Differential diagnosis of breast mass image-forming lesions based on changes in depth-width ratio and internal echo intensity by hand-held probe compression
- 49 Downloads
Abstract
Purpose
Regarding mass image-forming lesions, the 2005 Guidelines for Ultrasonic Diagnosis of Breast Diseases, published by the Japan Society of Ultrasonics in Medicine (JSUM), includes the evaluation of tumor compressibility, which is visually assessed by the degree of deformation caused by applying external pressure to the tumor. However, this is only a subjective estimation under real-time observation; consequently, quantitative evaluation of tumor deformation and the percentage change in internal echo intensity was attempted based on changes in the depth-width ratio and in the internal echo intensity on hand-held probe compression. We evaluated the usefulness of these measurements in the differential diagnosis of benign and malignant tumors.
Methods
The subjects were 139 patients (89 benign and 50 malignant cases) who underwent breast ultrasonography with a 10-MHz (from 4-to 10-MHz) linear probe. The deformation index (D.I.) of the tumor was defined as: [1 − (depth-width ratio with 3.0 ± 0.6-kg-weighted compression)/(depth-width ratio without compression)] × 100 (%). The rate of change in internal echo intensity was defined as the echo intensity with compression divided by the echo intensity without compression × 100 (%).
Results
There was a significant difference in the D.I. between benign lesions (35.5% ± 14.7%) and malignant lesions (15.4% ± 6.2%) (P < 0.001). The cut-off ratio in differentiating benign from malignant lesions was approximately 25%. The rate of change in echo intensity of benign lesions (149.7% ± 34.3%) was significantly higher than that of malignant lesions (122.9% ± 19.9%) (P < 0.001).
Conclusion
Using an electronic linear probe, quantitative indexes including the D.I. and the rate of change in internal echo intensity could be obtained with the help of a weight meter, and could prove effective for the differential diagnosis of breast mass-image forming lesions.
Keywords
ultrasonography mammary tissue characterization breast neoplasm deformation indexPreview
Unable to display preview. Download preview PDF.
References
- 1.The Japan Society of Ultrasonics in Medicine. Diagnostic criteria for breast lesions. Jpn J Med Ultrasonics 1989;16:106–107 (in Japanese).Google Scholar
- 2.Japan Association of Breast and Thyroid Sonology (JABTS). Guideline for breast ultrasound — management and diagnosis. Tokyo: Nankodo; 2004. (in Japanese).Google Scholar
- 3.Terminology and Diagnostic Criteria Committee of the Japan Society of Ultrasonics in Medicine. 2005 guidelines for ultrasonic diagnosis of breast diseases regarding the mass image-forming types. J Med Ultrasonics 2005;32:127–129.CrossRefGoogle Scholar
- 4.Ueno E, Tohno E, Soeda S, et al. Dynamic tests in real-time breast echography. Ultrasound Med Biol 1988;14(1):53–57.PubMedCrossRefGoogle Scholar
- 5.Krouskop TA. Elastic moduli of breast and prostate tissues under compression. Ultrasonic Imaging 1998;20:260–274.PubMedGoogle Scholar
- 6.Shiina T. Tissue elasticity imaging. In: Itoh K, editor. Medical ultrasound — new technology and clinical application. Tokyo: Ishiyaku; 2004. pp. 85–88 (in Japanese).Google Scholar
- 7.Okada K, Matsumura T, Mitake T. Development of real-time tissue elastography. Jpn J Radiol Technol 2005;61(6):811–816 (in Japanese).Google Scholar
- 8.Enami H, Sakata K, Furuta T, et al. Study on longitudinal transverse ratio of breast tumors by compression ultrasonography. Jpn J Med Ultrasonics 1987;14(3):26–34 (in Japanese).Google Scholar
- 9.Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006;239(2):341–350.PubMedCrossRefGoogle Scholar
- 10.Thomas A, Fisher T, Frey H, et al. Real-time elastography — an advanced method of ultrasound: first results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 2006;28(3):335–340.PubMedCrossRefGoogle Scholar
- 11.Shimamoto K, Sawaki A, Ikeda M, et al. Interobserver agreement in sonographic diagnosis of breast tumors. Eur J Ultrasound 1998;8(1):25–31.PubMedCrossRefGoogle Scholar
- 12.Shimamoto K, Ikeda M, Sawaki A, et al. Usefulness of sonographic diagnostic criteria for breast lesions: analysis of interobserver agreement among medical students. J Med Ultrasonics 1998;25(12):1117–123 (in Japanese).Google Scholar