Abstract
Proposal of systematization for the elastographic study in the ultrasound routine. Evaluation was made of 308 patients forwarded to the breast intervention service in the CTC-Genesis from May 1, 2007 to March 1, 2008 to perform percutaneous breast biopsy. Prior to the percutaneous biopsy, an ultrasound study and an elastography were performed. Lesions were primarily analyzed and classified according to the Bi-Rads lexicon criteria by the conventional ultrasound scan (B mode). The elastography was then performed and analyzed in accordance with the systematization proposed by the authors, using images obtained during compression and after decompression of the area of interest. Lesions were classified following the system developed by the authors using a four-point scale, where scores (1) and (2) were considered benign, score (3) probably benign and score (4) suspicion of malignancy. Results obtained by the two methods were compared with the histological results using the areas within the ROC (receiver operator curves) curves. The area within the curve for elastography was of 0.952 with a confidence interval between 0.910 and 0.966, error of 0.023, and of 0.867 with a confidence interval between 0.823 and 0.903, error of 0.0333 for the ultrasound. When the areas were compared, a difference between the curves of 0.026 was observed, which was statistically significant. This work shows the systematization of the elastographic study using information obtained during compression and after decompression of the ultrasound scan sample, thus showing that elastography might enhance the assessment of risk of malignancy for lesions characterized by the ultrasound.
Highlights
Evaluation was made of 308 patients forwarded to the breast intervention service in the CTC-Genesis from May 1, 2007 to March 1, 2008 to perform percutaneous breast biopsy
The elastography was performed and analyzed in accordance with the systematization proposed by the authors, using images obtained during compression and after decompression of the area of interest
Lesions were classified following the system developed by the authors using a four-point scale, where scores (1) and (2) were considered benign, score (3) probably benign and score (4) suspicion of malignancy
Summary
Estudo ultrassonográfico convencional O estudo convencional deve ser precedido de palpação manual e de anamnese detalhada para avaliação global das mamas das pacientes. Deve-se realizar uma compressão manual de forma contínua sobre a mama da paciente na área a ser estudada, perpendicular ao peitoral, até encontrar resistência não forçada do parênquima. O escore 2 é conferido às lesões que após a descompressão apresentam variação de cor para mais macia abrangendo mais que 50% da amplitude do nódulo quando comparada com a imagem durante a compressão. Já o escore 3 é dado às lesões que após a descompressão apresentam variação de cor em menos de 50% da área do nódulo (entre 10% e 50%). No escore 4 encontramos as lesões que não apresentam variação significativa na cor durante a compressão e após a descompressão do parênquima, permanecendo azul nas duas imagens (Figura 2). Tabela 1- Comparação de estudos clínicos de elastografia mamária descritos na literatura
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