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Can strain US-elastography with strain ratio (SRE) improve the diagnostic accuracy in the assessment of breast lesions? Preliminary results

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Abstract

Purpose

To assess the diagnostic value of strain ratio elastography (SRE), a semiquantitative elastosonographic method based on the displacement of the tissue from an external source (manual compression with the transducer), as compared and in combination with conventional ultrasound for the differentiation of breast lesions.

Methods

One hundred and eighty-two patients with breast lesions consecutively underwent B-mode, color Doppler US, and strain US-elastography. Each lesion was classified according to the BI-RADS lexicon by evaluating the size, the B-mode, and color Doppler features and then evaluated by SRE. Histology proven by biopsy was used as the gold standard and the patients with malignant lesions subsequently underwent operations. The diagnostic performance of each method was assessed with 2 × 2 contingency tables and ROC curve analysis. To maximize the SRE sensitivity and specificity, the SRE cut-off value was calculated using the Youden test.

Results

Histological examination revealed 66 benign and 116 malignant breast lesions. The conventional ultrasound showed sensitivity and specificity for the differentiation of benign and malignant lesions of 86.2% and 75.8%, respectively. Similar results were found for strain US-elastography with a cut-off of 2.49, with sensitivity and specificity of 89.7% and 72.7%, respectively. The association of conventional ultrasound with the SRE value increased the sensitivity (98.3%) but decreased the specificity compared with conventional US alone (63.6%).

Conclusion

Strain US-elastography can be associated with BI-RADS US examination. According to our preliminary results, it helped increase the sensitivity although it decreased the specificity. However, further multicenter studies on a larger population are warranted.

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Abbreviations

AUC:

Area under curve

AUROC:

Area under the receiver operating characteristic curve

BI-RADS:

Breast imaging, reporting and data system

EFSUMB:

European Federation of Ultrasound in Medicine and Biology

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operation characteristic

ROI:

Region of interest

SRE:

Strain ratio elastography

US:

Ultrasound

WFUMB:

World Federation of Ultrasound in Medicine and Biology

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Funding

This work received no specific funding.

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Authors and Affiliations

  1. Department of Radiology, Oncology, and Anatomy Pathology, Policlinico Umberto I, University Sapienza of Rome, Rome, Italy

    Daniela Elia, Daniele Fresilli, Patrizia Pacini, Sara Cardaccio, Giorgia Polti, Olga Guiban, Ilaria Celletti, Eriselda Kutrolli, Carlo De Felice, Rossella Occhiato, Federica Pediconi, Ferdinando D’Ambrosio & Vito Cantisani

  2. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

    Corrado De Vito

  3. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy

    Maria Ida Amabile, Alessandro De Luca, Vito D’Andrea & Massimo Vergine

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  1. Daniela Elia
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Corresponding author

Correspondence to Daniela Elia.

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Conflict of interest

Federica Pediconi lectured for Bracco, Bayer and Siemens; Vito Cantisani lectured for Bracco, Samsung and Canon. The other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards.

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Elia, D., Fresilli, D., Pacini, P. et al. Can strain US-elastography with strain ratio (SRE) improve the diagnostic accuracy in the assessment of breast lesions? Preliminary results. J Ultrasound 24, 157–163 (2021). https://doi.org/10.1007/s40477-020-00505-3

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