148 breastmasses were included from 113 patients with mean age of 45 years (age range 15-80 years).
Distribution of benign and malignant breast lesions in various age groups are presented in fig.2 & 3.
Fig. 2: Distribution of 148 breast masses
Fig. 3
Mean age for malignant lesions in the study population was 49 years and for benign lesions,
it was 40 years (fig 4).
Fig. 4: Fig 4: Mean age for benign and malignant breast masses in Indian population
Of all the benign lesions (74),
fibroadenoma was the commonest (50 lesions,
67%).
Others were fibrocystic changes (7),
epithelial hyperplasia,
granulomas,
benign phyllodes,
lipoma,
papilloma & apocrine metaplasia.
Among all the histopathologically diagnosed malignant lesions (74),
invasive ductal carcinoma was the commonest (60 lesions,
81%).
Others were invasive lobular carcinoma,
ductal carcinoma in situ,
malignant phyllodes,
carcinosarcoma,
mucinous carcinoma and medullary variant of ductal carcinoma.
Histological details are presented in Table 1.
Table 1.
Histopathologic diagnosis
Histopathology |
No.
of lesions |
Percentage |
Malignant |
|
|
Invasive ductal carcinoma |
60 |
81% |
Invasive lobular carcinoma |
4 |
5.4% |
DCIS |
4 |
5.4% |
Mlignant Phyllodes |
2 |
2.7% |
Carcinosarcoma |
2 |
2.7% |
Mucinous carcinoma |
1 |
1.4% |
Medullary carcinoma |
1 |
1.4% |
Benign |
|
|
Fibroadenoma |
50 |
67.4% |
Fibrocystic changes |
7 |
9.5% |
Granulomas/Abscess |
6 |
8.1% |
Epithelial hyperplasia |
6 |
8.1% |
Benign phyllodes |
2 |
2.7% |
Papilloma |
1 |
1.4% |
Lipoma |
1 |
1.4%
|
Apocrine metaplasia |
1 |
1.4%
|
Mean shear wave velocity for malignant breast masses was significantly higher ( 7.59+/- 2.57m/s) than for benign lesions (3.11+/- 1.76m/s) with P value<0.0001)
Fig.
5
Fig. 5: ARFI distribution of benign and malignant breast masses
Using ROC curve,
the cut-off value of Shear wave velocity for VTQ mode was 4.30m/s for predicting malignancy with 88% sensitivity,
85% specificity and an area under the curve of 0.892 (95% Confidence Interval:0.830-0.937)
Fig 6.
Fig. 6: ROC curve: Diagnostic performance of Shear wave velocity in differentiating benign and malignant breast masses.
Area under ROC curve (AUC)=0.892
95 % Confidence Interval= 0.830-0.937
P value=<0.0001
Cut off=4.30m/s
Sensitivity= 87.84%
Specificity= 85.14%
Cases:
Fig. 7: Invasive ductal carcinoma: Hypoechoic mass with angular margins on conventional US corresponding to ACR BIRADS 4b
(a) Lesion was black on VTI with Area Ratio (AR) more than 1.
(b) On VTQ mode, Shear wave velocity was high, >9m/s.
Fig. 8: Fibroadenoma: ACR BIRADS 4a lesion on conventional US with low shear wave velocities on VTQ elastography.
Fig. 9: Invasive ductal carcinoma: (a) BIRADS 4a lesion on US.(b) Black on VTI mode of elastography. (c) High shear wave velocity on VTQ mode of elastography.