Added Value of a New Strain Elastography Technique in Conventional Ultrasound for the Diagnosis of Breast Masses: A Prospective Multicenter Study

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Dec 3

PMID 34858859

Citations 2

Authors

Qi Wei

Yu-Jing Yan

Ge-Ge Wu

Xi-Rong Ye

Fan Jiang

Jie Liu

Gang Wang

Yi Wang

Yu Wang

Zhi-Ping Pan

Jin-Hua Hu

Juan Song

Christoph F Dietrich

Xin-Wu Cui

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to explore the value of elasticity score (ES) and strain ratio (SR) combined with conventional ultrasound in distinguishing benign and malignant breast masses and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.

Methods: This prospective, multicenter study included 910 patients from nine different hospitals. The acquisition and analysis of conventional ultrasound and strain elastography (SE) were obtained by radiologists with more than 5 years of experience in breast ultrasound imaging. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of conventional ultrasound alone and combined tests with ES and/or SR were calculated and compared.

Results: The optimal cutoff value of SR for differentiating benign from malignant masses was 2.27, with a sensitivity of 60.2% and a specificity of 84.8%. When combined with ES and SR, the AUC of the new BI-RADS classification increased from 0.733 to 0.824 ( < 0.001); the specificity increased from 48.1% to 68.5% ( < 0.001) without a decrease in the sensitivity (98.5% . 96.4%, = 0.065); and the PPV increased from 52.2% to 63.7% ( < 0.001) without a loss in the NPV (98.2% . 97.1%, = 0.327). All three combinations of conventional ultrasound, ES, and SR could reduce the biopsy rate of category 4a lesions without reducing the malignant rate of biopsy (from 100% to 68.3%, 34.9%, and 50.4%, respectively, all < 0.001).

Conclusions: SE can be used as a useful and non-invasive additional method to improve the diagnostic performance of conventional ultrasound by increasing AUC and specificity and reducing the unnecessary biopsy of BI-RADS 4a lesions.

Citing Articles

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Xue N, Zhang S Gland Surg. 2022; 11(10):1722-1729.

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References

Hooley R, Scoutt L, Philpotts L . Breast ultrasonography: state of the art. Radiology. 2013; 268(3):642-59. DOI: 10.1148/radiol.13121606. View

Ji T, Gao S, Liu Z, Xing H, Zhao G, Ma Q . 99mTc-Glu-c(RGDyK)-Bombesin SPECT Can Reduce Unnecessary Biopsy of Masses That Are BI-RADS Category 4 on Ultrasonography. J Nucl Med. 2016; 57(8):1196-200. DOI: 10.2967/jnumed.115.168773. View

Balcik A, Polat A, Bayrak I, Polat A . Efficacy of Sonoelastography in Distinguishing Benign from Malignant Breast Masses. J Breast Health. 2017; 12(1):37-43. PMC: 5351433. DOI: 10.5152/tjbh.2015.2843. View

Shiina T, Nightingale K, Palmeri M, Hall T, Bamber J, Barr R . WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015; 41(5):1126-47. DOI: 10.1016/j.ultrasmedbio.2015.03.009. View

Cantisani V, David E, Barr R, Radzina M, De Soccio V, Elia D . US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography. Ultraschall Med. 2020; 42(5):533-540. DOI: 10.1055/a-1134-4937. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Yi A, Cho N, Chang J, Koo H, Yun B, Moon W . Sonoelastography for 1,786 non-palpable breast masses: diagnostic value in the decision to biopsy. Eur Radiol. 2011; 22(5):1033-40. DOI: 10.1007/s00330-011-2341-x. View

Musila Mutala T, Ndaiga P, Aywak A . Comparison of qualitative and semiquantitative strain elastography in breast lesions for diagnostic accuracy. Cancer Imaging. 2016; 16(1):12. PMC: 4882872. DOI: 10.1186/s40644-016-0070-8. View

Hatzung G, Grunwald S, Zygmunt M, Geaid A, Behrndt P, Isermann R . Sonoelastography in the diagnosis of malignant and benign breast lesions: initial clinical experiences. Ultraschall Med. 2010; 31(6):596-603. DOI: 10.1055/s-0029-1245526. View

10.

Saftoiu A, Gilja O, Sidhu P, Dietrich C, Cantisani V, Amy D . The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall Med. 2019; 40(4):425-453. DOI: 10.1055/a-0838-9937. View

11.

Lee S, Chung J, Choi H, Choi S, Ryu E, Ko K . 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. Radiology. 2017; 285(2):660-669. DOI: 10.1148/radiol.2017162424. View

12.

Menezes R, Sardessai S, Furtado R, Sardessai M . Correlation of Strain Elastography with Conventional Sonography and FNAC/Biopsy. J Clin Diagn Res. 2016; 10(7):TC05-10. PMC: 5020250. DOI: 10.7860/JCDR/2016/20239.8177. View

13.

DeLong E, Delong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3):837-45. View

14.

Rosen D, Jiang J . Modeling Uncertainty of Strain Ratio Measurements in Ultrasound Breast Strain Elastography: A Factorial Experiment. IEEE Trans Ultrason Ferroelectr Freq Control. 2019; 67(2):258-268. PMC: 8011866. DOI: 10.1109/TUFFC.2019.2942821. View

15.

Regner D, Hesley G, Hangiandreou N, Morton M, Nordland M, Meixner D . Breast lesions: evaluation with US strain imaging--clinical experience of multiple observers. Radiology. 2006; 238(2):425-37. PMC: 1761922. DOI: 10.1148/radiol.2381041336. View

16.

Bojanic K, Katavic N, Smolic M, Peric M, Kralik K, Sikora M . Implementation of Elastography Score and Strain Ratio in Combination with B-Mode Ultrasound Avoids Unnecessary Biopsies of Breast Lesions. Ultrasound Med Biol. 2017; 43(4):804-816. DOI: 10.1016/j.ultrasmedbio.2016.11.019. View

17.

Barr R, Nakashima K, Amy D, Cosgrove D, Farrokh A, Schafer F . WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast. Ultrasound Med Biol. 2015; 41(5):1148-60. DOI: 10.1016/j.ultrasmedbio.2015.03.008. View

18.

Di Segni M, De Soccio V, Cantisani V, Bonito G, Rubini A, Di Segni G . Automated classification of focal breast lesions according to S-detect: validation and role as a clinical and teaching tool. J Ultrasound. 2018; 21(2):105-118. PMC: 5972107. DOI: 10.1007/s40477-018-0297-2. View

19.

Zhao X, Yao J, Zhou X, Hao S, Mu W, Li L . Strain Elastography: A Valuable Additional Method to BI-RADS?. Ultraschall Med. 2018; 39(5):526-534. DOI: 10.1055/s-0043-115108. View

20.

Xiao X, Jiang Q, Wu H, Guan X, Qin W, Luo B . Diagnosis of sub-centimetre breast lesions: combining BI-RADS-US with strain elastography and contrast-enhanced ultrasound-a preliminary study in China. Eur Radiol. 2016; 27(6):2443-2450. DOI: 10.1007/s00330-016-4628-4. View