Compression Sonoelastography Research Articles

Experience of using compression sonoelastography for diagnosis of metastatic lesions of the lymph nodes in patients wit breast cancer

In this article we consider the experience of compression sonoelastography lymph nodes in the axillary region preoperative diagnostic algorithm of examination ofpatients with malignant tumors of the mammary glands.

To the article of Vasilyev D.A. and authors: "Ways of the sonoelastography diagnostic significance improving in the differential diagnosis of thyroid nodules"

In a brief in the format review of equals the conclusions of the article of Vasilyev D.A. et al. were analyzed in position with evidence-based medicine. Fundamental errors in the method of compression sonoelastography of thyroid are listed .

Standardized Technique of Compression Sonoelastography (Strein-Elastography) of Internal Organs (Draft)

The paper presents the 4 stages of compression elastography standardized technique which is clearly structured on gray-scale images phasing evaluation of qualitative and semi-quantitative elastography. Comparative data on the diagnostic efficiency and reproducibility standard and the proposed methods of elastography in 1034 people with focal formations breast, thyroid, and soft tissues are presented. The advantage of standardized technique is proved.

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part I and II.

I have carefully read the comments on two articles published by myself in issues 51 and 52 of “Journal of Ultrasonography,” concerning the differentiation of the character of solid lesions in the breasts in compression sonoelastography. I would like to thank Dr. Dominique Amy for his perceptive comments to which I shall try to relate. The application of a proper technique of ultrasound (US) examination and the usage of adequate terminology with respect to the assessed structures is undoubtedly significant. In my own research, I used standard radial technique of breast assessment and the visualized focal lesions were evaluated in two planes. Bearing in mind the terminology used, I agree that, histologically, there is no such a term as glandular tissue and that it indeed is a misnomer. It, however, became so strongly established in the standards of our US examination descriptions and reports that the usage of correct terms: epithelial and connective tissue might occur to be incomprehensible. This probably requires changing. With reference to the further part of the comment concerning the character of lesions categorized to group II (benign lesions), I must say that cystic lesions (anechoic, BIRADS-US 2, cysts) were not included in the examination. Only solid lesions, which manifested the features characteristic of BIRADS-US 3, 4 and 5, were taken into account. However, the microscopic verification revealed that approximately 57% of lesions in group II were fibrocystic. In the majority of cases, these lesions presented themselves as hypoechoic, one was hyperechoic and 14 were isoechoic and were accompanied by additional features characteristic of BIRADS-US 3 and 4. As far as the third remark is concerned connected with sonoelastography and sonoelastograms, I made every effort to perform the examinations in accordance with the guidelines proposed by the authors of the method (A. Itoh, E. Ueno), bearing in mind the limitations mentioned by Dr. Amy. Sonoelastographic techniques, due to their innovative character, are being continuously perfected. However, in the assessment of focal lesions, particularly those categorized as BIRADS-US 3, compression sonoelastography has already proven to be relevant which is confirmed by the guidelines published in “Ultraschall in der Medizin”/”European Journal of Ultrasound”(1). In the sonoelastograms published in the paper, I presented examples of focal lesions in the breasts with their surrounding structures on the basis of the guidelines published by Itoh and Ueno in “Radiology” in 2006(2). The compression level on all five presented sonoelastograms was identical (level 3). The FLR ratio, however, was presented in only one example elastogram for the purposes of illustrating the measurement technique. In both subject groups, FLR ratio was calculated for 94 out of 99 lesions. The size of lesions in both examined groups was analyzed in greater detail in the author's doctoral thesis (defended on 25 October 2012 in Cancer Centre, The Institute of Maria Sklodowska-Curie in Warsaw) – three measurements were analyzed in two perpendicular planes. The lesions in group I in all dimensions were greater than those in group II in a statistically significant way, which indeed, was only briefly mentioned in the commented publication. Unfortunately, malignant lesions are detected too late in Poland. Similarly, the rate of preinvasive carcinomas found in patients treated in Poland (4.4% in 2009 according to the Polish National Cancer Registry) is lower as compared to other countries of Western Europe or the USA. With reference to the comments concerning focality and centricity of breast neoplasms, I wish to explain that in group I, several patients manifested multifocal lesions (39 malignancies detected in 30 women). However, this issue was not analyzed in detail. What is more, in the part of the paper devoted to the discussion about false negative cases in elastograms, it was shown that in the subject group of malignant lesions (group I), there were cases of preinvasive and invasive ductal carcinomas (J Ultrason 2013; 13: 43). There were no cases of colloid (mucinous) carcinomas in the analyzed material. Thus, this type of a neoplasm was not discussed. I recognize the authority of Dr. Amy in the field of ultrasound assessment of the breasts, including the emphasized importance of having basic knowledge of anatomy as well as of pathophysiology and pathogenesis of breast carcinoma, and I would like to thank for a thorough analysis of my publication. I am particularly grateful for directing my attention to the need for using appropriate terminology both in everyday practice and in academic papers.

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part I and II.

In its volumes 12 no. 51 and 13 no. 52, “Journal of Ultrasonography” contains two important articles regarding the part played by elastography in the diagnostic imaging of the breast and a statistical comparative study of earlier publications(1, 2). However, this remarkable piece of work calls for a few remarks since it concerns an organ about which still little is known – the breast, and a technique which is recent and still innovating – elastography. Far from being critical, these remarks are meant to be constructive in order to contribute to the improvement of diagnostic performances. These remarks concern: the study of the anatomy of the breast; the choice of the vocabulary in breast ultrasound; the techniques of echography and elastography; the analysis of the size of lesions; the multifocal, multicentric or diffuse character of breast cancer; and lastly, the comparison with various recent publications.

Correlation of B-mode sonography and compression elastography for diagnosis of tendon degeneration: a pictorial review

A pictorial review of 76 examinations of the extensor carpi ulnaris tendon using compression sonoelastography in conjunction with B-mode ultrasound imaging is presented here. A comparison of these two technologies is presented and the corresponding images were evaluated to determine whether there is correlation between the two technologies. Furthermore, the possibility that tendon degeneration and softening can be diagnosed earlier than has previously been possible using both of these technologies rather than B-mode imaging alone was explored and the results presented. Patients with unilateral or bilateral extensor carpi ulnaris tenosynovitis were scanned as part of a larger rheumatoid arthritis research study, which included extensor carpi ulnaris evaluation as part of its protocol. B-mode images were acquired with corresponding compression sonoelastography colour map, the region of interest being that portion of the tendon between the ulnar styloid and the insertion at the fifth metacarpal base. Seven paired images from different patients, which represent the varying appearances of extensor carpi ulnaris tenosynovitis seen in the study cohort are shown. Healthy tendons have a uniform hyperechoic fibrillar pattern longitudinally on B-mode imaging with predominantly mid-blue overlay on elastography. Tenosynovitis is shown on grey scale to have the usual appearances of loss of fibrillar echotexture and hypoechoic mucoid degeneration with the elastographic colour map showing predominantly red, yellow and green areas of tendon softening. There appears to be good correlation between the B-mode images and the elastographic overlay. The additional tissue characteristics yielded by sonoelastography in relation to tendon and peritendinous soft tissue elasticity may provide clinicians with information that could alter patient management. This technique shows promise in the earlier detection of tendon degeneration.

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part I: The diagnostic value of the ultrasound B-mode imaging in the differentiation diagnostics of solid, focal lesions in the breast in relation to the pathomorphological verification.

The aim of this study was to evaluate the diagnostic value of the ultrasound B-mode imaging in the differentiation diagnostics of solid lesions in the breast in relation to the pathomorphological verification. From January to July 2010, 375 ultrasound breast examinations were conducted. The study enrolled 80 women aged 17–83, with 99 solid, focal lesions present in breasts, which were qualified for pathomorphological verification on the basis of the ultrasound examination. All patients underwent: the interview, physical examination, ultrasound examination and sonoelastography. The ultrasound features of the lesions, their vascularization patterns in the Doppler examination as well as the adjacent tissues were determined. Next, the focal lesions were categorized according to the BIRADS-US classification. The obtained results were analyzed statistically. In the group of 80 patients, 99 focal, solid lesions in breasts were visualized, including 39 neoplastic, malignant lesions (group I) and 60 lesions of benign nature (group II). The malignant lesions were often characterized by: greater size, irregular shape (34/39), prevalence of the anteroposterior dimension over the lateral-lateral dimension (22/39), acoustic shadowing (20/39), the margins not well-circumscribed (37/39), spiculated margins (16/39) and the presence of calcifications (14/39). The benign lesions were much more often hyper- and isoechogenic (14/60). In group I the lesions more often demonstrated the features of increased vascularization (29/39) and the presence of irregularly shaped vessels (23/29). This vascularization more often originated in the adjacent tissues. In the surroundings of the malignant neoplastic lesions, the presence of edema (16/39) and skin thickening (6/39) occurred more frequently and the abnormal axillary lymph nodes were more often diagnosed. The lesions of group I were assigned to the following BIRADS categories: BIRADS-US 4 (9 lesions) and BIRADS-US 5 (30 lesions). In group II, there was a prevalence of BIRADS-US 3 and 4 categories (58 lesions) and 2 lesions were classified to BIRADS-US 5 category. In the statistical analysis of the models based on BIRADS classification, it was demonstrated that BIRADS 4 showed the highest sum of sensitivity and specificity values of 173.6% in differentiation of the character of focal lesions in the breast (sensitivity 76.92%, specificity 96.67%).

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part II: Diagnostic value of BIRADS-US classification, Tsukuba score and FLR ratio.

Sonoelastography is a dynamically developing method of ultrasound examination used to differentiate the character of focal lesions in the breasts. The aim of the Part II of the study is to determine the usefulness of sonoelastography in the differentiation diagnosis of focal breast lesions including the evaluation of the diagnostic value of Tsukuba score and FLR ratio in characterizing solid lesions in the breasts. Furthermore, the paper provides a comparison of classic B-mode imaging and sonoelastography.Material and methodsFrom January to July 2010 in the Ultrasound Department of the Cancer Centre, The Institute of Maria Skłodowska-Curie, 375 breast ultrasound examinations were conducted. The examined group included patients who in B-mode examinations presented indications for pathological verification. They were 80 women aged between 17 and 83 (mean age was 50) with 99 solid focal lesions in the breasts. All patients underwent: the interview, physical examination, B-mode ultrasound examination and elastography of the mammary glands and axillary fossae. The visualized lesions were evaluated according to BIRADS-US classification and Tsukuba score as well as FLR ratio was calculated. In all cases, the histopathological and/or cytological verification of the tested lesions was obtained.ResultsIn the group of 80 patients, the examination revealed 39 malignant neoplastic lesions and 60 benign ones. The mean age of women with malignant neoplasms was 55.07 (SD = 10.54), and with benign lesions – 46.9 (SD = 15.47). In order to identify threshold values that distinguish benign lesions from malignant ones, a comparative analysis of statistical models based on BIRADS-US classification and Tsukuba score was conducted and the cut-off value for FLR was assumed. The sensitivity and specificity values for BIRADS-US 4/5 were 76.92% and 96.67% and for Tsukuba 3/4 – 64.1% and 98.33% respectively. The assumed FLR threshold value to differentiate between benign and malignant lesions in the breasts equaled 3.13. The combined application of both classifications (with the threshold value of BIRADS-US 4/Tsukuba 3) improved the total value of sensitivity and specificity of character differentiation of focal lesions (87.2% and 95% respectively).ConclusionsIn the case of problematic focal lesions, i.e. BIRADS-US 3, the study revealed that obtaining Tsukuba score of 1 and 2 for lesions classified as BIRADS-US 3 confirms their benign character. This allows to avoid the cytological verification.

US Elastography of Breast and Prostate Lesions

Elastography is a technique that maps relative tissue stiffness. Ultrasonographic (US) elastography (sonoelastography) is a novel modality that is the subject of active research for clinical applications, primarily breast and prostate lesion imaging. Breast and prostate tumors generally have biomechanical properties different from those of normal tissues: Tumors are usually stiffer. This phenomenon is responsible for tissue contrast on elastograms. For the prostate gland and breast, the main image acquisition techniques are vibration sonoelastography and compression sonoelastography. The sonoelastographic appearances of several common breast lesions, including fibroadenomas, simple and complex cysts, ductal carcinomas, malignant lymph nodes, and hematomas, are reviewed. In addition, the US elastographic appearances of the normal prostate gland, prostate carcinomas, and benign prostate hyperplasia are illustrated. Potential pitfalls in the interpretation of elastograms, including false-positive and false-negative images, are illustrated. These imaging findings are derived from ongoing research because sonoelastography is not yet accepted for routine clinical use.