Browse > Article
http://dx.doi.org/10.3348/kjr.2013.14.4.559

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)
Publication Information
Korean Journal of Radiology / v.14, no.4, 2013 , pp. 559-567 More about this Journal
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
Breast; Neoplasm; Sonoelastography;
Citations & Related Records
연도 인용수 순위
  • Reference
1 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   DOI   ScienceOn
2 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971;76:378-382   DOI
3 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   DOI   ScienceOn
4 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   DOI   ScienceOn
5 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   DOI   ScienceOn
6 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   DOI   ScienceOn
7 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   DOI   ScienceOn
8 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   DOI   ScienceOn
9 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   DOI
10 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   DOI   ScienceOn
11 Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am 2010;48:931-987   DOI   ScienceOn
12 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
13 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   DOI   ScienceOn
14 Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 2003;227:183- 191   DOI   ScienceOn
15 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
16 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   DOI   ScienceOn
17 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   DOI   ScienceOn
18 Wellman PS, Dalton EP, Krag D, Kern KA, Howe RD. Tactile imaging of breast masses: first clinical report. Arch Surg 2001;136:204-208   DOI   ScienceOn
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   DOI
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   DOI   ScienceOn
21 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   DOI   ScienceOn
22 Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer 1995;76:626-630   DOI   ScienceOn
23 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   DOI   ScienceOn
24 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   DOI   ScienceOn
25 Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 2001;221:641-649   DOI   ScienceOn
26 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   DOI   ScienceOn
27 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   DOI   ScienceOn
28 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   DOI   ScienceOn
29 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   DOI   ScienceOn
30 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   DOI   ScienceOn
31 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   DOI   ScienceOn