Purpose
To determine the diagnostic performance of elastography scoring (ES), strain ratio (SR) measurement, and combined ES and SR scoring for breast lesions referred for biopsy.
Methods and Materials
Patients referred for ultrasound guided biopsy of one or more breast lesions were included in this study after informed consent was given. All subjects were evaluated on the same date of biopsy.Hitachi Hi Vision900 Ultrasound was used for elastography score (ES) images and strain ratio (SR) measurements.Elastography system operators/readers were considered newcomers to the technique, but received technical training prior to study initiation.For elastography scoring, lesions were assigned a score using the five–point visual system (Fig 1) from Ueno, et. al. [3]. The ES was...
Results
A total of 285 lesions were evaluated. Of these lesions, 208 were benignand 77 were malignant. Atypiawasincluded asa positivebiopsy result.SensitivitySpecificityPPVNPVAccuracyES0.570.740.470.820.77SR0.750.760.550.910.80Diagnostic PerformanceElastography Scores (ES) were plotted (Fig 1) to demonstrate the frequency of ES negative lesions (0, 1, 2) and ES positive lesions (3, 4, 5). An ES score of 2 was the most frequent ES negative score, while a score of 4 was most common for ES positive scores.Strain ratios (SR)were also analyzed among biopsy-proven benign and malignant lesions to determine the mean and range...
Conclusion
Strain ratio assessment provides additional information about a lesion’s strain characteristics andserves as an objectivecomplement tovisual elastography scoring.Combining SR assessment with ES improved sensitivity,specificity, PPV, NPVand accuracy compared tovisual scoring alone. In this series, 16 lesions with false negative ES score showed SR values in the true positive range for SR.Study limitations include a small sample size, operator experience, and potential selection bias as our site is a cancer referral center. Our sensitivity, specificity,NPV/PPV andaccuracy were less than expected as compared to other reported trials....
References
1. Poplack SP, Carney PA, Weiss JE, Titus-Ernstoff L, Goodrich ME, Tosteson AN. Screening mammography: costs and use of screening-related services. Radiology. Jan 2005;234(1):79-85.2. Garra BS, Cespedes EI, Ophir J, et al. Elastography of breast lesions: initial clinical results. Radiology. Jan 1997;202(1):79-86.3. Hiltawsky KM, Kruger M, Starke C, Heuser L, Ermert H, Jensen A. Freehand ultrasound elastography of breast lesions: clinical results. Ultrasound Med Biol. Nov 2001;27(11):1461-1469.4. Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology....
Personal Information
Todd R. Kumm, M.D.Clinical appointment: Assistant ProfessorDepartment of Radiology, University of South
[email protected] R. Grajo, M.D.Clinical appointment: Resident PhysicianDepartment of Radiology, University of South
[email protected] Chau, M.D.Clinical appointment: Assistant ProfessorDepartment of Radiology, H. Lee Moffitt Cancer Center & Research
[email protected] Tucker, M.D.Clinical appointment: Resident PhysicianDepartment of Radiology, University of South
[email protected] Szabunio, M.D. (Corresponding Author)Clinical appointment: Associate ProfessorDepartment of Radiology,H. Lee Moffitt Cancer Center & Research Institute.Address: H. Lee Moffitt Cancer Center & Research InstituteAttn: Dr. Margaret Szabunio12902 Magnolia Drive, WCB-RAD MDTampa, FL 33612Phone: (813)...