Abstract
Elastography (ES) is a technique that, when associated with traditional B mode ultrasound (US), allows the degree of elasticity of tissue to be evaluated according to a color scale system. The aims of the study were to compare the diagnostic characteristics of two widely used techniques adopted in breast cancer screening; US and color Doppler (CD), with those of the same two techniques plus ES, and assessment of the same diagnostic characteristics when the three methods were applied to lesions < or >1 cm. Methods used included subjecting 212 women to investigations aimed at the early diagnosis of breast cancer outside the screening model, whereby 395 lesions were detected by US, ES, and CD, with a definitive diagnosis proved by histological exam. The diagnostic performance of US, ES, CD, and their combinations was calculated. The results showed that comparing the diagnostic characteristics of the three methods with reference to the definitive histological results for malignant breast lesions, the best diagnostic accuracy was obtained when US, ES, and CD were combined (0.837). For lesions <1 cm, diagnostic accuracy was 0.782, and for those >1 cm, it was 0.886. In the lesions <1 cm, which were more difficult to study, a positive ES score (>4) appeared to be sufficient to deepen the diagnosis, even though 35 % of the ES or US positive lesions were not malignant. By contrast, in lesions >1 cm, the probability of having a malignant lesion when all three tests were positive was very high (97 %). It was concluded that early diagnosis is a key factor in breast cancer, so an economically sustainable, non-invasive pathway is the target of diagnostic breast imaging.
Riassunto
L’elastosonografia (ES) è una metodica che associata all’ecografia consente di valutare l’elasticità e rigidità dei tessuti utilizzando una scala cromatica. Obiettivi di questo studio sono: confrontare le caratteristiche diagnostiche dell’ecografia (US) e del doppler (CD), due metodiche utilizzate per la diagnosi di tumore al seno, con quelle dell’ES, da sola o in combinazione con le precedenti; valutare le stesse caratteristiche in lesioni < o >1cm. Metodi: 212 donne sono state sottoposte a valutazione per diagnosi precoce di tumore al seno, al di fuori di un programma di screening. 395 lesioni sono state studiate con US, ES, e CD e la diagnosi definitiva è risultata dall’esame istologico. E’ stata misurata la performance diagnostica delle 3 metodiche e delle loro combinazioni. Risultati: Dalla comparazione delle diverse metodiche emerge che la più elevata accuratezza diagnostica, per individuare lesioni maligne della mammella, si ottiene utilizzando le 3 metodiche congiuntamente (0.837). Per lesioni <1cm l’accuratezza diagnostica è 0.782, e per quelle >1cm 0.886. Nelle lesioni <1cm, le più complesse da valutare, un punteggio ES>4 sembra essere sufficiente per approfondire l’iter diagnostico, sebbene il 35% delle lesioni positive all’ES o all’US siano di tipo benigno. Diversamente, nelle lesioni >1cm la probabilità di avere una lesione maligna quando tutte e tre le metodiche sono positive è risultata molto alta (97%). Conclusioni. La diagnosi precoce rappresenta un fattore chiave nel carcinoma mammario; pertanto, un percorso economicamente sostenibile, e non invasivo è il target dell’imaging diagnostico per la mammella.
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Botticelli, A., Mazzotti, E., Di Stefano, D. et al. Positive impact of elastography in breast cancer diagnosis: an institutional experience. J Ultrasound 18, 321–327 (2015). https://doi.org/10.1007/s40477-015-0177-y
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DOI: https://doi.org/10.1007/s40477-015-0177-y