Abstract
PurposeHead-to-head comparison of Diffusion Weighted Imaging (DWI) and Acoustic Radiation Force Impulse (ARFI) elastography regarding the characterization of breast lesions in an assessment setting. MethodPatients undergoing an ultrasound examination including ARFI and an MRI protocol including DWI for the characterization of a BI-RADS 3–5 breast lesion between 06/2013 and 10/2016 were eligible for inclusion in this retrospective, IRB-approved study. 60 patients (30–84 years, median 50) with a median lesion size of 16 mm (range 5–55 mm) were included. The maximum shear wave velocity (SWVmax) and mean apparent diffusion coefficient (ADCmean) for each lesion were retrospectively evaluated by a radiologist experienced in the technique. Histology was the reference standard. Diagnostic performances of ARFI and DWI were assessed using ROC curve analysis. Spearman’s rank correlation coefficient and multivariate logistic regression were used to investigate the independence of both tests regarding their diagnostic information to distinguish benign from malignant lesions. ResultsCorresponding areas under the ROC curve for differentiation of benign (n = 16) and malignant (n = 49) lesions were 0.822 (ARFI) and 0.871 (DWI, p-value = 0.48). SWVmax and ADCmean values showed a significant negative correlation (ρ = −0.501, p-value < 0.001). In multivariate analysis, combination of ARFI and DWI did not improve the results of each single modality, thus no significant independent diagnostic information was present. ConclusionSignificant correlation between quantitative findings of ARFI and DWI in breast lesions exists. Thus, ARFI provides similar diagnostic information as a DWI-including protocol of an additional “problem-solving” MRI for the characterization of a sonographically evident breast lesion, improving the immediate patient management in the assessment setting.
Highlights
Breast cancer is the leading cause of cancer-related death among women worldwide [1]
Head-to-head comparison of Diffusion Weighted Imaging (DWI) and Acoustic Radiation Force Impulse (ARFI) elastography regarding the characterization of breast lesions in an assessment setting
We hypothesized that ARFI and DWI provide largely redundant in formation regarding tumour characterization and the aim of this study was to evaluate the association between quantitative ARFI and DWI metrics and compare their diagnostic performance in an assessment setting
Summary
Breast cancer is the leading cause of cancer-related death among women worldwide [1]. Even when using established diagnostic criteria as described in the Breast Imaging Reporting and Data System (BI-RADS) lexicon [3], B-mode US shows an inherently low specificity [4], leading to a sub stantial number of unnecessary breast biopsies. These carry a psychological burden for the patient and increase healthcare costs. To increase the specificity of breast US, different modalities beyond the standard B-mode are used One of these is elastography, which is based on the evaluation of tissue stiffness [5]. Since shear waves propagate faster in stiffer tissue, ARFI has been shown by several studies to be accurate in the identifi cation of malignant breast lesions [8,9,10]
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