Tsukuba Elasticity Score Research Articles

A preliminary study on the application of sono-elastography in differentiating endometrial carcinoma from benign endometrial lesions in a tertiary government hospital in the Philippines

[Objective]To evaluate the diagnostic value of sonoelastography to distinguish endometrial cancer from benign endometrial lesions. [Methods]A cross-sectional study was conducted and included 31 subjects with abnormal uterine bleeding who required endometrial sampling. Sonoelastography assessment was done qualitatively and quantitatively using Tsukuba elasticity score and strain ratio, respectively. Results were compared between those with endometrial cancer and those with benign endometrial lesions (hyperplasia and polyp) using Kruskal-Wallis test and Mann-Whitney U test. Diagnostic accuracies of Tsukuba elasticity score and strain ratio in differentiating endometrial cancer from benign endometrial lesions were determined with cut-off values derived from ROC analysis. [Discussion]Both the Tsukuba elasticity score and strain ratio value were significantly higher among patients with endometrial cancer (n = 15; mean age: 55.07 ± 8.53 years) compared to those with benign endometrial lesions (n = 16; mean age: 41.63 ± 8.02 years) (P < 0.0001). A Tsukuba elasticity score of ≥3 showed the highest diagnostic accuracy at 93.5%(95%CI: 79.3%–98.2%), with sensitivity of 86.7%(95%CI: 62.1%–96.3%), specificity of 100%(95%CI: 80.6%–100%), PPV of 100%(95%CI: 77.2%–100%), NPV of 88.9%(95%CI: 67.2%–96.9%), positive LR of undefined indicating high value and negative LR of 0.10(95%CI: 0.05–0.40). A Strain ratio value of ≥2 showed the highest diagnostic accuracy at 93.5%(95%CI: 79.3%–98.2%), with sensitivity of 93.3%(95%CI: 70.2%–98.8%), specificity of 93.8%(95%CI: 71.7%–98.9%), PPV of 93.3% (95%CI: 70.2%–98.8%), NPV of 93.8%(95%CI: 71.7%–98.9%), positive LR 14.9(95%CI: 2.1–107.1), and negative LR of 0.07(95%CI: 0.01–0.51). [Conclusion]The results indicate that sonoelastography can distinguish endometrial cancer from benign endometrial lesions.

Attempt to Evaluate the Influence of Morphology, Blood Flow, and Hardness in Mammary Gland Malignant Disease

It is important to make an appropriate diagnosis category by evaluating the morphology, blood flow, and hardness of mammary gland disease in breast ultrasound, such as screening and detailed examination. Therefore, understanding the characteristics and effects of B-mode (BM), color Doppler (CD), and elastography (EG) in ultrasonography is considered to lead to improvement in examination accuracy. In this study, we clarified the impact of each function on qualitative diagnosis, with the aim of assisting technologists with high-accuracy breast ultrasound. The subjects were 531 malignant tumor cases. The final evaluation of ultrasonography was classified into 5 levels, BM was classified into 5 levels, CD was classified into 4 levels based on blood flow evaluation, and EG was classified into 9 levels based on the Tsukuba elasticity score. The contribution rates of BM, CD, and EG were 70.4%, 15.0%, and 14.6% in all cases (correlation ratio 0.87). BM was most important at the time of breast ultrasound. No difference was observed between CD and EG. In the evaluation by malignant tumor, each characteristic was seen in the degree of influence. It became clear that comprehensive evaluation is important for benign/malignant evaluation and histological-type estimation.

Interacting Factors of Strain Ratio Values in Fibroadenomas and the Contribution of Color Scale.

Background:The purpose of this retrospective study is to investigate the association of qualitative and semiquantitative strain elastography (SE) features with factors such as lesion size, skin-to-lesion distance, and patient's age in fibroadenomas and to discuss false-positive results.Methods:A total of 120 lesions that were performed SE with histopathologically confirmed fibroadenoma were included in the study. All images were reviewed from the archiving system with a consensus of two radiologists. Tsukuba elasticity score was used for color scoring (from 1 to 5). Lesions with strain ratio (SR) ≥2.27 and color scale score of 4 or 5 were considered as false positive. The patients were divided into two groups according to the age: <50 and ≥50 years old. Regard of the size, lesions were divided into two groups: <15 mm and ≥15 mm. The distances of the lesions to the skin were also divided into two groups: <5 mm and ≥5 mm. Statistical analysis to identify associations between these groups and SR was carried out with Pearson Chi-square test and Fisher's exact test. The false-positive rates were calculated.Results:There was no statistically significant difference between patients' age, lesion size, skin-to-lesion distance, and SR values. The false-positive rate was 21.66% for SR, while it was 3.33% for color scale.Conclusion:SR values of the fibroadenomas were not affected by factors such as age, lesion size, and depth. In addition, false-positive rates significantly decrease when color scale scores are evaluated for fibroadenomas.

Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography

Background: The aim is to assess the value of strain elastography (SE) in differentiating likelihood of malignancy for the thyroid nodules, possessing the Bethesda Category III, IV, and V indeterminate cytology.Methods: The data was obtained by ultrasonography (US)-guided fine-needle aspiration (US-g-FNA) via 27-gauge needle, with the verification of indicated thyroidectomies in a retrospective analysis, from April 2010 to April 2014, by enrolling the documents of 262 consecutive patients, with 327 thyroid nodules, subjected to one-surgeon performed neck US, SE, and US-g-FNA with 27-G needle to rule out the malignancy.Results: 122 of 327 cases were Bethesda Category III, IV, and V with histopathologically benign, 110 (90.2%); PTC, 7 (5.7%); FTC, 4 (3.3%); HCC, 1 (0.8%). Tsukuba Elasticity Score (TES) 1, 2, 3, 4, and 5 were detected as 38 (31.1%), 8 (6.6%), 59 (48.4%), 4 (3.3%), and 13 (10.7%), respectively for the cases with the indeterminate cytology. No significant difference was detected between TES 4 and 5 and malign histopathology by McNemar test (p = .727) with a good level of concordance, the kappa coefficient, 0.737.Conclusion: SE may be a useful tool in differentiating malign from benign thyroid nodules by selecting surgery adaptation even for Bethesda indeterminate cytology on FNAC.

Efekat anatomsko-topografskog i sonografskog položaja tiroidnih čvorova na malignitet tiroidne žlezde evaluacijom impresije na odnos između Betesda sistema, TBSRTC, rezultata elastografije i histopatologije

Background: The goal is to evaluate the association between the topo-sonographic polarity of the thyroid nodules and the thyroid malignancy by analyzing its effect on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), score of Strain Elastography (SE) for thyroid as Tsukuba Elasticity Score (TES), and histopathologic assessment. Material and Methods: A preliminary single-center retrospective study was carried out by including the documents of 641 consecutive eligible patients, possessing 770 thyroid nodules which undergone neck ultrasonography (US), Doppler US, SE, and US-guided-fine needle aspiration (FNA) during April 2011 to April 2017. The stiffness had been measured by TES of SE. The ability of the prediction of the malignancy by the polarity of 770 thyroid nodules considering the association between; i) TBSRTC and histopathology and ii) TES and histopathology had been evaluated. Results: Of the 770 thyroid nodules evaluated, 408 (53.0%) were located at the superior pole (Pol 1) while 362 (47.0%) were at the inferior pole (Pol 0) with 0.9046 AUC and 0.8171 AUC for the association between TBSRTC and histopathology and 0.9280 AUC and 0.7888 AUC for the association between TES and histopathology, respectively. However, those difference were not significant for Pol 1, topographically. Conclusion: The topograghic and sonographic polarity of the thyroid nodules may not be useful for estimating the thyroid malignancy by using the association between TBSRTC and histopathology with TES and histopathology. However, the association with Pol 1, the superior thyroid pole, was stronger though the difference was not significant.

Length Scale Matters: Real-Time Elastography versus Nanomechanical Profiling by Atomic Force Microscopy for the Diagnosis of Breast Lesions.

Real-time elastography (RTE) is a noninvasive imaging modality where tumor-associated changes in tissue architecture are recognized as increased stiffness of the lesion compared to surrounding normal tissue. In contrast to this macroscopic appraisal, quantifying stiffness properties at the subcellular level by atomic force microscopy (AFM) reveals aggressive cancer cells to be soft. We compared RTE and AFM profiling of the same breast lesion to explore the diagnostic potential of tissue elasticity at different length scales. Patients were recruited from women who were scheduled for a biopsy in the outpatient breast clinic of the University Hospital Basel, Switzerland. RTE was performed as part of a standard breast work-up. Individual elastograms were characterized based on the Tsukuba elasticity score. Additionally, lesion elasticity was semiquantitatively assessed by the strain ratio. Core biopsies were obtained for histologic diagnosis and nanomechanical profiling by AFM under near-physiological conditions. Bulk stiffness evaluation by RTE does not always allow for a clear distinction between benign and malignant lesions and may result in the false assessment of breast lesions. AFM on the other hand enables quantitative stiffness measurements at higher spatial, i.e., subcellular, and force resolution. Consequently, lesions that were false positive or false negative by RTE were correctly identified by their nanomechanical AFM profiles as confirmed by histological diagnosis. Nanomechanical measurements can be used as unique markers of benign and cancerous breast lesions by providing relevant information at the molecular level. This is of particular significance considering the heterogeneity of tumors and may improve diagnostic accuracy compared to RTE.

Comparative Study by Analytical Multidisciplinary Methods and Oxidative Stress in Breast Cancer Diagnosis

To evaluate the diagnostic performance of mammography, elastography and breast magnetic resonance imaging (MRI), as tools for breast cancer diagnosis, against pathological diagnosis as the gold standard. Other risk factors such as obesity and oxidative stress are also disccused. In this comparison study, a total of 169 female patients (mean age 51 years, range 35-77 years) were enrolled between January 2016 and June 2017. After the physical examination of the breasts, patients were further randomized into three groups to mammography, elastography, or breast MRI. Only women with detected lesions classified into breast imaging and reporting data system (BI-RADS) category or Tsukuba elasticity score from 2 to 5 were included. Histopathology was used as the gold standard for diagnosis. The diagnostic performance of each modality was calculated. Of a total of 50 pathologically confirmed cancers, 25 were detected by mammography, 11 by elastography, and 14 by breast MRI, which resulted in sensitivities of 84% (PPV = 78%), 75% (PPV = 64%) and 86% (PPV = 75%), respectively. Mammography, elastography, and breast MRI led to 6, 5, and 4 false positive findings, which resulted in specificities of 86% (NPV = 90%), 87% (NPV = 92%) and 89% (NPV = 94%), respectively. The area under the curve (AUC) values for the mammography, elastography and breast MRI were 0.849 (95% CI, 0.758-0.939), 0.809 (95% CI, 0.670-0.948) and 0.876 (95% CI, 0.769-0.983). The DOR values were 32 (95% CI, 8-125), 20 (95% CI, 4-99) and 51 (95% CI, 8-315). The breast MRI proved a slight advantage over mammography as a diagnostic tool in breast cancer diagnosis.

Role of Ultrasound Elastography in Characterization of Indeterminate Breast lesions (BIRADS 3&amp;4 lesions).

With the expanded role of screening breast ultrasonography and accumulating clinical experience, the American College of Radiology (ACR) has established the Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon to standardize terminology for description and management recommendations according to stratified risks. It has been established that probably benign (BI-RADS category 3) lesions having a malignancy rate of less than 2% require short-term imaging follow-up rather than immediate biopsy. The BI-RADS 4 category is assigned to suspicious lesions for which biopsy is recommended. Routine screening methods such as mammography and breast ultrasound are valuable methods for managing breast masses. Breast ultrasound is the preferable screening method as it provides high sensitivity for detecting breast cancer in women with dense breast tissue and can detect cancers not identified on mammography in asymptomatic women with dense breast tissue. In our study we included 46 patients with different breast lesions. All patients had a conventional B-mode ultrasound examination and were evaluated according to the BIRADS categories, then real time free-hand ultrasound elastography was performed in the same session and images were evaluated using both the Tsukuba elasticity score and the strain ratio method. Finally, the results were compared to the histopathologic results of those lesions. It was found that conventional B-mode ultrasound examination had a sensitivity of 72.73% and specificity of 83% While, elastography scoring alone turned out to have sensitivity of 65.5%, specificity of 83.4% using the Tsukuba score system. The additional of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity 98.4% and specificity 85.68% at a best cutoff point of 3.47. So we have found that elastography is an easy procedure with high diagnostic performance which can be easily integrated with the B-mode ultrasound examination in the same session and improves its specificity. That has proven benefit in minimizing the number of unnecessary biopsies especially in the assessment of BIRADS 3 and 4 lesions

Diagnostic performance of sonoelastographic Tsukuba score and strain ratio in evaluation of breast masses

The aim of this prospective study was to evaluate the diagnostic performance of the use of strain index ratio by sonoelastography to differentiate between benign and malignant breast lesions. Patients & MethodsThis prospective study including 40 females, complaining of breast masses which were suspicious to be malignant on clinical examination. All patients were submitted to B-mode Ultrasound and sonoelastography. Biopsy as a gold standard and pathological study were done for all breast lesions. ResultsUS examination of every mass was done and categorized according to BI-RADS categories according to ACR2013, according to US lexicon. Sonoelastography examination with Lesions classification was performed on the basis of a 5-point scoring method proposed by Tsukuba elasticity score. Then measurements of strain ratio were done. Statistical analysis of combination of the three methods was sensitivity of 96.7%, specificity of 100% when we use cut off value of 3–4 in elastography score and ≤3 cut off value of strain ratio. ConclusionThe combined use of strain ratio with Tsukuba score and BI-RADS categorization increased the diagnostic performance in differentiation between benign and malignant breast lesions.

Real-time elastosonography of lipomatous vs. malignant subcutaneous neoplasms in dogs: Preliminary results.

Real-time elastography is a recently introduced ultrasound technique allowing the investigation of elastic properties of tissues. A diagnostic accuracy study was conducted to test the performance of this technique in the assessment of subcutaneous lesions in dogs. Fifty-two dogs were prospectively included in the preliminary study (34 malignant and 18 benign lesions). B-mode ultrasound was performed assessing the shape, margins, heterogeneity, and echotexture of the lesions. On elastosonography, assessment of the percentage of softness/hardness was recorded. A qualitative assessment was performed according to the Tsukuba elasticity score with a 1-5 score, representing the increased percentage of high stiffness areas. Results were compared with cytology/histopathology of the lesions. Receiver Operating Curves of the overall diagnostic sensitivity and specificity were obtained. Fisher's exact test and Pearsons's Chi-squared test estimated the relationship between the B-mode appearance of the lesions and final diagnosis. A hardness cutoff of 50.25% was identified between lesions, with malignant neoplasms having higher percentages. A 100% specificity and 89% sensitivity for correctly detecting the nature of the lesion on elastosonography was established. Qualitative assessment of the Tsukuba elasticity score established 1.5 as the cutoff between elastograms of lipomatous and malignant lesions, with 100% sensitivity and 61% specificity in differentiating them. Real-time elastosonography is a novel, noninvasive, and accurate technique for differentiating malignant from benign lipomatous lesions in dogs. This method could be considered as a complementary tool with additional diagnostic value for routine invasive procedures, such as fine needle aspirates.

Sonoelastography Usage Among German DEGUM-Certified Breast Ultrasound Specialists

Sonoelastography of the breast is an emerging technology with evident data in the literature suggesting diagnostic advantages. Our study investigates the current usage of sonoelastography among German DEGUM-certified breast ultrasound specialists. We used a standardized questionnaire with 18 items. In 2012, the survey was sent to all members of the breast ultrasound section of the DEGUM (n = 654). The group of survey participants (n = 208) performs 193 025 breast ultrasound examinations and examines 20 110 breast cancers per year. 21.2 % of the participants in the survey use sonoelastography, mainly for diagnostic purposes in BI-RADS®-US 3 and 4 lesions, less often for other categories or under study conditions. The most commonly applied criteria for the evaluation of the elastogram are the Tsukuba Elasticity Score (43.2 %), the fat-lesion ratio (29.5 %) and the determination of tissue stiffness with shear wave elastography expressed in kilopascal (25.0 %). The majority of non-users of elastography (58.6 %) would like to have the option of using sonoelastography in the future. Sonoelastography is a feasible and helpful method in the evaluation of breast lesions. A significant number of German ultrasound specialists already apply this technology today. We expect a growing number of sonographers to perform sonoelastography in the near future, provided that they have the necessary ultrasound system and that they are trained in the method. Evidence from the literature and the recommendations of the medical societies support this development.

Breast Diagnosis: Concordance Analysis Between the BI-RADS Classification and Tsukuba Sonoelastography Score.

Aims.To establish the correlations between the ultrasound (US) BI-RADS classification and Tsukuba elastography score when assessing breast lesions. To determine which type of breast lesion (BI-RADS category) would benefit most from an elastographic assessment.Patients and methods.The investigated sample of imaging comprised a number of 129 images belonging to 92 subjects examined with a Hitachi 8500 US device. Each lesion was assessed according to the BI-RADS and Tsukuba elastography score. Histopathology was obtained by means of percutaneous biopsy or post-surgery. Fibroadenoma-like lesions unchanged over a period of 3 years were considered benign.Results.The 1, 2 and BGR Tsukuba scores mostly correlated with BI-RADS II and III lesions such as cysts, hamartomas, lipomas, hematomas, non-palpable fibroadenomas. Palpable fibroadenomas initially included in BI-RADS IVa/b category, usually received benign elasticity scores (1 or 2), the exception being represented by a minority of cases of old, fibrotic or calcified lesions (elastic score 3 or 4). Non-specific BI-RADS IVa/b lesions, such as mastopathic nodules demonstrated rather soft, elastic properties on elastogram (score 1 or 2). The 4 and 5 Ueno-Itoh scores were predominantly correlated with BI-RADS IVc and V categories represented by high risk lesions (radial scar, papillomas, atypical epithelial ductal hyperplasia) and in situ or invasive carcinomas.Conclusions.Generally the BI-RADS classification correlates well with the Tsukuba elasticity score, the main exception being represented by fibrotic, calcified lesions which falsely appear more suspicious post-elastography. BI-RADS III and IV lesions would benefit most from an elastographic assessment, a low Tsukuba score allowing a less invasive approach, while a high score imposes histopathological evaluation.

High resolution compression elastography and color doppler sonography in characterization of breast fibroadenoma.

To evaluate the use of color Doppler sonography and free hand sonoelastography in the assessment of breast fibroadenomas according to their size and shape. From December 2012 to March 2013 women with 16 solid breast masses, classified as BI-RADS category 3 or 4 were examined with B-mode ultrasound, sonoelastography and color Doppler sonography. Lesions were subdivided according to their shape in round, ovoid or macrolobulated and according to their size (<2.0 cm or ≥2.0 cm). Two readers assessed sonoelastographic findings at 12.5 MHz using the tsukuba elasticity score and results of Doppler sonography using a score of 0, 1 or 2, depending on the degree of perfusion. Among the 16 examined lesions 3 showed a round shape, 9 were ovoid and in 4 cases a macrolobulated appearance could be seen. No significant differences concerning Tsukuba-score depending on various shapes of fibroadenomas in B-mode sonography could be shown (p = 0.91) and also comparison of Tsukuba-scores and size of masses revealed no significant differences (p = 1.0). Sizes of fibroadenomas ≥2 cm were significantly associated with an increased vascularization of the lesions (p = 0.04) and a macrolobulated appearance in B-mode sonography (p = 0.04). The combination of color Doppler sonography and sonoelastography in addition to B-mode sonography leads to an increased accuracy in distinguishing benign from malignant breast masses and to an improvement in characterization of fibroadenomas independent of their shape or size.

Value of high resolution compression elastography and color doppler sonography in characterisation of breast lesions: Comparison of different high-frequency transducers

To evaluate the additional effect of higher frequent linear probes than 12.5 MHz in color Doppler sonography and free hand sonoelastography of benign and malignant breast masses and to compare different color encodings in sonoelastography. From December 2012 to March 2013, 37 patients with benign or malignant breast masses were prospectively included in this study. All solid masses have been histologically proven. Two readers assessed sonoelastographic findings at 12.5 MHz vs. 17 MHz according to the tsukuba elasticity score and additionally different color encodings were compared. Results of Doppler sonography using a score of 0, 1 or 2, depending on the degree of perfusion, also were assessed at 12.5 MHz vs. 17 MHz. Among the 37 examined breast masses there were 10 cysts, 16 fibroadenomas and 11 carcinomas. Median participant age was 49.0 years. Use of color Doppler sonography enabled to distinguish cysts from solid breast masses (p < 0.001), without an improvement at 17 MHz. Additional sonoelastography significantly improved the specificity in solid breast masses (p < 0.001). No changes could be seen using different colors in sonoelastography. Combination of color Doppler sonography and sonoelastography can increase the accuracy in distinguishing benign from malignant breast masses. The use of linear probes with a higher frequency than 12.5 MHz does not show any benefit, neither in color Doppler sonography nor in sonoelastography.

Evaluation of multimodality imaging using image fusion with ultrasound tissue elasticity imaging in an experimental animal model

To evaluate the ultrasound tissue elasticity imaging by comparison to multimodality imaging using image fusion with Magnetic Resonance Imaging (MRI) and conventional grey scale imaging with additional elasticity-ultrasound in an experimental small-animal-squamous-cell carcinoma-model for the assessment of tissue morphology. Human hypopharynx carcinoma cells were subcutaneously injected into the left flank of 12 female athymic nude rats. After 10 days (SD ± 2) of subcutaneous tumor growth, sonographic grey scale including elasticity imaging and MRI measurements were performed using a high-end ultrasound system and a 3T MR. For image fusion the contrast-enhanced MRI DICOM data set was uploaded in the ultrasonic device which has a magnetic field generator, a linear array transducer (6-15 MHz) and a dedicated software package (GE Logic E9), that can detect transducers by means of a positioning system. Conventional grey scale and elasticity imaging were integrated in the image fusion examination. After successful registration and image fusion the registered MR-images were simultaneously shown with the respective ultrasound sectional plane. Data evaluation was performed using the digitally stored video sequence data sets by two experienced radiologist using a modified Tsukuba Elasticity score. The colors "red and green" are assigned for an area of soft tissue, "blue" indicates hard tissue. In all cases a successful image fusion and plan registration with MRI and ultrasound imaging including grey scale and elasticity imaging was possible. The mean tumor volume based on caliper measurements in 3 dimensions was ~323 mm3. 4/12 rats were evaluated with Score I, 5/12 rates were evaluated with Score II, 3/12 rates were evaluated with Score III. There was a close correlation in the fused MRI with existing small necrosis in the tumor. None of the scored II or III lesions was visible by conventional grey scale. The comparison of ultrasound tissue elasticity imaging enables a secure differentiation between different tumor tissue areas in comparison to image fusion with MRI in our small study group. Therefore ultrasound tissue elasticity imaging might be used for fast detection of tumor response in the future whereas conventional grey scale imaging alone could not provide the additional information. By using standard, contrast-enhanced MRI images for reliable and reproducible slice positioning, the strongly user-dependent limitation of ultrasound tissue elasticity imaging may be overcome, especially for a comparison between baseline and follow-up measurements.

Ultrasound real-time elastography can predict malignancy in BI-RADS®-US 3 lesions

BackgroundLesions of the breast that are classified BI-RADS®-US 3 by ultrasound are probably benign and observation is recommended, although malignancy may occasionally occur.In our study, we focus exclusively on BI-RADS®-US 3 lesions and hypothesize that sonoelastography as an adjunct to conventional ultrasound can identify a high-risk-group and a low-risk-group within these patients.MethodsA group of 177 breast lesions that were classified BI-RADS®-US 3 were additionally examined with real-time sonoelastography. Elastograms were evaluated according to the Tsukuba Elasticity Score. Pretest and posttest probability of disease (POD), sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) and likelihood-ratios (LR) were calculated. Furthermore, we analyzed the false-negative and false-positive cases and performed a model calculation to determine how elastography could affect the proceedings in population screening.ResultsIn our collection of BI-RADS®-US 3 cases there were 169 benign and eight malignant lesions. The pretest POD was 4.5% (95% confidence interval (CI): 2.1–9.0). In patients with a suspicious elastogram (high-risk group), the posttest POD was significantly higher (13.2%, p = 0.041) and the positive LR was 3.2 (95% CI: 1.7–5.9). With a benign elastogram (low-risk group), the posttest POD decreased to 2.2%. SE, SP, PPV and NPV for sonoelastography in BI-RADS®-US 3 lesions were 62.5% (95% CI: 25.9–89.8), 80.5% (95% CI: 73.5–86.0), 13.2% (95% CI: 5.0–28.9) and 97.8% (95% CI: 93.3–99.4), respectively.ConclusionsSonoelastography yields additional diagnostic information in the evaluation of BI-RADS®-US 3 lesions of the breast. The examiner can identify a low-risk group that can be vigilantly observed and a high-risk group that should receive immediate biopsy due to an elevated breast cancer risk.

Differential diagnosis of breast lesions using ultrasound elastography

Context:The recent introduction of elastography has increased the specificity of USG and enabled early diagnosis of breast cancer. Quantitative elastography, especially with strain ratio (SR) index, improves diagnostic accuracy and decreased number of biopsies.Aims:The purpose of this study was to assess the role of USG elastography in the differential diagnosis of breast lesions.Settings and Design:This prospective study was conducted in the University of Medicine and Pharmacy Research Centre of Craiova.Materials and Methods:Fifty-eight patients diagnosed with breast lesions between January 2009 and January 2010 were included in this prospective study. All the patients were examined in the supine position, and the B-mode USG image was displayed alongside the elastography strain image. For obtaining the elastography images we used a EUS Hitachi EUB 8500 ultrasound system with a 6.5-MHz linear probe. The elastography strain images were scored according to the Tsukuba elasticity score.Statistical Analysis:We performed receiver operator characteristic (ROC) analysis for assessment of the role of USG elastography in the diagnosis of breast lesions.Results:We obtained a sensitivity of 86.7% and a specificity of 92.9% for elasticity score and a sensitivity of 93.3% and a specificity of 92.9% for SR (when a cutoff point of 3.67 was used). There was very good correlation between SR and elasticity score (Spearman coefficient of 0.911).Conclusions:Elastography is a fast, simple method that can complement conventional USG examination. This method has the lowest cost/efficiency ratio and it is also the most noninvasive and accessible imaging method, with an accuracy comparable to MRI.

Typical and Unusual Sonoelastographic Patterns of Breast Cystic Lesions: Impact on BI-RADS Classification

To describe the sonoelastographic appearance of breast cysts (simple, complicated-cysts with sedimentation and complex-cysts with internal solid parts). To assess the influence of sonoelastography on the BI-RADS classification of complicated cysts. A prospective study was conducted and all cysts diagnosed by the same radiologist between May 2007 and July 2008 in our breast unit were included. Each lesion was assessed according to BI-RADS and the Tsukuba elasticity score using a Hitachi 8500 US device. Cytology or histopathology was obtained for complicated and complex cysts. 49 simple, 43 complicated and 14 complex cysts were detected. The elasticity patterns were divided into 4 categories: typical BGR (blue-green-red) pattern, appearance similar to that described for solid. lesions, variants of BGR, an inverse score of 3. The BGR pattern was predominant in breast cysts. Atypical elasticity patterns were mostly associated with complicated and complex cysts. BI-RADS classification of complicated cysts before and after elastography showed a statistically significant difference in terms of final category assessment (most of the complicated cysts were downgraded to BI-RADS 2 after elastography). Being aware of the wide spectrum of elastographic patterns of breast cysts and considering elastography when assessing the BI-RADS category of complicated cysts may lead radiologists to better patient management.