Ultrasound Real-time Elastography Can Predict Malignancy in BI-RADS®-US 3 Lesions

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2013 Mar 28

PMID 23530903

Citations 17

Authors

Sebastian Wojcinski

Esther Boehme

Andre Farrokh

Philipp Soergel

Friedrich Degenhardt

Peter Hillemanns

Affiliations

Soon will be listed here.

Abstract

Background: Lesions of the breast that are classified BI-RADS®-US 3 by ultrasound are probably benign and observation is recommended, although malignancy may occasionally occur. In our study, we focus exclusively on BI-RADS®-US 3 lesions and hypothesize that sonoelastography as an adjunct to conventional ultrasound can identify a high-risk-group and a low-risk-group within these patients.

Methods: A group of 177 breast lesions that were classified BI-RADS®-US 3 were additionally examined with real-time sonoelastography. Elastograms were evaluated according to the Tsukuba Elasticity Score. Pretest and posttest probability of disease (POD), sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) and likelihood-ratios (LR) were calculated. Furthermore, we analyzed the false-negative and false-positive cases and performed a model calculation to determine how elastography could affect the proceedings in population screening.

Results: In our collection of BI-RADS®-US 3 cases there were 169 benign and eight malignant lesions. The pretest POD was 4.5% (95% confidence interval (CI): 2.1-9.0). In patients with a suspicious elastogram (high-risk group), the posttest POD was significantly higher (13.2%, p = 0.041) and the positive LR was 3.2 (95% CI: 1.7-5.9). With a benign elastogram (low-risk group), the posttest POD decreased to 2.2%. SE, SP, PPV and NPV for sonoelastography in BI-RADS®-US 3 lesions were 62.5% (95% CI: 25.9-89.8), 80.5% (95% CI: 73.5-86.0), 13.2% (95% CI: 5.0-28.9) and 97.8% (95% CI: 93.3-99.4), respectively.

Conclusions: Sonoelastography yields additional diagnostic information in the evaluation of BI-RADS®-US 3 lesions of the breast. The examiner can identify a low-risk group that can be vigilantly observed and a high-risk group that should receive immediate biopsy due to an elevated breast cancer risk.

Citing Articles

Application of computer-aided diagnosis to predict malignancy in BI-RADS 3 breast lesions.

He P, Chen W, Bai M, Li J, Wang Q, Fan L Heliyon. 2024; 10(2):e24560.

PMID: 38304808 PMC: 10831749. DOI: 10.1016/j.heliyon.2024.e24560.

The value of elastography strain rate ratio in benign and malignant BI-RADS-US 3-4 breast masses.

Li X, Sun W, Zhang H Biomol Biomed. 2023; 24(3):625-632.

PMID: 38149832 PMC: 11088897. DOI: 10.17305/bb.2023.9878.

Comparisons among the Ultrasonography Prediction Model, Real-Time and Shear Wave Elastography in the Evaluation of Major Salivary Gland Tumors.

Cheng P, Lo W, Chang C, Wen M, Cheng P, Liao L Diagnostics (Basel). 2022; 12(10).

PMID: 36292177 PMC: 9600618. DOI: 10.3390/diagnostics12102488.

Can strain elastography be used in reclassification of indeterminate breast lesions in BIRADS lexicon?: A prospective study.

Sinha D, Kundaragi N, Sharma S, Kale S Indian J Radiol Imaging. 2021; 30(4):493-499.

PMID: 33737779 PMC: 7954173. DOI: 10.4103/ijri.IJRI_425_19.

Interacting Factors of Strain Ratio Values in Fibroadenomas and the Contribution of Color Scale.

Sezgin G, Coskun M, Apaydin M, Keceli M, Cetinoglu K, Tavusbay C J Med Ultrasound. 2020; 28(3):169-172.

PMID: 33282661 PMC: 7709523. DOI: 10.4103/JMU.JMU_112_19.

References

Wojcinski S, Farrokh A, Weber S, Thomas A, Fischer T, Slowinski T . Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS®-US classification system with sonoelastography. Ultraschall Med. 2010; 31(5):484-91. DOI: 10.1055/s-0029-1245282. View

Hille H, Vetter M, Hackeloer B . The accuracy of BI-RADS classification of breast ultrasound as a first-line imaging method. Ultraschall Med. 2011; 33(2):160-3. DOI: 10.1055/s-0031-1281667. View

Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T . Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006; 239(2):341-50. DOI: 10.1148/radiol.2391041676. View

Newcombe R . Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med. 1998; 17(8):873-90. DOI: 10.1002/(sici)1097-0258(19980430)17:8<873::aid-sim779>3.0.co;2-i. View

Barr R, Lackey A . The utility of the "bull's-eye" artifact on breast elasticity imaging in reducing breast lesion biopsy rate. Ultrasound Q. 2011; 27(3):151-5. DOI: 10.1097/RUQ.0b013e31822a9c75. View

Madjar H, Ohlinger R, Mundinger A, Watermann D, Frenz J, Bader W . [BI-RADS-analogue DEGUM criteria for findings in breast ultrasound--consensus of the DEGUM Committee on Breast Ultrasound]. Ultraschall Med. 2006; 27(4):374-9. DOI: 10.1055/s-2006-926943. View

Hahn M, Roessner L, Krainick-Strobel U, Gruber I, Kramer B, Gall C . [Sonographic criteria for the differentiation of benign and malignant breast lesions using real-time spatial compound imaging in combination with XRES adaptive image processing]. Ultraschall Med. 2010; 33(3):270-4. DOI: 10.1055/s-0029-1245497. View

Parkin D, Bray F, Ferlay J, Pisani P . Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55(2):74-108. DOI: 10.3322/canjclin.55.2.74. View

Urbschat I, Kieschke J, Schlanstedt-Jahn U, von Gehlen S, Thiel A, Jensch P . [Contributions of the epidemiological cancer registries to the evaluation of mammography screening in Germany]. Gesundheitswesen. 2005; 67(7):448-54. DOI: 10.1055/s-2005-858515. View

10.

Wojcinski S, Cassel M, Farrokh A, Soliman A, Hille U, Schmidt W . Variations in the Elasticity of Breast Tissue During the Menstrual Cycle Determined by Real-time Sonoelastography. J Ultrasound Med. 2012; 31(1):63-72. DOI: 10.7863/jum.2012.31.1.63. View

11.

Moon W, Choi J, Cho N, Park S, Chang J, Jang M . Computer-aided analysis of ultrasound elasticity images for classification of benign and malignant breast masses. AJR Am J Roentgenol. 2010; 195(6):1460-5. DOI: 10.2214/AJR.09.3140. View

12.

Parkin D, Fernandez L . Use of statistics to assess the global burden of breast cancer. Breast J. 2006; 12 Suppl 1:S70-80. DOI: 10.1111/j.1075-122X.2006.00205.x. View

13.

Ciurea A, Bolboaca S, Ciortea C, Botar-Jid C, Dudea S . The influence of technical factors on sonoelastographic assessment of solid breast nodules. Ultraschall Med. 2010; 32 Suppl 1:S27-34. DOI: 10.1055/s-0029-1245684. View

14.

Thomas A, Degenhardt F, Farrokh A, Wojcinski S, Slowinski T, Fischer T . Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol. 2010; 17(5):558-63. DOI: 10.1016/j.acra.2009.12.006. View

15.

Fierbinteanu-Braticevici C, Andronescu D, Usvat R, Cretoiu D, Baicus C, Marinoschi G . Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. World J Gastroenterol. 2009; 15(44):5525-32. PMC: 2785054. DOI: 10.3748/wjg.15.5525. View

16.

Thomas A, Fischer T, Frey H, Ohlinger R, Grunwald S, Blohmer J . Real-time elastography--an advanced method of ultrasound: First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol. 2006; 28(3):335-40. DOI: 10.1002/uog.2823. View

17.

Sadigh G, Carlos R, Neal C, Dwamena B . Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring. Breast Cancer Res Treat. 2011; 133(1):23-35. DOI: 10.1007/s10549-011-1857-8. View