B-Mode Ultrasound Combined with Color Doppler and Strain Elastography in the Diagnosis of Non-mass Breast Lesions: A Prospective Study

Non-mass breast lesions on ultrasound (US) are areas without an associated mass. The purpose of this study was to evaluate whether combining B-mode US with color Doppler US and strain elastography (SE) improves US differentiation between benign and malignant non-mass breast lesions and the decision for biopsy. In this prospective study, three different radiologists analyzed the US images of 77 non-mass lesions independently and recorded Breast Imaging Reporting and Data System (BI-RADS) categories for four data sets. The image characteristics and BI-RADS categories of the four data sets were analyzed by another radiologist. The final diagnosis was made on the basis of pathologic findings. Values for area under the receiver operating curve (AUC), sensitivity, specificity and accuracy were compared among the data sets. The AUC of B-mode US combined with both color Doppler US and SE was greater than that of B-mode US alone (0.666 vs. 0.828) (p = 0.011). The specificity of making the decision for biopsy increased from 6.5% to 38.7% when B-mode US was combined with color Doppler and SE, without a statistically significant change in sensitivity (p < 0.001). Combined use of color Doppler and SE could improve the diagnostic value of B-mode US in distinguishing benign from malignant non-mass breast lesions and the specificity of making the decision for biopsy of non-mass breast lesions.     

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions?

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.     

Semi-Quantitative and Qualitative Assessment of Breast Ultrasound Elastography in Differentiating Between Malignant and Benign Lesions

The purpose of this study was to evaluate the diagnostic value of qualitative and semi-quantitative assessment of ultrasound elastography in differentiating between benign and malignant breast lesions. This prospective study was conducted in two tertiary medical centers. Consecutive B-mode ultrasound and real-time elastographic images were obtained for 67 malignant and 101 benign breast lesions in 168 women. Four experienced radiologists analyzed B-mode ultrasound alone and B-mode ultrasound combined with elastography independently. Conventional ultrasound findings were classified according to the American College of Radiology Breast Imaging Reporting and Data System classification. The elastographic assessment was based on qualitative and semi-quantitative parameters (i.e., strain pattern, width ratio, strain ratio). The sensitivity and specificity of combined elastography and conventional ultrasound were significantly higher than that of conventional ultrasound alone. The sensitivity, specificity, positive predictive value and negative predictive value was 97%, 61.4%, 62.5% and 96.8%, respectively, for conventional ultrasound and 100%, 93%, 99% and 90%, respectively, for combined technique. The semi-quantitative assessment with strain ratio and width ratio in elastography were the most useful parameters in differentiating between benign and malignant breast lesions. Cut-off point values for width ratio of more than 1.1 and strain ratio of more than 5.6 showed a high predictive value of malignancy with specificities of 84% and 76%, respectively (p < 0.001). This combined technique also had the best results in detecting carcinoma and could reduce the need of unnecessary biopsy for benign lesions with indeterminate or equivocal features.     

Comparison of Strain and Shear Wave Elastography for the Differentiation of Benign From Malignant Breast Lesions,Combined With B-mode Ultrasonography: Qualitative and Quantitative Assessments

Our aim was to compare the diagnostic performance of strain elastography (SE) and shear-wave elastography (SWE), combined with B-mode ultrasonography (US), in breast cancer. For 79 breast lesions that underwent SE and SWE, two radiologists reviewed five data sets (B-mode US, SWE, SE and two combined sets). Qualitative and quantitative elastographic data and Breast Imaging Reporting and Data System (BI-RADS) categories were recorded. The area under the receiver operating characteristic curve (AUC) was evaluated. No significant difference in the AUC between the two elastography methods was noted. After subjective assessment by reviewers, the AUC for the combined sets was improved (SWE, 0.987; SE, 0.982; B-mode US, 0.970; p < 0.05). When SE and SWE were added, 38% and 56% of benign BI-RADS category 4a lesions with a low suspicion of cancer were downgraded without false-negative results, respectively. SE and SWE performed similarly. Therefore, addition of SE or SWE improved the diagnostic performance of B-mode US, potentially reducing unnecessary biopsies.     

An Innovative Ultrasound Strain Elastographic Method for the Differential Diagnosis of Breast Tumors

In this monocentric perspective study examining 64 lesions (19 benign and 45 malignant), we tested an innovative ultrasound elastographic method for diagnosing breast tumors. A new region of control and a new index designating the strain ratio (SR) were used. A traditional ultrasound elastographic method was used as the control. The results indicated that the SR ratios of the benign and malignant groups were 0.25 ± 0.22 and 1.10 ± 1.53, respectively, and this difference was statistically significant. The area under the receiver operating characteristic curve of the SR ratio method was 0.95, the cutoff point was 0.37 and the sensitivity and specificity were 95.56% and 94.74%, respectively. The two receiver operating characteristic curves of the traditional method and the SR of the proposed method were significantly different, at a p value of 0.02. Compared with that of the traditional method, the SR obtained with the new method had a larger area under the receiver operating characteristic curve, sensitivity, specificity and objectivity.     

Clinical value of relative quantification ultrasound elastography in characterizing breast tumors

ObjectivesTo evaluate ultrasound elastography (USE) using strain ratio (SR), a relative quantification approach for breast lesions characterization.MethodsOne hundred forty-seven consecutive patients with a total of 156 breast lesions underwent USE. Technical accuracy was assessed automatically. For SR evaluation a rounded ROI was depicted inside fat (F), glandular tissue (G) and inside the lesion (L), preferably at the same depth. R1, mean value of the G and F ratio, stands for in background tissue composition elasticity. R2; mean value of L/F stands for in lesion elasticity, both evaluated in arbitrary unit (au). Two-years follow-up and pathology results were standard of reference. Mann–Whitney test, ROC analysis and Chi-square with Yates correction were used.ResultsWith the exception of 27 cysts, 17 malignant and 112 benign lesions were found. R1 values were 1.6 ± 0.7 au and 1.2 ± 0.9 au (p = 0.015 NS); R2 values were 6.1 ± 2.5 au and 1.9 ± 1.3 au (p < 0.001) for malignant and benign lesions, respectively. A threshold of 3.3 au showed a sensitivity and specificity of 88% and 87%, respectively with an AUC of 93%. Fifteen false positive and two false negative were detected.ConclusionRelative quantification of ultrasound elastography allows to find high levels of diagnostic accuracy in characterizing breast tumors above all in downgrading BI-RADS 3 and 4 lesions.     

Evaluation of Real-Time Tissue Sono-elastography in the Assessment of 214 Breast Lesions: Limitations of This Method Resulting from Different Histologic Subtypes,Tumor Size and Tumor Localization

Real-time sono-elastography is an ultrasound-based technique used to estimate tissue elasticity. Several publications have reported that this method has the ability to differentiate between malignant and benign breast lesions. However, on the basis of current literature, sono-elastography returned false-negative results in 25% of cases with certain lesions, such as mucinous carcinoma. Our data indicate that elastography has higher specificity (96.5% vs. 84.4%) and lower sensitivity (86.9% vs. 93.9%) than B-mode ultrasound. Our evidence suggests that elastography performs significantly worse in lesions ≥20 mm in diameter (sensitivity = 61.1%, specificity = 97.2%) than in lesions <20 mm in diameter (sensitivity = 92.6%, specificity = 96.2%). Furthermore, elastography returned false-negative results in all cases mucinous carcinoma. Finally, in eight cases we obtained a valid elastogram. Our data indicate that this finding is probably due to tumor depth.     

Can strain US-elastography with strain ratio (SRE) improve the diagnostic accuracy in the assessment of breast lesions? Preliminary results

PurposeTo assess the diagnostic value of strain ratio elastography (SRE), a semiquantitative elastosonographic method based on the displacement of the tissue from an external source (manual compression with the transducer), as compared and in combination with conventional ultrasound for the differentiation of breast lesions.MethodsOne hundred and eighty-two patients with breast lesions consecutively underwent B-mode, color Doppler US, and strain US-elastography. Each lesion was classified according to the BI-RADS lexicon by evaluating the size, the B-mode, and color Doppler features and then evaluated by SRE. Histology proven by biopsy was used as the gold standard and the patients with malignant lesions subsequently underwent operations. The diagnostic performance of each method was assessed with 2 × 2 contingency tables and ROC curve analysis. To maximize the SRE sensitivity and specificity, the SRE cut-off value was calculated using the Youden test.ResultsHistological examination revealed 66 benign and 116 malignant breast lesions. The conventional ultrasound showed sensitivity and specificity for the differentiation of benign and malignant lesions of 86.2% and 75.8%, respectively. Similar results were found for strain US-elastography with a cut-off of 2.49, with sensitivity and specificity of 89.7% and 72.7%, respectively. The association of conventional ultrasound with the SRE value increased the sensitivity (98.3%) but decreased the specificity compared with conventional US alone (63.6%).ConclusionStrain US-elastography can be associated with BI-RADS US examination. According to our preliminary results, it helped increase the sensitivity although it decreased the specificity. However, further multicenter studies on a larger population are warranted.     

Utility of B-Mode,Color Doppler and Elastography in the Diagnosis of Breast Cancer: Results of the CD-CONFIRM Multicenter Study of 1351 Breast Solid Masses

The usefulness of color Doppler ultrasound (CD) in distinguishing between benign and malignant breast lesions remains controversial. Our prior study, the Japan Association of Breast and Thyroid Sonology (JABTS) BC-04 study (malignant: 839, benign: 569), found CD was useful in breast cancer diagnosis, and we developed CD diagnostic criteria. The first aim of the current study (the CD-CONFIRM study) was to evaluate the usefulness of the CD diagnostic criteria. The second aim was to evaluate the relationship between CD and elastography. We evaluated ultrasound images of breast masses from 13 institutions (malignant: 639, benign: 712). While the sensitivity of B-mode alone was very high and was not significantly improved with CD, the specificity was significantly improved with CD (61.2%–69.2%, p < 0.0001). Furthermore, the specificity of the combination of B-mode and CD improved significantly with the addition of elastography (72.8%–79.0%, p < 0.0001). This study found that the CD criteria are useful, and CD and elastography are independent.     

Shear Wave Elastography (SWE): An Analysis of Breast Lesion Characterization in 83 Breast Lesions

Qualitative and quantitative shear wave elastography (SWE) criteria were assessed to differentiate between malignant and benign breast lesions. This prospective study included 83 lesions. SWE features measured included maximal stiffness values inside the lesion (E_lesion) and in the peri-lesion area (E_perilesion) and ratio values (R_lesion and R_perilesion) according to the formula E_lesion or E_perilesion/E_fat, with E_fat corresponding to normal fatty tissue. We compared ultrasonography (B-mode), SWE and histologic sizes. With qualitative and quantitative SWE analysis, sensitivity was 94% and specificity 73%. Malignant lesions appeared more heterogeneous, with higher stiffness and ratio values than benign lesions (p < 0.001). For malignant lesions, SWE size was better correlated to histologic size than B-mode size. Using benign SWE signs to selectively downgrade category 4a and 4b lesions, the specificity improved from 13% to 51% without loss in sensitivity (100%) compared to ultrasound.     

Semi-Quantitative Strain Ratio Determined Using Different Measurement Methods: Comparison of Strain Ratio Values and Diagnostic Performance Using One- versus Two-Region-of-Interest Measurement

We evaluated the agreement and diagnostic performance of strain ratio values using measurements made with one and two user-defined regions of interest (ROIs) on breast elastography. Two hundred forty-three breast masses of 226 women (mean age: 48.2 y) were included. Ultrasonography (US) and elastography images of the masses were recorded. Strain ratio was measured twice on the same elastography image; strain ratio 1, applying one ROI at the target mass for measurement, and strain ratio 2, applying one ROI at the target mass and another ROI as reference strain. The two strain ratio measurements were in substantial agreement, with an intra-class correlation coefficient of 0.655 (95% confidence interval: 0.577–0.722). Specificity, positive predictive value and accuracy (cutoffs: 2.66 and 2.35) were significantly improved for US combined with the two strain ratio measurements (all p values < 0.05). Strain ratios measured using one or two user-defined ROIs were in substantial agreement, both contributing to the improved diagnostic performance of breast US.     

比较声触诊组织量化与弹性应变率比值法诊断乳腺疾病

目的 比较声触诊组织量化(VTQ)与弹性应变率(SR)比值法判断乳腺病变良恶性的价值.方法 对103例女性患者共126个乳腺病变进行压迫式弹性成像检查,获得相应的弹性图,测量SR值;进一步应用声辐射力脉冲成像测量病灶的VTQ值;以病理结果为金标准,构建ROC曲线,比较两种方法的诊断价值.结果 VTQ值判断乳腺病变良恶性的最佳临界点为6.64 m/s,ROC曲线下面积为0.88,其判断乳腺恶性病变的敏感度、特异度和准确率分别为82.61％(19/23)、100％(103/103)和96.83％(122/126).SR比值法判断乳腺恶性病变的ROC曲线下面积为0.87.二者ROC曲线下面积的差异无统计学意义(P＞0.05).结论 VTQ技术可用于判断乳腺良恶性病变,其诊断价值与SR比值法相当.     

Shear-Wave Elastography: Could it be Helpful for the Diagnosis of Non-Mass-Like Breast Lesions?

The goal of this study was to analyze the diagnostic performance of shear wave elastography (SWE) in differentiation of benign and malignant non-mass-like (NML) breast lesions. Three hundred sixteen consecutive breast lesions in 305 patients who have been scheduled for ultrasound (US)-guided core needle biopsy or vacuum-assisted biopsy or surgical excision between January 2013 and August 2013 were initially included in this study. Finally, 63 patients with 67 lesions classified as NML lesions comprised our study population. The features of SWE and its diagnostic performance in NML lesions were analyzed. Among the 67 NML lesions, 33 were malignant and 34 were benign. The maximum elastic modulus, mean elastic modulus, minimum elastic modulus, elastic modulus ratio and stiff rim sign of the malignant lesions were all significantly higher than those of benign lesions (p < 0.05). The combination of conventional US with maximum elastic modulus and stiff rim sign got significantly higher diagnostic specificity and positive predictive value (PPV) than conventional US (p < 0.05 for both). In the benign lesions, 23 (67.6%) unnecessary biopsies could have been eliminated after the combination of conventional US and SWE. SWE could increase diagnostic specificity and positive predictive values of NML breast lesions. The combination of conventional US and SWE could reduce unnecessary benign biopsies of NML lesions.     

Transforming Growth Factor β1 Could Influence Thyroid Nodule Elasticity and Also Improve Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

Ultrasound elastography has been a very useful tool in predicting the risk of malignant thyroid tumor for several years. The objective of this study was to determine if there is a correlation between strain ratio (SR), collagen deposition and transforming growth factor β1 (TGF-β1) expression in different types of thyroid nodules and if TGF-β1 is related to cervical lymph node metastasis. 102 nodules from 81 patients who underwent thyroid resection surgery in our hospital were retrospectively studied. All of these patients had undergone ultrasound elastography scanning before surgery. Masson staining and immunohistochemical staining were used to evaluate the ratio of expression of collagen deposition and TGF-β1. There was a significant difference between benign and malignant thyroid nodules in SR (8.913 ± 11.021 vs. 1.732 ± 0.727, p = 0.000), collagen content (0.371 ± 0.125 vs. 0.208 ± 0.057, p = 0.000) and TGF-β1 expression (0.336 ± 0.093 vs. 0.178 ± 0.071, p = 0.000). A cutoff of 2.99 for SR measurement was selected for the highest Youden index for predicting malignant thyroid nodules, which yielded 87.88% sensitivity, 100% specificity, 100% positive predictive value, 83.72% negative predictive value and 92.15% accuracy. Expression of collagen and TGF-β1 was positively correlated with SR measurements (coefficient = 0.839 for collagen and 0.855 for TGF-β1, p = 0.000). Among 61 nodules with papillary thyroid carcinoma, the average SR for the metastasis group was higher than that for the non-metastasis group (10.955 ± 13.805 and 7.852 ± 7.931, respectively), but without statistical significance (p = 0.287). Collagen deposition was significantly higher in the metastasis group than in the non-metastasis group (0.421 ± 0.091 vs. 0.353 ± 0.118, p = 0.011). TGF-β1 expression was also significantly higher in the metastasis group than in the non-metastasis group (0.378 ± 0.0.69 vs. 0.328 ± 0.091, p = 0.016). To conclude, TGF-β1 may contribute to thyroid nodule elasticity by promoting collagen deposition. In papillary thyroid carcinoma, overexpression of TGF-β1, as well as collagen deposition, may be a risk factor for cervical lymph node metastasis.     

超声弹性成像比值法在乳腺非肿块型病变良恶性鉴别诊断中的应用研究

目的探讨超声弹性成像比值法在乳腺非肿块型病变良恶性鉴别诊断中的应用价值。方法选取本院收治的55例乳腺非肿块型病变患者作为研究对象,均行超声弹性成像检查,分别采用应变率比值法和改良五分法评估病变的良恶性。以病理结果为金标准,对比两种评估方式对乳腺非肿块型病变良恶性的诊断效能。结果病理结果诊断出良性病变23例,恶性病变32例。超声弹性成像SR法共诊断出乳腺良性病变24例(21例与病理结果相符),恶性病变31例(29例与病理结果相符);改良五分法诊断出乳腺良性病变28例(18例与病理结果相符),恶性病变27例(22例与病理结果相符)。与改良五分法相比,SR法对乳腺非肿块型病变的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值均明显更高,分别为91.30%、90.63%、90.91%、87.50%和93.55%(P<0.05)。结论乳腺非肿块型病变行超声弹性成像检查,采用应变率比值法对恶性病变有较高的诊断灵敏度及特异度,且诊断结果更为客观,其能有效提高乳腺肿瘤超声诊断的准确度。     

Acoustic Radiation Force Impulse Elastography for Chronic Liver Disease: Comparison with Ultrasound-Based Scores of Experienced Radiologists,Child-Pugh Scores and Liver Function Tests

The purpose of our study was to investigate whether acoustic radiation force impulse (ARFI) elastography provides better diagnostic performance for diagnosis of chronic liver disease and correlates better with Child-Pugh scores and liver function tests, compared with an ultrasound (US) scoring system based on visual assessment of conventional B-mode US images by experienced radiologists. Five hundred and twenty-one patients with clinically proven chronic liver disease (n = 293), fatty liver (n = 95) or normal liver (n = 133) were included in this study. B-mode liver US and ARFI elastography were performed in all patients. ARFI elastography was performed at least five times, with each measurement obtained at a different area of the right hepatic lobe; mean shear wave velocity (SWV) was calculated for each patient. The mean SWV was compared with US-based scores from two radiologists (based on liver surface nodularity, parenchyma echotexture and hepatic vein contour), Child-Pugh scores and liver function tests. The mean SWV of the normal liver group was 1.08 m/s ± 0.15; of the fatty liver group, 1.02 m/s ± 0.16; and of the chronic liver disease group, 1.66 m/s ± 0.60 (p < 0.001). The area under the receiver operating characteristics curve of the mean SWV in ARFI elastography was significantly higher than that of the conventional B-mode US-based scores by two radiologists (0.89 vs. 0.74 and 0.77, p < 0.05), with a sensitivity of 75.4% and a specificity of 89.5% at the cut-off value of 1.22 m/s. The sensitivity of the mean SWV was significantly higher than the US-based scores (p < 0.001), although the specificity was not (p > 0.05). The mean SWV was better correlated with Child-Pugh scores and all liver function tests (except total protein) than the US-based scores from two radiologists. In conclusion, ARFI elastography showed better diagnostic performance than visual assessment of experienced radiologists for diagnosis of chronic liver disease, as well as for evaluation of the severity of chronic liver disease. (E-mail: leejy4u@snu.ac.kr)     

Comparing Performance of Combinations of Shear Wave Elastography and B-Mode Ultrasound in Diagnosing Breast Masses: Is It Influenced by Mass Size?

We determined the diagnostic performance of combinations of shear wave elastography (SWE) and B-mode ultrasound (US) in differentiating malignant from benign breast masses, and we investigated whether performance is affected by mass size. In this prospective study of 315 consecutive patients with 326 breast masses, US and SWE were performed before biopsy. Masses were categorized into two subgroups on the basis of mass size (≤15 mm and >15 mm), and the optimal thresholds for the SWE parameters were determined for each subgroup using receiver operating characteristic curves. The combination proposed here achieved an area under the receiver operating characteristic curve of 0.943, 95.00% sensitivity and 81.18% specificity, which approximated the diagnostic performance of US alone. The performance of the combinations using the subgroups' thresholds did not differ significantly from those based on the entire study group's thresholds, but the optimal thresholds were higher in the subgroup of larger masses. Further research is needed to determine whether mass size affects the performance of combinations of SWE and US.     

Development of an Ultrasound Prediction Model to Discriminate between Malignant and Benign Liver Lesions

To discriminate between malignant and benign liver lesions, we evaluated the ultrasound features of the target lesions in 266 patients and established a prediction model using a logistic regression algorithm. The prediction model based on independent factors was expressed as predictive score = 1.129 × interaction of irregular shape and unclear boundary + 1.398 × occupying effect + 2.363 × hypo-echoic halo + 1.987 × marginal vascular sign + 3.627 × cirrhosis background + 2.976 × nodule in nodule sign + 3.690 × metastasis sign. Receiver operating characteristic curve analysis revealed that the optimal cutoff predictive score was 2.8 (area under the curve = 0.942). The specificity of the prediction model was not significantly different from that of computed tomography/magnetic resonance imaging (91.7% vs. 98.8%, p = 0.077), whereas the prediction model had a lower sensitivity (90.1% vs. 97.8%, p < 0.001) and accuracy (90.6% vs. 98.1%, p < 0.001) than computed tomography/magnetic resonance imaging. We conclude that the ultrasound prediction model exhibited good diagnostic performance in discriminating malignant from benign liver lesions.     

Screening Breast Lesions Using Shear Modulus and Its 1-mm Shell in Sound Touch Elastography

The aim of the study described here was to screen breast lesions using either or both shear modulus (G) and its 1-mm shell (S) in sound touch elastography through a retrospective study of 209 consecutive women with breast lesions. The ability of G and S data to differentiate between malignant and benign lesions was evaluated using the receiver operating characteristic (ROC) curve. The optimal cutoff point, sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR–) were calculated. Then, the parameters were pooled to determine the area under the summary receiver operating curve (AUSROC). The pooled sensitivity (PSen), pooled specificity (PSpe), pooled LR+ (PLR+), pooled LR– (PLR–) and diagnostic score (DS) were calculated. Pathologic examination results were used as the reference. In total, 209 patients with 155 benign and 54 malignant lesions were enrolled. For G_max, G_mean and G_sd, the cutoff values were 35.15 kPa (p?=?0.0001), 10.18 kPa (p?=?0.0001) and 5.18 kPa (p?=?0.0001), respectively. For S_max, S_mean and S_sd, the cutoff values were 40.94 kPa (p?=?0.001), 13.12 kPa (p?=?0.0001) and 7.97 kPa (p?=?0.0001), respectively. There were no significant differences in G_min and S_min between benign and malignant lesions. For the pooled six parameters, the PSen, PSpe, PLR+, PLR–, DS and AUSROC were 86% (95% confidence interval: 82%–89%), 82% (80%–85%), 4.90 (4.24–5.68), 0.17 (0.13–0.22), 3.36 (3.00–3.72) and 91% (88–93%), respectively. The G and S parameters of sound touch elastography could provide valuable data for the evaluation of breast lesions. Additionally, use of multiple parameters or combined use of the six parameters may be more effective in the evaluation of breast lesions.     

Real-time elastography--an advanced method of ultrasound: First results in 108 patients with breast lesions.

OBJECTIVES: To evaluate whether real-time elastography, a new, non-invasive method for the diagnosis of breast cancer, improves the differentiation and characterization of benign and malignant breast lesions. METHODS: Real-time elastography was carried out in 108 potential breast tumor patients with cytologically or histologically confirmed focal breast lesions (59 benign, 49 malignant; median age, 53.9 years; range, 16-84 years). Tumor and healthy tissue were differentiated by measurement of elasticity based on the correlation between tissue properties and elasticity modulus. Evaluation was performed using the three-dimensional (3D) finite element method, in which the information is color-coded and superimposed on the B-mode ultrasound image. A second observer evaluated the elastography images, in order to improve the objectivity of the method. The results of B-mode scan and elastography were compared with those of histology and previous sonographic findings. Sensitivities and specificities were calculated, taking histology as the gold standard. RESULTS: B-mode ultrasound had a sensitivity of 91.8% and a specificity of 78%, compared with sensitivities of 77.6% and 79.6% and specificities of 91.5% and 84.7%, respectively, for the two observers evaluating elastography. Agreement between B-mode ultrasound and elastography was good, yielding a weighted kappa of 0.67. CONCLUSIONS: Our initial clinical results suggest that real-time elastography improves the specificity of breast lesion diagnosis and is a promising new approach for the diagnosis of breast cancer. Elastography provides additional information for differentiating malignant BI-RADS (breast imaging reporting and data system) category IV lesions.