Combination of conventional ultrasonography and virtual touch tissue imaging quantification for differential diagnosis of breast lesions smaller than 10 mm.

Abstract

To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. A total of 98 breast lesions smaller than 10 mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75-9.34 m/s), significantly higher than that of benign lesions (2.68±1.02 m/s; range, 1.18-4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy.