Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Sonoelastography in Distinguishing Benign from Malignant Complex Breast Mass and Making the Decision to Biopsy

  • Kim, Mi Young (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, and Institute of Radiation Medicine) ;
  • Cho, Nariya (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, and Institute of Radiation Medicine) ;
  • Yi, Ann (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, and Institute of Radiation Medicine) ;
  • Koo, Hye Ryoung (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, and Institute of Radiation Medicine) ;
  • Yun, Bo La (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Moon, Woo Kyung (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, and Institute of Radiation Medicine)
  • Received : 2013.02.05
  • Accepted : 2013.03.31
  • Published : 2013.07.01
⟨ Previous Next ⟩

Abstract

Objective: To evaluate the additional effect of sonoelastography on the radiologist's ability for distinguishing benign from malignant complex breast masses and to decide whether to perform biopsy by B-mode US. Materials and Methods: One hundred eighteen complex breast masses (15 malignant lesions, 103 benign lesions) were included. Five blinded readers independently assessed the likelihood of the malignancy score from 1 to 5 for two data sets (B-mode ultrasound alone and B-mode ultrasound with sonoelastography). Elasticity scores were categorized as 0, 1, or 2 based on the degree and distribution of strain of the echogenic component within complex masses. The readers were asked to downgrade the likelihood of the malignancy score when an elasticity score of 0 was assigned and to upgrade the likelihood of the malignancy score when an elasticity score of 2 was assigned. The likelihood of the malignancy score was maintained as it was for the lesions with an elasticity score of 1. The Az values, sensitivities, and specificities were compared. Results: The Az value of B-mode ultrasound with sonoelastography (mean, 0.863) was greater than that of B-mode ultrasound alone (mean, 0.731; p = 0.001-0.007) for all authors. The specificity of B-mode ultrasound with sonoelastography (mean, 37.1%) was greater than that of B-mode ultrasound alone (mean, 3.8%; p < 0.001) for all readers. The addition of sonoelastography led to changes in decisions. A mean of 33.6% of benign masses were recommended for follow-up instead of biopsy. Conclusion: For complex breast masses, sonoelastography allows increase in both the accuracy in distinguishing benign from malignant lesions and the specificity in deciding whether to perform biopsy.

Keywords

References

  1. Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer 1995;76:626-630 https://doi.org/10.1002/1097-0142(19950815)76:4<626::AID-CNCR2820760413>3.0.CO;2-Z
  2. Buchberger W, DeKoekkoek-Doll P, Springer P, Obrist P, Dunser M. Incidental findings on sonography of the breast: clinical significance and diagnostic workup. AJR Am J Roentgenol 1999;173:921-927 https://doi.org/10.2214/ajr.173.4.10511149
  3. Buchberger W, Niehoff A, Obrist P, DeKoekkoek-Doll P, Dunser M. Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR 2000;21:325-336 https://doi.org/10.1016/S0887-2171(00)90027-1
  4. Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 2001;221:641-649 https://doi.org/10.1148/radiol.2213010364
  5. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002;225:165-175 https://doi.org/10.1148/radiol.2251011667
  6. Leconte I, Feger C, Galant C, Berliere M, Berg BV, D'Hoore W, et al. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR Am J Roentgenol 2003;180:1675-1679 https://doi.org/10.2214/ajr.180.6.1801675
  7. Crystal P, Strano SD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 2003;181:177-182 https://doi.org/10.2214/ajr.181.1.1810177
  8. Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology 2012;265:59-69 https://doi.org/10.1148/radiol.12120621
  9. Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Bohm-Velez M, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008;299:2151-2163 https://doi.org/10.1001/jama.299.18.2151
  10. Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am 2010;48:931-987 https://doi.org/10.1016/j.rcl.2010.06.007
  11. American College of Radiology. Breast imaging reporting and data system-ultrasound. In: American College of Radiology, ed. Breast imaging reporting and data system, 4th ed. Reston, VA: American College of Radiology, 2003
  12. Omori LM, Hisa N, Ohkuma K, Fujikura Y, Hiramatsu K, Enomoto I, et al. Breast masses with mixed cystic-solid sonographic appearance. J Clin Ultrasound 1993;21:489-495 https://doi.org/10.1002/jcu.1870210803
  13. Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 2003;227:183- 191 https://doi.org/10.1148/radiol.2272020660
  14. Chang YW, Kwon KH, Goo DE, Choi DL, Lee HK, Yang SB. Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med 2007;26:47-53
  15. Tea MK, Grimm C, Fink-Retter A, Bikas D, Kroiss R, Kubista E, et al. The validity of complex breast cysts after surgery. Am J Surg 2009;197:199-202 https://doi.org/10.1016/j.amjsurg.2007.11.028
  16. Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging 1998;20:260-274 https://doi.org/10.1177/016173469802000403
  17. Wellman PS, Dalton EP, Krag D, Kern KA, Howe RD. Tactile imaging of breast masses: first clinical report. Arch Surg 2001;136:204-208 https://doi.org/10.1001/archsurg.136.2.204
  18. Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006;239:341-350 https://doi.org/10.1148/radiol.2391041676
  19. Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW. Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med 2010;29:551-563 https://doi.org/10.7863/jum.2010.29.4.551
  20. Cho N, Moon WK, Park JS, Cha JH, Jang M, Seong MH. Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol 2008;9:111-118 https://doi.org/10.3348/kjr.2008.9.2.111
  21. Cho N, Jang M, Lyou CY, Park JS, Choi HY, Moon WK. Distinguishing benign from malignant masses at breast US: combined US elastography and color doppler US--influence on radiologist accuracy. Radiology 2012;262:80-90 https://doi.org/10.1148/radiol.11110886
  22. Yi A, Cho N, Chang JM, Koo HR, La Yun B, Moon WK. Sonoelastography for 1,786 non-palpable breast masses: diagnostic value in the decision to biopsy. Eur Radiol 2012;22:1033-1040 https://doi.org/10.1007/s00330-011-2341-x
  23. Tan SM, Teh HS, Mancer JF, Poh WT. Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography--a clinical approach. Breast 2008;17:252-257 https://doi.org/10.1016/j.breast.2007.10.015
  24. Thomas A, Fischer T, Frey H, Ohlinger R, Grunwald S, Blohmer JU, et al. Real-time elastography--an advanced method of ultrasound: first results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 2006;28:335-340 https://doi.org/10.1002/uog.2823
  25. Tardivon A, El Khoury C, Thibault F, Wyler A, Barreau B, Neuenschwander S. [Elastography of the breast: a prospective study of 122 lesions]. J Radiol 2007;88(5 Pt 1):657-662 https://doi.org/10.1016/S0221-0363(07)89872-6
  26. Zhi H, Ou B, Luo BM, Feng X, Wen YL, Yang HY. Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions. J Ultrasound Med 2007;26:807-815 https://doi.org/10.7863/jum.2007.26.6.807
  27. Booi RC, Carson PL, O'Donnell M, Roubidoux MA, Hall AL, Rubin JM. Characterization of cysts using differential correlation coefficient values from two dimensional breast elastography: preliminary study. Ultrasound Med Biol 2008;34:12-21 https://doi.org/10.1016/j.ultrasmedbio.2007.07.003
  28. Cho N, Moon WK, Chang JM, Kim SJ, Lyou CY, Choi HY. Aliasing artifact depicted on ultrasound (US)-elastography for breast cystic lesions mimicking solid masses. Acta Radiol 2011;52:3-7 https://doi.org/10.1258/ar.2010.100116
  29. Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971;76:378-382 https://doi.org/10.1037/h0031619
  30. Berg WA, Blume JD, Cormack JB, Mendelson EB. Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology 2006;241:355-365 https://doi.org/10.1148/radiol.2412051710
  31. Warren RM, Pointon L, Thompson D, Hoff R, Gilbert FJ, Padhani A, et al. Reading protocol for dynamic contrastenhanced MR images of the breast: sensitivity and specificity analysis. Radiology 2005;236:779-788 https://doi.org/10.1148/radiol.2363040735

Cited by

  1. Practice guideline for the performance of breast ultrasound elastography vol.33, pp.1, 2013, https://doi.org/10.14366/usg.13012
  2. Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity vol.205, pp.2, 2015, https://doi.org/10.2214/ajr.14.13448
  3. A pure mucocele-like lesion of the breast diagnosed on ultrasonography-guided core-needle biopsy: is imaging follow-up sufficient? vol.34, pp.2, 2015, https://doi.org/10.14366/usg.14036
  4. Combined Use of Ultrasound Elastography and B-Mode Sonography for Differentiation of Benign and Malignant Circumscribed Breast Masses vol.34, pp.11, 2013, https://doi.org/10.7863/ultra.14.11027
  5. Does the Reporting Quality of Diagnostic Test Accuracy Studies, as Defined by STARD 2015, Affect Citation? vol.17, pp.5, 2016, https://doi.org/10.3348/kjr.2016.17.5.706
  6. Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions vol.11, pp.11, 2013, https://doi.org/10.1371/journal.pone.0167118
  7. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  8. Quantification of breast stiffness using MR elastography at 3 Tesla with a soft sternal driver: A reproducibility study vol.45, pp.5, 2013, https://doi.org/10.1002/jmri.25511
  9. Strain histograms are equal to strain ratios in predicting malignancy in breast tumours vol.12, pp.10, 2013, https://doi.org/10.1371/journal.pone.0186230
  10. Virtual touch tissue imaging and quantification: value in malignancy prediction for complex cystic and solid breast lesions vol.7, pp.None, 2017, https://doi.org/10.1038/s41598-017-07865-7