Abstract
Purpose
This study was undertaken to evaluate the value of quantitative elastography in the diagnosis of breast tumours.
Materials and methods
Conventional ultrasound (US) and quantitative elastography were performed in 108 women with 114 breast lesions by two experienced radiologists, and pathological results were available in all cases. For each lesion, the maximum, mean, and minimum (min) elasticity and elasticity ratio between lesions and surrounding tissue were measured. The Breast Imaging Reporting and Data System (BI-RADS) categories were assessed with conventional US in all lesions.
Results
Malignant lesions exhibited significantly higher maximum and mean elasticity (111.57±69.29 kPa and 54.49±33.70 kPa) than did benign lesions (59.00±45.3 kPa and 36.64±26.18 kPa) (p<0.01). For maximum elasticity versus BI-RADS, performance results were sensitivity 60.9 % vs. 78.3%, specificity 85.3% vs. 98.5%, positive predictive value (PPV) 73.7% vs. 97.3 %, negative predictive value (NPV) 76.3% vs. 87.0 % and accuracy 75.4% vs. 90.3%. BI-RADS had significantly better accuracy than maximum elasticity (p<0.01). Maximum and mean elasticity of invasive ductal carcinoma (IDC) were significantly higher than those of fibroadenoma (p<0.01), whereas the difference was not statistically significant with fibroadenosis, papilloma and inflammation (p>0.01). Maximum and mean elasticity and elasticity ratio of BI-RADS 5 were all significantly higher than those of BI-RADS 3 (p<0.01). Reliability for maximum and mean elasticity were almost perfect [intraclass correlation coefficients (ICC)=0.87 and 0.79].
Conclusions
Shear-wave elastography gives quantitative elasticity information that could potentially help in breast-lesion characterisation, although it cannot replace conventional BI-RADS in the differentiation of breast lesions.
Riassunto
Obiettivo
Valutare l’utilità dell’elastografia quantitativa nella diagnosi del tumore alla mammella.
Materiali e metodi
108 donne con lesioni alla mammella sono state sottoposte ad ecografia convenzionale ed a studio elastografico quantitativo mediante supersonic shear imaging da due radiologi esperti; in ogni caso era disponibile il riscontro anatomopatologico delle lesioni. Per ogni lesione sono state misurate l’elasticità massima, media e minima, ed il rapporto di elasticità tra le lesioni ed il tessuto circostante. In tutti i casi sono state stimate le categorie BI-RADS (the Breast Imaging Reporting and Data System) mediante ecografia convenzionale. Risultati. Le lesioni maligne manifestavano elasticità massima e media significativamente maggiore (111,57±69,29 kPa e 54,49 ± 33,70 kPa) rispetto alle lesioni benigne (59,00±45,35 kPa e 36,64±26,18 kPa) (p<0,01). L’elasticità massima, nei confronti delle categorie BI-RADS, presentava sensibilità del 60,9 % vs. 78,3%, specificità del 85,3% vs. 98,5%, valore predittivo positivo (VPP) 73,7% vs. 97,3 %, valore predittivo negativo (VPN) 76,3% vs. 87,0 % ed accuratezza 75,4% vs. 90,3%. Le categorie BI-RADS presentano un’accuratezza significativamente migliore dell’elasticità massima (p<0,01). L’elasticità media e massima del carcinoma duttale invasivo (CDI) è risultata significativamente maggiore rispetto al fibroadenoma (p<0,01), mentre non sono emerse differenze statisticamente significative con la fibroadenosi, il papilloma e l’infiammazione (p>0,01). Le lesioni con BI-RADS 5 presentavano tutte un’elasticità media e massima significativamente maggiore rispetto alle lesioni con BI-RADS 3 (p<0,01). L’affidabilità dell’elasticità massima e media è risultata essere pressochè perfetta [coefficiente di correlazione intraclasse (CCI)=0,87 e 0,79].
Conclusioni
L’elastografia quantitativa mediante supersonic shear imaging fornisce informazioni che potrebbero essere potenzialmente utili nella caratterizzazione delle lesioni alla mammella, sebbene non possa sostituire il sistema BI-RADS convenzionale nella loro differenziazione.
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Wang, Z.L., Li, J.L., Li, M. et al. Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours. Radiol med 118, 583–590 (2013). https://doi.org/10.1007/s11547-012-0903-x
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DOI: https://doi.org/10.1007/s11547-012-0903-x