Characterization of Breast Lesions Using a Novel Combined Approach of Ultrasonography and Elastography Prior to Invasive Procedures: Are New Age Modalities Set to Replace the Diagnostic Giant?

Sachin Khanduri,Iffat Ali,Tariq Imam,Mazhar Khan,Minal Hamza,Shahla Khan,Anvisha Shukla,Zahid S Ahmad

doi:10.7759/cureus.4954

Sachin Khanduri, Iffat Ali + Show 6 more

Open Access

https://doi.org/10.7759/cureus.4954

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Journal: Cureus	Publication Date: Jun 20, 2019
Citations: 1	License type: cc-by

Affiliation: Era's Lucknow Medical College and Hospital

Abstract

ObjectiveThe goal of this study was to evaluate the diagnostic yield of B-mode ultrasound and ultrasound elastography used alone and in combination for differentiating breast lesions into benign and malignant.Materials and methodsEighty-five patients were investigated with B-mode ultrasonography and elastography and provided a Breast Imaging Reporting, and Data System (BI-RADS) score based on ultrasonography, strain ratio, and elastography score (ES) based on elastography. Each lesion was then evaluated by a combination method, combining BI-RADS with strain ratio and BI-RADS with elastography score. Each modality was assessed for the successful detection and characterization of the lesion and whether combining ultrasonography B-mode imaging with strain elastography improves diagnosis and is reliable enough to replace invasive procedures such as biopsy that have been the mainstay of diagnosis.ResultsOf 85 lesions, 23 lesions (27%) were found to be malignant, and 62 lesions (72.9%) were benign. When used alone, BI-RADS had 100.0% sensitivity, 13% specificity, 50% and 100% positive and negative predictive values (respectively), and 72.9% accuracy. BI-RADS results were then combined with strain ratio (SR) and ES. BI-RADS with SR had 91.3% sensitivity, 95.2% specificity, 87.5% and 96.7% positive and negative predictive values (respectively), and 94.1% accuracy. Similarly, BI-RADS with ES had 91.3% sensitivity, 93.5% specificity, 84.0% and 96.7% positive and negative predictive values, and 92.9% accuracy.ConclusionsThe combination method performs better at diagnosing breast lesions than BI-RADS alone and can be used as an early and preliminary basis for diagnosis and in settings where invasive procedures cannot be performed. Combining strain elastography and BI-RADS also help characterize which lesions are better suited for biopsy, leading to a decline in unnecessary invasive procedures.

Highlights

Breast cancer is the most frequently diagnosed cancer and the chief cause of cancer deaths among women worldwide
BI-RADS with strain ratio (SR) had 91.3% sensitivity, 95.2% specificity, 87.5% and 96.7% positive and negative predictive values, and 94.1% accuracy
In a similar study performed by Arslan et al that combined BI-RADS and strain elastography and BI-RADS and elastography score (ES), an increase was detected in the rates of specificity, positive predictive value (PPV), and accuracy compared to BI-RADS alone

Summary

Introduction

Breast cancer is the most frequently diagnosed cancer and the chief cause of cancer deaths among women worldwide. Breast cancer alone accounts for 25% of all cancer cases and 15% of all cancer deaths among women [1]. Mammography and ultrasonography are the diagnostic methods that have shown the highest sensitivity in the detection of breast cancer; mammography performed on dense breasts may often yield false-negative results [3]. Ultrasonographic elastography (sonoelastography) is a noninvasive imaging technique that can be used to depict relative tissue stiffness or displacement (strain) in response to an imparted force [4,5]. Ultrasonographic elastography is based on the premise that there are significant differences in the mechanical properties of tissues that can be detected by applying an external mechanical force [6,7]

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