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La radiologia medica

, 116:1027 | Cite as

Characterisation of indeterminate focal breast lesions on grey-scale ultrasound: role of ultrasound elastography

  • T. V. BartolottaEmail author
  • R. Ienzi
  • A. Cirino
  • C. Genova
  • F. Ienzi
  • D. Pitarresi
  • E. Safina
  • M. Midiri
Breast Radiology / Senologia

Abstract

Purpose

This study was undertaken to evaluate the role of ultrasound (US) elastography in characterising focal breast lesions classified as indeterminate on B-mode US.

Materials and methods

Eighty-four focal breast lesions, 64 benign and 20 malignant (mean diameter, 15.1 mm), detected but not characterised on B-mode US in 72 women, Breast Imaging Reporting and Data System (BI-RADS) US category 3 (n=56) or category 4 (n=28), were studied with US elastography and classified in consensus by two radiologists according to a five-point colour scale. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of US elastography compared with conventional US were calculated in relation to microhistology (n=67) and cytology (n=17), which were used as the reference standard.

Results

A total of 65/84 (77.4%) lesions were correctly classified as benign or malignant using US elastography, whereas the remaining 19/84 (22.6%) were incorrectly assessed. There were no statistically significant differences between US elastography and B-mode US with regard to sensitivity (70% vs. 68.4%), specificity (79.6% vs. 78.5%), PPV (51.8% vs. 48.1%) and NPV 89% vs. 89.5% (p>0.5). By contrast, a statistically significant difference was noted in the evaluation of BI-RADS 3 lesions, in which US elastography had 50% sensitivity, 86% specificity, 30% PPV and 93.5% NPV compared with BI-RADS 4 lesions (78.6%, 57.1%, 64.7% and 72.7%) (p<0.5).

Conclusions

The high NPV of US elastography may help reduce the use of biopsy in BI-RADS 3 lesions, but its low PPV in BI-RADS 4 lesions does not allow avoidance of biopsy on the basis of the US elastographic score alone in this group of lesions.

Keywords

Breast Ultrasound elastography Breast neoplasms 

Caratterizzazione delle lesioni focali mammarie indeterminate all’ecografia in scala di grigi: ruolo della elastosonografia

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare il ruolo dell’elastosonografia nella caratterizzazione delle lesioni focali mammarie indeterminate all’ecografia di base

Materiali e metodi

Ottantaquattro lesioni focali mammarie, 64 benigne e 20 maligne (diametro medio: 15,1 mm), rilevate ma non caratterizzate all’ecografia di base in 72 donne — punteggio ecografico breast imaging reporting and data system (BI-RADS) 3 (n=56) o BI-RADS 4 (n=28) -, sono state sottoposte ad elastosonografia e classificate in consenso da due radiologi secondo una scala colorimetrica in cinque punti. Sono stati calcolati sensibilità, specificità, valori predittivo positivo (VPP) e negativo (VPN) dell’elastosonografia rispetto all’ecografia convenzionale in relazione alla metodica di riferimento: microistologia (n=67) e citologia (n=17)

Risultati

Sessantacinque/84 (77,4%) lesioni sono state correttamente classificate come benigne o maligne all’elastosonografia, mentre le rimanenti 19/84 (22,6%) sono state erroneamente valutate. Non sono state riscontrate differenze statisticamente significative tra elastosonografia ed ecografia B-mode con tassi di sensibilità, specificità, VPP e VPN pari rispettivamente al 70%, 79,6%, 51,8% e 89%, e al 68,4%, 78,5%, 48,1% e 89,5% (p>0,5). L’elastosonografia ha presentato differenze statisticamente significative nella valutazione delle lesioni mammarie in classe BI-RADS 3, con valori pari a 50%, 86%, 30% e 93,5%, rispetto a quelle BI-RADS 4 (78,6%, 57,1%, 64,7% e 72,7%) (p<0,5)

Conclusioni

L’elevato VPN dell’elastosonografia può essere utile per evitare l’estensivo ricorso alla biopsia nelle lesioni mammarie in classe BI-RADS 3, ma il basso VPP in quelle BI-RADS 4 non consente di escludere il ricorso alla biopsia sulla scorta del solo punteggio elastosonografico

Parole chiave

Mammella Elastosonografia Neoplasie mammarie 

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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • T. V. Bartolotta
    • 1
    Email author
  • R. Ienzi
    • 1
  • A. Cirino
    • 1
  • C. Genova
    • 1
  • F. Ienzi
    • 1
  • D. Pitarresi
    • 1
  • E. Safina
    • 1
  • M. Midiri
    • 1
  1. 1.Dipartimento di Biotecnologie Mediche e Medicina Legale, Sezione di Diagnostica per ImmaginiPoliclinico UniversitarioPalermoItaly

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