Evaluating the usefulness of breast strain elastography for intraductal lesions

Springer Science and Business Media LLC - Tập 48 Số 1 - Trang 63-70 - 2021
Yumi Kokubu1, Keiko Yamada1, Masahiko Tanabe2, Ayumi Izumori3, Chieko Kato1, Rie Horii4, Shinji Ohno5, Kiyoshi Matsueda6
1Department of Ultrasound, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
2Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, Tokyo, Japan
3Department of Breast Surgery, Takamatsu Heiwa Hospital, Takamatsu, Japan
4Department of Pathology, Saitama Cancer Center, Saitama, Japan
5Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
6Department of Diagnostic Imaging, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

Tóm tắt

Abstract Purpose Strain elastography for imaging lesion stiffness is being used as a diagnostic aid in the malignant/benign discrimination of breast diseases. While acquiring elastography in addition to B-mode images has been reported to help avoid performing unnecessary biopsies, intraductal lesions are difficult to discriminate whether they are malignant or benign using elastography. An objective evaluation of strain in lesions was performed in this study by measuring the elasticity index (E-index) and elasticity ratio (E-ratio) of lesions as semi-quantitative numerical indicators of the color distribution of strain. We examined whether ductal carcinoma in situ (DCIS) and intraductal papilloma could be distinguished using these semi-quantitative numerical indicators. Methods In this study, 170 ultrasonographically detected mass lesions in 162 cases (106 malignant lesions and 64 benign lesions)—in which tissue biopsy by core needle biopsy and vacuum-assisted biopsy, or surgically performed histopathological diagnosis, was performed—were selected as subjects from among 1978 consecutive cases (from January 2014 to December 2016) in which strain elastography images were acquired, in addition to standard B-mode breast ultrasonography, by measuring the E-index and E-ratio. Results The cut-off values for E-index and E-ratio in the malignant/benign discrimination of breast lesions were determined to be optimal values at 3.5 and 4.2, respectively, based on receiver operating characteristic (ROC) curve analysis. E-index sensitivity, specificity, accuracy, and AUC value (area under the curve) were 85%, 86%, 85%, and 0.860, respectively, while those for E-ratio were 78%, 74%, 74%, and 0.780, respectively. E-index yielded superior results in all aspects of sensitivity, specificity, accuracy, and AUC values, compared to those of E-ratio. The mean E-index values for malignant tumors and benign tumors were 4.46 and 2.63, respectively, indicating a significant difference (P < 0.001). E-index values of 24 DCIS lesions and 25 intraductal papillomas were 3.88 and 3.35, respectively, which showed a considerably close value, while the false-negative rate for DCIS was 29.2%, and the false-positive rate for intraductal papilloma was as high as 32.0%. Conclusion E-index in strain elastography yielded better results than E-ratio in the malignant/benign discrimination of breast diseases. On the other hand, E-index has a high false-negative rate and false-positive rate for intraductal lesions, a factor which should be taken into account when making ultrasound diagnoses.

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Tài liệu tham khảo

Nakashima K, Shiina T, Sakurai T, et al. JSUM ultrasound elastography practice guidelines: breast. J Med Ultrasonics. 2013;40:359–91.

Fodor D, Pascu I, Pop S, et al. The utility of elastography and CEUS for the differentiation between benign and malignant cervical lymphadenopathy. Three cases report Med Ultrason. 2013;15:63–6.

Alam F, Naito K, Horiguchi J, et al. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR. 2008;191:604–10.

Dighe M, Bae U, Richardson ML, et al. Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology. 2008;248:662–9.

Yi A, Cho N, Chang JM, et al. Sonoelastography for 1786 non-palpable breast masses: diagnostic value in the decision to biopsy. Eur Radiol. 2012;22:1033–40.

Zhi H, Xiao XY, Ou B, et al. Could ultrasonic elastography help the diagnosis of small (< 2 cm) breast cancer with the usage of sonographic BI-RADS classification? Eur J Radiol. 2012;81:3216–21.

Sadigh G, Carlos RC, Neal CH, et al. Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring. Breast Cancer Res Treat. 2012;133:23–35.

Lee SH, Chung J, Choi HY, et al. Evaluation of screening US-detected breast masses by combined use of elastography and color Doppler US with B-mode US in women with dense breasts: a multicenter prospective study. Radiol. 2017;285:660–9.

Bojanic K, Katavic N, Smolic M, et al. Implementation of elastography score and strain ratio in combination with B-mode ultrasound avoids unnecessary biopsies of breast lesions. Ultrasound Med Biol. 2017;43:804–16.

Liu XJ, Zhu Y, Liu PF, et al. Elastography for breast cancer diagnosis: a useful tool for small and BI-RADS 4 lesions. Asian Pac J Cancer Prev. 2014;15:10739–43.

Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.

Itoh A. Ultrasonic diagnosis of breast lesions combined with “real-time tissue elastography.” J Med Ultasonics. 2013;40:257–66.

Park CS, Kim SH, Jung NY, et al. Interobserver variability of ultrasound elastography and the ultrasound BI-RADS lexicon of breast lesions. Breast Cancer. 2015;22:153–60.

Cho N, Jang M, Lyou CY, et al. Distinguishing benign from malignant masses at breast US: combined US elastography and color Doppler US—influence on radiologist accuracy. Radiology. 2012;262:80–90.

Stachs A, Hartmann S, Stubert J, et al. Differentiating between malignant and benign breast masses: factors limiting sonoelastographic strain ratio. Ultraschall Med. 2013;34:131–6.

Matsuoka Y, Kawauchi N, Sugino N, et al. The optimal cutoff value of elasticity index and ratio for discrimination between benign breast mass and invasive carcinoma on breast ultrasound. J Med Ultrasonics. 2017;44:529–34.

Mutala TM, Ndaiga P, Aywak A. Comparison of qualitative and semiquantitative strain elastography in breast lesions for diagnostic accuracy. Cancer Imaging. 2016;16:12.

Japan Association of Breast and Thyroid Sonology. Guidelines for Breast Ultrasound-Management and Diagnosis. 3rd ed. Tokyo: Nankodo; 2014.

Havre RF, Elde E, Gilja OH, et al. Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra-and interobserver validations. Ulrasound Med Biol. 2008;34:1638–50.

Chang JM, Moon WK, Cho N, et al. Breast mass evaluation: Factors influencing the quality of US elastography. Radiology. 2011;259:59–64.

Cho N, Moon WK, Kim HY, et al. Sonoelastographic strain index for differentiation of benign and malignant nonpalpable breast masses. J Ultrasound Med. 2010;29:1–7.

Fischer T, Peisker U, Fiedor S, et al. Significant differentiation of focal breast lesions: raw data-based calculation of strain ratio. Ultraschall Med. 2012;33:372–9.

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Springer Science and Business Media LLC

Tập 48 Số 1

63-70

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