.04) and AUC of colour pattern was 0.947. AUC of combined studies was significantly higher than for a single study (P?<?0.0001). When adding SWE to category 4 lesions, lesions were dichotomised according to % of malignancy: 2.1 % vs. 43.2 % (category 4a) and 0 % vs. 100 % (category 4b) for E_ratio and 2.4 % vs. 25.8 % (category 4a) for colour pattern (P?<?0.05).

Conclusions

Shear-wave elastography showed a good diagnostic performance. Adding SWE features to BI-RADS improved the diagnostic performance and may be helpful to stratify category 4 lesions.

Key points

? Quantitative and qualitative shear-wave elastography provides further diagnostic information during breast ultrasound. ? The elasticity ratio (E _ratio ) showed the best diagnostic performance in SWE. ? E _ratio and four-colour overlay pattern significantly differed between benign and malignant lesions. ? SWE features allowed further stratification of BI-RADS category 4 lesions.     

Breast ultrasound elastography—Results of 193 breast lesions in a prospective study with histopathologic correlation

Purpose

To evaluate the diagnostic performance of ultrasound elastography in breast masses.

Material and methods

193 lesions (129 benign, 64 malignant) were analyzed with the EUB 8500 Logos-ultrasonic-unit (Hitachi Medical, Japan) and a linear-array-transducer of 7.5-13-MHz. Standard of reference was cytology (FNAfine needle aspiration) or histology (core biopsy). The elastic-score was classified according to a 6-point colour-scale (Ueno classification; 1-3 = benign, 4-5 = malignant). Conventional B-mode ultrasound (US) findings were classified according to the BI-RADS classification. Statistical analysis included sensitivity, specificity, ROC-analysis and kappa-values for intra-/interobserver reliability.

Results

The mean score for elasticity was 4.1 ± 0.9 for malignant lesions, and 2.1 ± 1.0 for benign lesions (p < 0.001). With a best cut-off point between elasticity scores 3 and 4, sensitivity was 96.9%, and specificity 76%. Setting a best cut-off point for conventional US between BI-RADS 4 and 5, sensitivity was 57.8%, and specificity 96.1%. Elastography provided higher sensitivity and lower specificity than conventional US, but two lesions with elasticity score 1 were false negative, whereas no lesion scored BI-RADS 1-3 were false negative. ROC-curve was 0.884 for elastography, and 0.820 for conventional US (p < 0.001). Weighted kappa-values for intra-/interobserver reliability were 0.784/0.634 for BI-RADS classification, and 0.720/0.561 for elasticity scores.

Conclusion

In our study setting, elastography does not have the potential to replace conventional B-mode US for the detection of breast cancer, but may complement conventional US to improve the diagnostic performance.     

Real-time ultrasound elastography: an assessment of enlarged cervical lymph nodes

Objectives

To determine the efficacy of real-time elastography (RTE), compared with our previously proposed prediction model, in the detection of malignancy in cervical lymph nodes (LNs).

Methods

One hundred and thirty-one patients underwent ultrasound-guided fine needle aspiration biopsy (ultrasound FNAB) after ultrasound and RTE evaluation. The formula of the RTE scoring system was a four-point visual scale, based on a previously determined model. The formula of the prediction model was: $ 0.06\times \left( {\mathrm{age}} \right)+4.76\times \left( {{{{\mathrm{short}-\mathrm{axis}}} \left/ {{\mathrm{long}-\mathrm{axis}\;\mathrm{ratio}}} \right.}} \right)+2.15\times \left( {\mathrm{internal}\;\mathrm{echo}} \right)+1.80\times \left( {\mathrm{vascular}\;\mathrm{pattern}} \right) $ . An extended model was constructed with four previous predictors and elasticity scores, using a logistic regression model.

Results

Final histology revealed 77 benign and 54 malignant LNs. In the elasticity score system, sensitivity was 66.7 %, specificity was 57.1 %, the positive predictive value (PPV) was 52.2 % and the negative predictive value (NPV) was 71.0 %. In the prediction model system, sensitivity was 79.6 %, specificity was 92.2 %, the PPV was 87.8 % and the NPV was 86.6 %. When the extended and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) was 0.94 and 0.95, respectively (P?>?0.05).

Conclusions

Qualitative RTE offers no additional value over conventional ultrasound in predicting malignancy in cervical LNs.

Key Points

? An ultrasound system can help in the assessment of cervical lymph nodes. ? Grey-scale and power Doppler ultrasound remain fundamental for neck nodal evaluation. ? Qualitative real-time elastography provided no additional value compared with current prediction models.     

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound

Purpose

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI).

Materials and methods

Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up.

Results

Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered.

Conclusions

Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.     

Three-dimensional shear-wave elastography for differentiating benign and malignant breast lesions: comparison with two-dimensional shear-wave elastography

Objectives

To evaluate the interobserver agreement and the diagnostic performance of 3D shear-wave elastography (SWE) for breast lesions in comparison with 2D SWE.

Methods

A total of 163 breast lesions (malignant 48, benign 115) in 146 women who underwent B-mode ultrasound and SWE before biopsy were included. Two radiologists reviewed six data sets (B-mode, SWE, and a combination of both for 2D and 3D ultrasound). B-mode and SWE features were recorded. BI-RADS category was assigned for B-mode and combined sets. Interobserver variability was assessed using the κ statistic. Diagnostic performance of each data set was evaluated using the area under the ROC curve (AUC).

Results

SWE showed substantial to almost perfect agreement, with E_homo in 2D SWE being higher than in 3D SWE. The AUC of 2D SWE was higher than 3D SWE for all SWE features, significantly so for E_col (0.933 vs. 0.867, P?=?0.002) and E_max (0.961 vs. 0.874, P?=?0.006). After adding SWE to B-mode ultrasound, the AUC in 2D ultrasound increased significantly (0.968 vs. 0.912, P?=?0.008), but 3D ultrasound showed no significant difference (0.966 vs. 0.935; P?=?0.07).

Conclusion

For 3D SWE, interobserver agreement was good, but the diagnostic performance was inferior to 2D SWE even after adding to B-mode ultrasound.

Key Points

? Shear-wave elastography (SWE) provides further diagnostic information during breast ultrasound. ? 3D SWE diagnostic performance is inferior to 2D SWE. ? In 3D SWE, interobserver agreement was good. ? 2D B-mode ultrasound showed significant diagnostic improvement when combined with 2D SWE. ? 3D B-mode ultrasound performance was not significantly improved when combined with 3D SWE.     

Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses?

Objective

To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses.

Materials and methods

Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria.

Results

Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p < 0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p < 0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively.

Conclusion

PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.     

Impact of breast mass size on accuracy of ultrasound elastography vs. conventional B-mode ultrasound: a meta-analysis of individual participants

Objectives

To conduct an individual patient data meta-analysis comparing the diagnostic performance of ultrasound elastography (USE) versus B-mode ultrasound (USB) across size ranges of breast masses.

Methods

An extensive literature search of PubMed and other medical/general purpose databases from inception through August 2011 was conducted. Corresponding authors of published studies that reported a direct comparison of the diagnostic performance of USE using the elasticity score versus USB for characterisation of focal breast masses were contacted for their original patient-level data set. Summary diagnostic performance measures were compared for each test within and across three mass size groups (<10 mm, 10–19 mm, and >19 mm).

Results

The patient-level data sets were received from five studies, providing information on 1,412 breast masses. For breast masses <10 mm (n?=?543; 121 malignant), the sensitivity/specificity of USE and USB were 76 %/93 % and 95 %/68 %, respectively. For masses 10–19 mm of size (n?=?528; 247 malignant), sensitivity/specificity of USE and USB were 82 %/90 % and 95 %/67 %, respectively. For masses >19 mm of size (n?=?325; 162 malignant), sensitivity/specificity of USE and USB were 74 %/94 % and 97 %/55 %, respectively.

Conclusion

Regardless of the mass size, USE has higher specificity and lower sensitivity compared to USB in characterising breast masses. The performance of each of these two tests does not vary significantly by mass size.

Key Points

? Ultrasound elastography is increasingly used for breast lesions. ? Its diagnostic performance is not dependent on the size of the mass. ? Ultrasound elastography has higher specificity/lower sensitivity than B-mode ultrasound. ? Elastography is advised when B-mode results are equivocal.     

Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging

Objectives

To prospectively compare the diagnostic performance of ultrasound (US), multidetector computed tomography (MDCT) and contrast-enhanced magnetic resonance imaging (MRI) in cirrhotic patients who were candidates for liver transplantation.

Methods

One hundred and forty consecutive patients with 163 hepatocellular carcinoma (HCC) nodules underwent US, MRI and MDCT. Diagnosis of HCC was based on pathological findings or substantial growth at 12-month follow-up. Four different image datasets were evaluated: US, MDCT, MRI unenhanced and dynamic phases, MRI unenhanced dynamic and hepatobiliary phase. Diagnostic accuracy, sensitivity, specificity, PPV and NPV, with corresponding 95 % confidence intervals, were determined. Statistical analysis was performed for all lesions and for three lesion subgroups (<1 cm, 1-2 cm, >2 cm).

Results

Significantly higher diagnostic accuracy, sensitivity and NPV was achieved on dynamic + hepatobiliary phase MRI compared with US, MDCT and dynamic phase MRI alone. The specificity and PPV of US was significantly lower than that of MDCT, dynamic phase MRI and dynamic + hepatobiliary phase MRI. Similar results were obtained for all sub-group analyses, with particular benefit for the diagnosis of smaller lesions between 1 and 2 cm.

Conclusions

Dynamic + hepatobiliary phase MRI improved detection and characterisation of HCC in cirrhotic patients. The greatest benefit is for diagnosing lesions between 1 and 2 cm.

Key Points

? US, CT and MRI can all identify HCC in cirrhotic patients ? US has good sensitivity but suffers from false-positive findings ? Dynamic CT and MR have similar diagnostic performance for diagnosing HCC ? Dynamic + hepatobiliary phase MRI significantly improves detection and characterisation of HCC ? The greatest benefit is for the diagnosis of lesions between 1 and 2 cm     

Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound

Objective

To prospectively evaluate the technical feasibility of percutaneous real-time contrast-enhanced ultrasound (CEUS) guided biopsy of focal hepatic lesions that are not confidently localised on B-mode US.

Methods

The study included 44 patients (mean age, 61.3 years) whose biopsy target could not be confidently localised on B-mode US performed by two independent radiologists. Biopsy was attempted under the guidance of both CEUS and B-mode US simultaneously displayed on a single monitor. Final diagnosis was established based on the pathological examination of the biopsy specimen as well as on clinical and radiological follow-up.

Results

The size and depth of the target lesions were 18.0?±?9.0 mm (mean ± SD) and 41.8?±?17.2 mm respectively. Five patients with negative or indistinct CEUS findings did not undergo biopsy, while 39 patients completed the biopsy. In 38 of the 39 patients, the biopsy result was concordant with the final diagnosis. In the remaining one patient, the biopsy failed to prove metastasis. As there were six cases of technical failure, the technical success rate was 86% (38/44). The sensitivity in diagnosing malignancy was 88% (30/34).

Conclusion

Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localised on B-mode US.     

Combination of elastography and tissue quantification using the acoustic radiation force impulse (ARFI) technology for differential diagnosis of breast masses

Purpose

We evaluated the diagnostic performance of elastography and tissue quantification using acoustic radiation force impulse (ARFI) technology for differential diagnosis of breast masses.

Materials and methods

There were 161 mass lesions. First, lesion correspondence on ARFI elastographic images to those on the B-mode images was evaluated: no findings on ARFI images (pattern 1), lesions that were bright inside (pattern 2), lesions that were dark inside (pattern 4), lesions that contained both bright and dark areas (pattern 3). In addition, pattern 4 was subdivided into 4a (dark area same as B-mode lesion) and 4b (dark area larger than lesion). Next, shear wave velocity (SWV) was measured using virtual touch tissue quantification.

Results

There were 13 pattern 1 lesions and five pattern 2 lesions; all of these lesions were benign, whereas all pattern 4b lesions (n?=?43) were malignant. When the value of 3.59?m/s was chosen as the cutoff value, the combination of elastography and tissue quantification showed 91?% (83?C91) sensitivity, 93?% (65?C70) specificity, and 92?% (148?C161) accuracy.

Conclusion

The combination of elastography and tissue quantification is thought to be a promising ultrasound technique for differential diagnosis of breast-mass lesions.     

The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging

Objective

To asses the value of second-look ultrasound (US) for identifying BIRADS 3 (Breast Imaging Reporting Data System) mammary lesions detected by breast Magnetic Resonance imaging (MRI).

Materials and methods

From April 2008 to May 2009 330 breast MRI were performed of which 60 patients are classified as BIRADS 3. 84 lesions underwent second-look US and percutaneous vacuum biopsy Vacora system US-guided. Statistical analysis: lesions were stratified into two groups: visible on US (Group 1) and not visible on US (Group 2).The clinical impact of second-look US was studied in terms of negative predictive value (NPV).

Results

The positive predictive value (PPV) of category 3 BIRADS MRI was found to be 89%. Second look-US results detected lesions in 51% of the MRI enhancing lesions. The second look-US showed a NPV of 97%. The NPV of second look-US was significantly greater than the NPV of MRI BIRADS 3 (97% vs 89%, p < 0.05). The logistic regression analysis showed a higher number of malignant lesions in group 1 than in group 2 (7vs 2, OR 3.7, p < 0.05).

Conclusions

The second-look US permitted the correct management of subcentimetric MRI BIRADS 3 lesions not visible with conventional imaging tecniques.     

Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging

Purpose

To assess the utility of second-look ultrasound (US) for identifying and characterising incidental enhancing lesions detected by breast magnetic resonance imaging (MRI).

Materials and methods

From among 655 consecutive breast MRI studies, 62 lesions (MRI visible, nonpalpable, occult at first-look US and mammography) were recommended for second-look US. MRI enhancement of lesions was mass-like in 59 cases (95%) and non-mass-like in three (5%). Forty-two lesions (68%) were ??10 mm; only three lesions (5%) were >20 mm. Of all lesions, the Breast Imaging Reporting and Data System (BI-RADS) MRI category was highly suggestive of malignancy in six cases (10%), suspicious abnormality in 33 (53%) and probably benign in 23 (37%). The correlation between MRI lesion appearance, lesion size, histopathology findings and detection rate at second-look US were analysed. The reference standard was histopathology and/or follow-up (range 18?C24 months). Statistical analysis was performed with the Fisher exact test.

Results

Second-look US identified 44 out of 62 (71%) lesions depicted at MRI. The detection rate at second-look US was higher for mass-like MRI lesions (75%) than nonmass-like lesions (0%), for lesion size >10mm (90%) and for BI-RADS 4 lesions (88%). Second-look US-guided biopsy detected 12 out of 17 (71%) malignant lesions. There was no correlation between the likelihood of carcinoma and the presence of a sonographic correlate.

Conclusions

Second-look US is a reliable problemsolving tool in identifying and characterising most incidental MRI findings. It contributes to accurately selecting the cases in which MRI-guided biopsy is required.