Abstract
Our purpose was to evaluate Virtual Touch IQ (VTIQ) elastography and identify quantitative “rule-in” and “rule-out” thresholds for the probability of malignancy, which can help avoid unnecessary breast biopsies. 189 patients with 196 sonographically evident lesions were included in this retrospective, IRB-approved study. Quantitative VTIQ images of each lesion measuring the respective maximum Shear Wave Velocity (SWV) were obtained. Paired and unpaired, non-parametric statistics were applied for comparisons as appropriate. ROC-curve analysis was used to analyse the diagnostic performance of VTIQ and to specify “rule-in” and “rule-out” thresholds for the probability of malignancy. The standard of reference was either histopathology or follow-up stability for >24 months. 84 lesions were malignant and 112 benign. Median SWV of benign lesions was significantly lower than that of malignant lesions (p < 0.001). The application of a “rule-out” threshold of 1.9 m/s lead to a sensitivity of >98% with a concomitant significant (p = 0.032) reduction in false positive cases of almost 15%, whereas a “rule-in” threshold of 6.5 m/s suggested a probability of malignancy of >95%. In conclusion, VTIQ elastography accurately differentiates malignant from benign breast lesions. The application of quantitative “rule-in” and “rule-out” thresholds is feasible and allows reduction of unnecessary benign breast biopsies by almost 15%.
Highlights
Ultrasound (US) of the breast is a valuable adjunct to mammography in the characterization of breast lesions
Intralesional calcifications as well as a high degree of fibroblastic proliferation or stromal hyalinization have been recognized as reasons, that may lead to false positive results, rendering high stiffness measurements in benign lesions[9,11]
In order to be eligible for inclusion in the study, an examination had to meet the following criteria: a breast lesion visible at B-mode US with at least 5 mm in size (BI-RADS 2–5); no previous biopsy or neoadjuvant chemotherapy; colour coded Virtual Touch IQ (VTIQ) image of the lesion with quantitative measurement of its Shear Wave Velocities (SWV); histologic confirmation of the lesions, or, in case of a benign lesion (BI-RADS 2), stability for at least 24 months of follow-up
Summary
Ultrasound (US) of the breast is a valuable adjunct to mammography in the characterization of breast lesions. The need to reduce the false-positive US findings has resulted in research efforts adding further US techniques for lesion evaluation before biopsy[2,7] Elastography, one of these new promising techniques, evaluates the mechanical properties of tissue. In contrast to previous approaches, VTIQ enables a simultaneous qualitative and quantitative evaluation of tissue stiffness, measuring Shear Wave Velocities (SWV)[8]. Due to both the new algorithm used as well as the smaller ROI size (2 × 2 mm compared to 5 × 5 mm in previous versions), VTIQ has a higher rate of successful measurements as compared to previous versions of ARFI elastography[8]. Our aim was to evaluate VTIQ elastography and identify quantitative “rule-in” and “rule-out” threshold values for the probability of malignancy, which can help avoid unnecessary breast biopsies
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