Breast Multiparametric Ultrasound: a Single-center Experience

Overview

Journal J Ultrasound

Publisher Springer

Specialty Radiology

Date 2024 Aug 5

PMID 39103741

Authors

Calogero Zarcaro

Alessia Angela Maria Orlando

Fabiola Ferraro

Simona Donia

Arianna Melita

Giuseppe Micci

Roberto Cannella

Tommaso Vincenzo Bartolotta

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the role of multiparametric ultrasound (mpUS) in the characterization of focal breast lesions (FBLs).

Methods: This prospective study enrolled patients undergoing multiparametric breast ultrasound for FBLs. An experienced breast radiologist evaluated the following ultrasound features: US BI-RADS category, vascularization pattern (internal, vessels in rim and combined) and presence of penetrating vessels with each Doppler method (Color-Doppler, Power-Doppler, Microvascular imaging), strain ratio (SR) and Tsukuba score (TS) with Strain Elastography (SE), E, E, E and E with 2D-shear wave elastography (2D-SWE). Core biopsy for all BI-RADS 4-5 FBLs and 24-month follow-up for all BI-RADS 2-3 FBLs were considered for standard of reference. The diagnostic performance was assessed with the area under curve (AUCs) and cut-off values were determined according to the Youden's index.

Results: A total of 139 FBLs were included with 75/139 (53.9%) benign and 64/139 (46.1%) malignant FBLs. Internal vascularization patterns (p < 0.001), penetrating vessels (p < 0.001), TS 4-5 (p < 0.001) and all 2D-SWE parameters (p < 0.001) were significantly different between benign and malignant FBLs. The BI-RADS score provided an AUC of 0.876 (95% CI 0.810-0.926) for the diagnosis of malignant FBLs. Among the 2D-SWE measurements, an excellent diagnostic performance was observed for E with an AUC of 0.915 (95% CI 0.856-0.956) and E of 0.908 (95% CI 0.847-0.951). Optimal cutoff for the diagnosis of malignant FBLs were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, E > 82.6 kPa, E > 66.0 kPa, E > 54.4 kPa and E > 330.8. Multiparametric ultrasound, particularly SWE, can improve specificity in the characterization of FBLs.

References

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

Elia D, Fresilli D, Pacini P, Cardaccio S, Polti G, Guiban O . Can strain US-elastography with strain ratio (SRE) improve the diagnostic accuracy in the assessment of breast lesions? Preliminary results. J Ultrasound. 2020; 24(2):157-163. PMC: 8137748. DOI: 10.1007/s40477-020-00505-3. View

Youk J, Gweon H, Son E . Shear-wave elastography in breast ultrasonography: the state of the art. Ultrasonography. 2017; 36(4):300-309. PMC: 5621798. DOI: 10.14366/usg.17024. View

Kapetas P, Clauser P, Woitek R, Wengert G, Lazar M, Pinker K . Quantitative Multiparametric Breast Ultrasound: Application of Contrast-Enhanced Ultrasound and Elastography Leads to an Improved Differentiation of Benign and Malignant Lesions. Invest Radiol. 2019; 54(5):257-264. PMC: 8284878. DOI: 10.1097/RLI.0000000000000543. 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

Park H, Kim S, Yun B, Jang M, Kim B, Lee S . Comparison of One- and Two-Region of Interest Strain Elastography Measurements in the Differential Diagnosis of Breast Masses. Korean J Radiol. 2020; 21(4):431-441. PMC: 7082658. DOI: 10.3348/kjr.2019.0479. View

Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X . Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991; 13(2):111-34. DOI: 10.1177/016173469101300201. 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

Svensson W, Pandian A, Hashimoto H . The use of breast ultrasound color Doppler vascular pattern morphology improves diagnostic sensitivity with minimal change in specificity. Ultraschall Med. 2010; 31(5):466-74. DOI: 10.1055/s-0028-1109478. View

10.

Elseedawy M, Whelehan P, Vinnicombe S, Thomson K, Evans A . Factors influencing the stiffness of fibroadenomas at shear wave elastography. Clin Radiol. 2015; 71(1):92-5. DOI: 10.1016/j.crad.2015.10.029. View

11.

Berg W . Supplemental screening sonography in dense breasts. Radiol Clin North Am. 2004; 42(5):845-51, vi. DOI: 10.1016/j.rcl.2004.04.003. View

12.

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

13.

Schneider B, Miller K . Angiogenesis of breast cancer. J Clin Oncol. 2005; 23(8):1782-90. DOI: 10.1200/JCO.2005.12.017. View

14.

Pesce K, Binder F, Chico M, Swiecicki M, Galindo D, Terrasa S . Diagnostic performance of shear wave elastography in discriminating malignant and benign breast lesions : Our experience with QelaXtoTM software. J Ultrasound. 2020; 23(4):575-583. PMC: 7588561. DOI: 10.1007/s40477-020-00481-8. View

15.

Watanabe T, Kaoku S, Yamaguchi T, Izumori A, Konno S, Okuno T . Multicenter Prospective Study of Color Doppler Ultrasound for Breast Masses: Utility of Our Color Doppler Method. Ultrasound Med Biol. 2019; 45(6):1367-1379. DOI: 10.1016/j.ultrasmedbio.2019.01.021. View

16.

Berg W, Cosgrove D, Dore C, Schafer F, Svensson W, Hooley R . Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 2012; 262(2):435-49. DOI: 10.1148/radiol.11110640. View

17.

Duma M, Chiorean A, Chiorean M, Bolboaca S, Florea M, Feier D . Breast Diagnosis: Concordance Analysis Between the BI-RADS Classification and Tsukuba Sonoelastography Score. Clujul Med. 2015; 87(4):250-7. PMC: 4620667. DOI: 10.15386/cjmed-362. View

18.

Diao X, Zhan J, Chen L, Chen Y, Cao H . Role of Superb Microvascular Imaging in Differentiating Between Malignant and Benign Solid Breast Masses. Clin Breast Cancer. 2020; 20(6):e786-e793. DOI: 10.1016/j.clbc.2020.06.009. View

19.

Ganau S, Javier Andreu F, Escribano F, Martin A, Tortajada L, Villajos M . Shear-wave elastography and immunohistochemical profiles in invasive breast cancer: evaluation of maximum and mean elasticity values. Eur J Radiol. 2015; 84(4):617-22. DOI: 10.1016/j.ejrad.2014.12.020. View

20.

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