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Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy

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To retrospectively evaluate whether sonoelastographic evaluation could help predict the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy.


One hundred and three consecutive nonpalpable DCIS lesions diagnosed at US-guided needle biopsy were analyzed. To identify the preoperative factors associated with upgrade to invasive cancers on surgical histology, lesion size, B-mode US findings, elasticity score, biopsy variables, and histological variables were analyzed using univariate and multivariate logistic regression. Interobserver agreement for the elasticity score was evaluated using the multi-rater κ statistics.


The overall upgrade rate was 23% (24 of 103). Elasticity score was found to be the only independent predictor of invasion. The upgrade rates according to the median elasticity score was 6.7% (1 of 15) for a score of 1, 20.6% (13 of 63) for a score of 2, and 40.0% (10 of 25) for a score of 3 (Odds ratio [OR] = 1; OR = 4.19, P = 0.207; OR = 12.32, P = 0.039, respectively). No association was found between other factors and the upgrade rate. The overall interobserver agreement for the elasticity score was moderate (κ = 0.587; P < .001).


Sonoelastographic lesion stiffness is an independent preoperative predictor of invasion in some patients with nonpalpable DCIS at US-guided needle biopsy.

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  1. Liberman L (2002) Percutaneous image-guided core breast biopsy. Radiol Clin North Am 40:483–500

    Article  PubMed  Google Scholar 

  2. Morrow M, Venta L, Stinson T, Bennett C (2001) Prospective comparison of stereotactic core biopsy and surgical excision as diagnostic procedures for breast cancer patients. Ann Surg 233:537–541

    Article  PubMed  CAS  Google Scholar 

  3. Lee CH, Carter D, Philpotts LE et al (2000) Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted? Radiology 217:466–470

    PubMed  CAS  Google Scholar 

  4. Jackman RJ, Burbank F, Parker SH et al (2001) Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology 218:497–502

    PubMed  CAS  Google Scholar 

  5. King TA, Farr GH Jr, Cederbom GJ et al (2001) A mass on breast imaging predicts coexisting invasive carcinoma in patients with a core biopsy diagnosis of ductal carcinoma in situ. Am Surg 67:907–912

    PubMed  CAS  Google Scholar 

  6. Hoorntje LE, Schipper ME, Peeters PH et al (2003) The finding of invasive cancer after a preoperative diagnosis of ductal carcinoma-in-situ: causes of ductal carcinoma-in-situ underestimates with stereotactic 14-gauge needle biopsy. Ann Surg Oncol 10:748–753

    Article  PubMed  Google Scholar 

  7. Yen TW, Hunt KK, Ross MI et al (2005) Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ: a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ. J Am Coll Surg 200:516–526

    Article  PubMed  Google Scholar 

  8. Goyal A, Douglas-Jones A, Monypenny I et al (2006) Is there a role of sentinel lymph node biopsy in ductal carcinoma in situ? Analysis of 587 cases. Breast Cancer Res Treat 98:311–314

    Article  PubMed  Google Scholar 

  9. Dillon MF, McDermott EW, Quinn CM et al (2006) Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol 93:559–563

    Article  PubMed  Google Scholar 

  10. Lee JW, Han W, Ko E et al (2008) Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus. J Surg Oncol 98:15–20

    Article  PubMed  Google Scholar 

  11. Rutstein LA, Johnson RR, Poller WR et al (2007) Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ. Breast J 13:251–257

    Article  PubMed  Google Scholar 

  12. Moran CJ, Kell MR, Flanagan FL, Kennedy M, Gorey TF, Kerin MJ (2007) Role of sentinel lymph node biopsy in high-risk ductal carcinoma in situ patients. Am J Surg 194:172–175

    Article  PubMed  Google Scholar 

  13. Hung WK, Ying M, Chan M, Mak KL, Chan LK (2010) The impact of sentinel lymph node biopsy in patients with a core biopsy diagnosis of ductal carcinoma in situ. Breast Cancer 17:276–280

    Article  PubMed  Google Scholar 

  14. Lyman GH, Giuliano AE, Somerfield MR et al (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720

    Article  PubMed  Google Scholar 

  15. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X (1991) Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 13:111–134

    Article  PubMed  CAS  Google Scholar 

  16. Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–350

    Article  PubMed  Google Scholar 

  17. Cho N, Moon WK, Park JS, Cha JH, Jang M, Seong MH (2008) Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol 9:111–118

    Article  PubMed  Google Scholar 

  18. Scaperrotta G, Ferranti C, Costa C et al (2008) Role of sonoelastography in non-palpable breast lesions. Eur Radiol 18:2381–2389

    Article  PubMed  Google Scholar 

  19. Tan SM, Teh HS, Mancer JF, Poh WT (2008) Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—a clinical approach. Breast 17:252–257

    Article  PubMed  CAS  Google Scholar 

  20. Sohn YM, Kim MJ, Kim EK, Kwak JY, Moon HJ, Kim SJ (2009) Sonographic elastography combined with conventional sonography: how much is it helpful for diagnostic performance? J Ultrasound Med 28:413–420

    PubMed  Google Scholar 

  21. Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW (2010) Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med 29:551–563

    PubMed  Google Scholar 

  22. Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T (1998) Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging 20:260–274

    PubMed  CAS  Google Scholar 

  23. American College of Radiology (2003) Breast imaging reporting and data system-Ultrasound (BI-RADS™). American College of Radiology, Reston

    Google Scholar 

  24. Cho N, Moon WK, Park JS (2009) Real-time US elastography in the differentiation of suspicious microcalcifications on mammography. Eur Radiol 19:1621–1628

    Article  PubMed  Google Scholar 

  25. Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76:378–382

    Article  Google Scholar 

  26. Berg WA, Blume JD, Cormack JB, Mendelson EB (2006) Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology 241:355–365

    Article  PubMed  Google Scholar 

  27. Warren RM, Pointon L, Thompson D et al (2005) Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis. Radiology 236:779–788

    Article  PubMed  Google Scholar 

  28. Regner DM, Hesley GK, Hangiandreou NJ et al (2006) Breast lesions: evaluation with US strain imaging–clinical experience of multiple observers. Radiology 238:425–437

    Article  PubMed  Google Scholar 

  29. Moon WK, Myung JS, Lee YJ, Park IA, Noh DY, Im JG (2002) US of ductal carcinoma in situ. Radiographics 22:269–280

    PubMed  Google Scholar 

  30. Londero V, Zuiani C, Furlan A, Nori J, Bazzocchi M (2007) Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast. Radiol Med 112:863–876

    Article  PubMed  CAS  Google Scholar 

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This study was supported by a grant of the Korea Healthcare Technology R and D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea. (A090675)

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Correspondence to Woo Kyung Moon.

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Cho, N., Moon, W.K., Chang, J.M. et al. Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy. Eur Radiol 21, 1618–1627 (2011).

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