Virtual touch tissue imaging and quantification: value in malignancy prediction for complex cystic and solid breast lesions

Ying Zhang,Ya-Ping He,Cai-Ping Zou,Wei-Wei Ren,Yue-Wu Du,Xiao-Long Li,Hui-Xiong Xu,Chong-Ke Zhao

doi:10.1038/s41598-017-07865-7

Abstract

This study was aimed to evaluatethe usefulness of conventional ultrasound (US) and US elastography, including the latest virtual touch tissue imaging and quantification (VTIQ), in malignancy prediction for complex cystic and solid breast lesions. Eighty-nine complex cystic and solid breast lesions were subject to conventional US and US elastography, including strain elastography (SE), virtual touch tissue imaging (VTI) and VTIQ. Among the 89 lesions, thirty-four (38.2%) lesions were malignant and 55 (61.8%) lesions were benign. Sixteen variables were subject to multivariate logistic regression analysis. Pattern 4b in VTI (odds ratio, OR:15.278), not circumscribed margin of lesion (OR:12.346), SWS mean >4.6 m/s in VTIQ (OR:11.896), and age elder than 50 years (OR:6.303) were identified to be independent predictors for malignancy. In receiver operating characteristic (ROC) curve analyses, associated areas under the ROC curve (Az) for conventional US could be significantly elevated, from 0.649 to 0.918, by combining with US elastography (p < 0.0001). The combined diagnostic method was able to improve the specificity (32.7% vs. 87.3%, p < 0.0001) without sacrificing the sensitivity (97.1% vs. 85.3%, p = 0.075). Both conventional US and US elastography contribute substantially to malignancy prediction in complex cystic and solid lesions. The diagnostic efficacy of conventional US in terms of Az and specificity could be significantly improved by combining with US elastography.

Highlights

The incidence and mortality of breast cancer is high
(ARFI) imaging (i.e. Virtual touch tissue imaging, virtual touch tissue imaging (VTI); Siemens Medical Solutions, Mountain View, CA, USA) and point shear wave speed (SWS) measurement (i.e. Virtual touch tissue quantification, VTQ; Siemens Medical Solutions, Mountain View, CA, USA), a kind of SWS imaging (i.e. Virtual touch tissue imaging and quantification, virtual touch tissue imaging and quantification (VTIQ); Siemens Medical Solutions, Mountain View, CA, USA) has drawn attention because of the improvements made in terms of multiple-point measurement, shear wave quality map and smaller region of interests (ROIs)
Thirty-four (38.2%) lesions were pathologically confirmed as malignancy, including invasive ductal carcinoma (n = 25), mucinous carcinoma (n = 2), ductal carcinoma in situ (DCIS) (n = 3), solid papillary carcinoma (n = 1), intraductal papillary carcinoma (n = 1), malignant phyllodes tumor (n = 1)

Summary

Introduction

The incidence and mortality of breast cancer is high. American College of Radiology (ACR) Breast Imaging Report and Data System (BI-RADS) was originally established for breast imaging to standardize and unify terminology among different diagnostic approaches as well as different subjects. As to the diagnostic efficacy, conventional US is able to achieve high sensitivity (71.2–100%) in malignancy prediction with the specificity sacrificed somewhile (32–92%)[1, 11]. Numeral studies have observed that conventional US and adjunctive US elastography are able to improve specificity in malignancy prediction for solid breast lesions without sacrificing sensitivity and to decrease the possibility of unnecessary biopsy or operation[12,13,14,15,16,17,18]. According to the diagnostic performance in solid breast lesions, it is reasonable to expect the contribution conventional US and US elastography, especially the latest VTIQ technique, made to malignancy prediction in complex cystic and solid breast lesions. The present study was aimed to characterize malignant complex cystic and solid lesions with VTIQ technique

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Conclusion