Real-time tissue elastography combined with BIRADS-US classification system for improving breast lesion evaluation

Purpose

The purpose of this study was to establish the correlation of prospectively interpreted ultrasound elastography (USE) results with American College of Radiology Breast Imaging Reporting and Data System (BIRADS) assessment and pathologic diagnoses of sonographically visible breast masses and to determine whether USE can improve distinction of benign and malignant lesions.

Patients and methods

Between April 2012 and January 2014, sonoelastography of focal breast lesions was carried out in 410 patients with subsequent histological confirmation. We present data focusing on the sensitivity (SE), specificity (SP) and the positive (PPV) and negative predictive value (NPV) of sonoelastography. In addition we performed an analysis of the diagnostic performance, expressed by the pretest and posttest probability of disease (POD), in BI-RADS-US 3 or 4 lesions as these categories can imply both malignant and benign lesions and a more precise prediction would be a preferable aim.

Results

Sonoelastography demonstrated an improved SP (89.5%) and an excellent PPV (86.8%) compared to B-mode ultrasound (76.1% and 77.2%). Especially in dense breasts ACR III–IV, the SP was even higher (92.8%). In BI-RADS-US 3 lesions, a suspicious elastogram significantly modified the POD from 8.3% to a posttest POD of 45.5%. In BI-RADS-US 4 lesions, we found a pretest POD of 56.6%. The posttest POD changed significantly to 24.2% with a normal elastogram and to 81.5% with a suspicious elastogram.

Conclusions

Real-time tissue elastography may provide additional characterization of breast lesions, improving specificity, particularly for BIRADS 3 and BIRADS 4 lesions.