Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography--a clinical approach

Ultrasound elastography using the extended combined auto-correlation method of tissue elasticity allows for real-time strain image visualisation using a free-hand probe with concurrent conventional B mode imaging. Four hundred and fifteen consecutive women with 550 breast lesions confirmed on B mode ultrasound were assessed with elastography using the elasticity score. There were 119 malignant and 431 benign lesions. The elastography sensitivity was 78.0%, specificity was 98.5% and overall accuracy was 93.8%. The median score for malignancy was 5 and that for benign lesions was 2. There was good correlation with B mode BIRADS category. 98.6% of lesions with an elasticity score of 2 or below (95%CI=96.8-99.4) were benign. BIRADS 3 lesions with an elasticity score of 2 or below may be re-classified as BIRADS 2 lesions. We found that 15.3% of BIRADS 2 and 3 lesions with an elasticity score of 3 were malignant. Real-time ultrasound elastography is user-friendly with a high accuracy rate, thereby improving B mode ultrasound assessment.     

Analysis of 107 breast lesions with automated 3D ultrasound and comparison with mammography and manual ultrasound

Objectives

Our aim was to investigate the diagnostic potential of an automated ultrasound (US) breast scanner prototype and compare it with manual US and mammography.

Methods

Ninety-seven patients with a total of 107 breast lesions had mammograms, manual US and an automated breast US scan. Multiplanar reconstructions in coronal, axial and the sagittal view were reconstructed from the automated dataset and visualized. After biopsy, all lesions were confirmed histologically. The data were evaluated according to the BIRADS (Breast Imaging Reporting and Data System) classification. The sensitivity and specificity were analyzed.

Results

The BIRADS criterion “margin” was significantly related to the overall BIRADS classification, independently of the US method being used. The sensitivity of mammography was significantly lower than of each US method (Fisher's exact test with p < 0.05). There were no significant differences between the US methods.

Conclusions

The reconstructed third (axial) image plane of the whole breast, which corresponds to a craniocaudal mammogram, can give additional information about both, site and differential diagnosis of a lesion. Although image quality was sufficient, automated US is not good enough to replace manual US at this time.     

Ultrasound-Guided Vacuum-Assisted Biopsy in Small Breast: A Cost-Saving Solution

Background

The study aimed to evaluate the feasibility and reliability of ultrasound-guided vacuum-assisted breast biopsy (US-VABB) for sampling of microcalcifications indicative of cancer when stereotactic vacuum-assisted breast biopsy cannot be performed because of reasons such as thin breast tissue, insufficient thickness at compression, and microcalcification situated close to the chest wall or in breast tissue of the axillary tail.

First clinical use of a standardized three-dimensional ultrasound for breast imaging

Objectives

The feasibility, image quality, and diagnostic potential of the prototype of an automated ultrasound (US) breast scanner were examined.

Methods

Ninety-seven patients with suspicious breast lesions had mammograms, manual US, and an automated breast US. The data were evaluated according to the breast imaging reporting and data system (BIRADS) classification, image quality, and amount to diagnostic information. All lesions were confirmed histological.

Results

The image quality of the three-dimensional (3D) data sets was equal to or satisfactory compared with cross-sectional images from manual US in at least 72% of cases (p < 0.05). The diagnostic information was equal or superior in at least 63% of cases (p < 0.05).

Conclusions

Standardized 3D US scanning is a promising diagnostic adjunct to mammography, but is no substitute for manual US at the current stage of development.     

Preoperative ultrasound guided needle localisation for non-palpable breast lesions

Background  

Breast cancer is a major cause of cancer-related morbidity and mortality in Indian women. Most cases present late and thus survival in Indian patients is poor compared to the western world. In the absence of a screening, early detection of breast cancer is a challenge in Indian subcontinent.     

Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions

Purpose

To determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions.

Materials and methods

Conventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration.

Results

BIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann–Whitney U test, p < 0.0001). By selecting a lesion cut-off value of 3.31 m/s we achieved 80.4% sensitivity and 73% specificity. Applying this threshold only to BIRADS 4a masses, we reached overall levels of 92% sensitivity and 72.9% specificity.

Conclusion

VTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies.     

How to optimize breast ultrasound

Breast cancer is the most common female cancer, and the second cause of cancer-related mortality of women in our society. Mammography is the gold-standard method of breast imaging. However it is not an optimal screening tool, especially in cases of dense breast parenchyma. Even when optimally performed, its sensitivity ranges between 69 and 90%. Ultrasound represents an additional diagnostic tool that raises the detection rate of benign and malignant breast lesions. It is the method of choice for differentiating solid from cystic lesions, for further characterizing mammographic findings and better appreciating palpable breast lesions. B-mode ultrasonography is used in every day practice. Harmonic imaging and compound imaging can be used to ameliorate the image contrast and resolution. Colour Doppler is used for studying lesion vascularization however there is no consensus as to whether it really permits to differentiate malignancies from benign lesions. New technical developments such as breast elastography, 3D ultrasound and dedicated ultrasound computed aided diagnosis (CAD) are promising methods for the future.