Effect of Quantitative and Semi-quantitative Elastography Methods for the Management of Borderline Lesions on Ultrasonography

Author(s): Direnç Özlem Aksoy*, Seyma Yildiz, Bahar Atasoy, Alpay Alkan, Sedat Giray Kandemirli, Mehmet Cingöz

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 17 , Issue 6 , 2021


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Graphical Abstract:


Abstract:

Background: Elastography (strain or shear-wave) is a method that estimates tissue stiffness.

Introduction: The aim of this study is to evaluate the quantitative and semi-quantitative ultrasound elastography methods for the diagnosis of BI-RADS 4a and BI-RADS 3 lesions, which are borderline for biopsy and follow-up.

Materials and Methods: 175 consecutive women with 193 ultrasound-visible breast lesions were classified on Conventional B-mode Ultrasonography (CUS) according to the BI-RADS scoring system. Quantitative and semiquantitative values from ultrasound elastography in the form of strain Elastography Ratio (SER), shear Wave Elastography (SWE) and Shear Wave Elastography Ratio (SWER) were obtained. The lesions categorized as BI-RADS 4a and BI-RADS 3 on ultrasound were subsequently re-categorized according to the elastography values.

Results: Except for the 13 BI-RADS 2 lesions, the remaining 180 lesions were biopsied. Pathology showed 83 lesions to be benign and 97 to be malignant. The sensitivity and specificity of the CUS were 96.9% and 75.0%, respectively with an accuracy of 86.0%. Cut-off points calculated based on ROC curves were 56.8 kPa for SWE, 3.53 for SWER and 3.81 for SER. When we downgraded BIRADS 4a lesions based on elastography results, the specificity (CUS+SER 96.9%, CUS+SWE 91.7%, and CUS+SWER 90.6%) and the accuracy (CUS+SER 95.3%, CUS+SWE 92.7%, and CUS+SWER 92.2%) were shown to be better than CUS. When we upgraded BI-RADS 3 lesions based on elastography results, the sensitivity of combined sets of SWE (99,0%) and SWER (100,0%) was better than CUS.

Conclusion: The rate of false-negative biopsies can be decreased with the combined use of elastography and ultrasonography.

Keywords: Quantitative, semiquantitative, elastography, BI-RADS 4a, BI-RADS 3, borderline breast lesions.

[1]
Dickinson RJ, Hill CR. Measurement of soft tissue motion using correlation between A-scans. Ultrasound Med Biol 1982; 8(3): 263-71.
[http://dx.doi.org/10.1016/0301-5629(82)90032-1] [PMID: 7101574]
[2]
Wilson LS, Robinson DE. Ultrasonic measurement of small displacements and deformations of tissue. Ultrason Imaging 1982; 4(1): 71-82.
[http://dx.doi.org/10.1177/016173468200400105] [PMID: 7199773]
[3]
Nakashima K, Shiina T, Sakurai M, et al. JSUM ultrasound elastography practice guidelines: breast. J Med Ultrason 2013; 40(4): 359-91.
[4]
Barr RG, Nakashima K, Amy D, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast. Ultrasound Med Biol 2015; 41(5): 1148-60.
[http://dx.doi.org/10.1016/j.ultrasmedbio.2015.03.008] [PMID: 25795620]
[5]
Yi A, Cho N, Chang JM, Koo HR, La Yun B, Moon WK. Sonoelastography for 1,786 non-palpable breast masses: diagnostic value in the decision to biopsy. Eur Radiol 2012; 22(5): 1033-40.
[http://dx.doi.org/10.1007/s00330-011-2341-x] [PMID: 22116557]
[6]
Mendelson EB, Böhm-Vélez M, Berg WA, et al. ACR BI-RADS® Ultrasound.ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology 2013.
[7]
Youk JH, Son EJ, Gweon HM, Kim H, Park YJ, Kim JA. Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B- mode ultrasonography: qualitative and quantitative assessments. Ultrasound Med Biol 2014; 40(10): 2336-44.
[http://dx.doi.org/10.1016/j.ultrasmedbio.2014.05.020] [PMID: 25130444]
[8]
Chang JM, Won JK, Lee KB, Park IA, Yi A, Moon WK. Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol 2013; 201(2): W347-56.
[http://dx.doi.org/10.2214/AJR.12.10416] [PMID: 23883252]
[9]
Zanello PA, Robim AF, Oliveira TM, et al. Breast ultrasound diagnostic performance and outcomes for mass lesions using Breast Imaging Reporting and Data System category 0 mammogram. Clinics (São Paulo) 2011; 66(3): 443-8.
[http://dx.doi.org/10.1590/S1807-59322011000300014] [PMID: 21552670]
[10]
Kim HJ, Kim SM, Kim B, et al. Comparison of strain and shear wave elastography for qualitative and quantitative assessment of breast masses in the same population. Sci Rep 2018; 8(1): 6197.
[http://dx.doi.org/10.1038/s41598-018-24377-0] [PMID: 29670125]
[11]
Ciurea AI, Bolboaca SD, Ciortea CA, Botar-Jid C, Dudea SM. The influence of technical factors on sonoelastographic assessment of solid breast nodules. Ultraschall Med 2011; 32(Suppl. 1): S27-34.
[http://dx.doi.org/10.1055/s-0029-1245684] [PMID: 20938896]
[12]
Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013; 34(3): 238-53.
[http://dx.doi.org/10.1055/s-0033-1335375] [PMID: 23605169]
[13]
Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006; 239(2): 341-50.
[http://dx.doi.org/10.1148/radiol.2391041676] [PMID: 16484352]
[14]
Ma Y, Zhang S, Li J, Li J, Kang Y, Ren W. Comparison of strain and shear-wave ultrasounic elastography in predicting the pathological response to neoadjuvant chemotherapy in breast cancers. Eur Radiol 2017; 27(6): 2282-91.
[http://dx.doi.org/10.1007/s00330-016-4619-5] [PMID: 27752835]
[15]
Ueno E, Umemoto T, Bando H, Tohno E, Waki K, Matsumura T. New Quantitative Method in Breast Elastography: Fat Lesion Ratio (FLR). Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago 2007.http://archive.rsna.org/2007/5015476.html
[16]
Zhi H, Xiao XY, Yang HY, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol 2008; 15(11): 1347-53.
[http://dx.doi.org/10.1016/j.acra.2008.08.003] [PMID: 18995186]
[17]
Jung NY, Park CS, Kim SH, et al. Sonoelastographic strain ratio: how does the position of reference fat influence it? Jpn J Radiol 2016; 34(6): 440-7.
[http://dx.doi.org/10.1007/s11604-016-0543-5] [PMID: 27059216]
[18]
Zhi H, Xiao XY, Yang HY, Ou B, Wen YL, Luo BM. Ultrasonic elastography in breast cancer diagnosis: strain ratio vs 5-point scale. Acad Radiol 2010; 17(10): 1227-33.
[http://dx.doi.org/10.1016/j.acra.2010.05.004] [PMID: 20650662]
[19]
Thomas A, Degenhardt F, Farrokh A, Wojcinski S, Slowinski T, Fischer T. Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol 2010; 17(5): 558-63.
[http://dx.doi.org/10.1016/j.acra.2009.12.006] [PMID: 20171905]
[20]
Parajuly SS, Lan PY, Yun MB, Gang YZ, Hua Z. Diagnostic potential of strain ratio measurement and a 5 point scoring method for detection of breast cancer: Chinese experience. Asian Pac J Cancer Prev 2012; 13(4): 1447-52.
[http://dx.doi.org/10.7314/APJCP.2012.13.4.1447] [PMID: 22799346]
[21]
Farrokh A, Wojcinski S, Degenhardt F. Diagnostische Aussagekraft der Strain-Ratio-Messung zur Unterscheidung zwischen malignen und benignen Brusttumoren. Ultraschall Med 2011; 32(4): 400-5.
[http://dx.doi.org/10.1055/s-0029-1245335] [PMID: 20425688]
[22]
Alhabshi SM, Rahmat K, Abdul Halim N, et al. Semi-quantitative and qualitative assessment of breast ultrasound elastography in differentiating between malignant and benign lesions. Ultrasound Med Biol 2013; 39(4): 568-78.
[http://dx.doi.org/10.1016/j.ultrasmedbio.2012.10.016] [PMID: 23384468]
[23]
Ng WL, Rahmat K, Fadzli F, et al. Shearwave Elastography Increases Diagnostic Accuracy in Characterization of Breast Lesions. Medicine (Baltimore) 2016; 95(12): e3146.
[http://dx.doi.org/10.1097/MD.0000000000003146] [PMID: 27015196]
[24]
Lee EJ, Jung HK, Ko KH, Lee JT, Yoon JH. Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses? Eur Radiol 2013; 23(7): 1803-11.
[http://dx.doi.org/10.1007/s00330-013-2782-5] [PMID: 23423637]
[25]
Berg WA, Cosgrove DO, Doré CJ, et al. BE1 Investigators. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology 2012; 262(2): 435-49.
[http://dx.doi.org/10.1148/radiol.11110640] [PMID: 22282182]
[26]
Çebi Olgun D, Korkmazer B, Kılıç F, et al. Use of shear wave elastography to differentiate benign and malignant breast lesions. Diagn Interv Radiol 2014; 20(3): 239-44.
[http://dx.doi.org/10.5152/dir.2014.13306] [PMID: 24509183]
[27]
Evans A, Whelehan P, Thomson K, et al. Differentiating benign from malignant solid breast masses: value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification. Br J Cancer 2012; 107(2): 224-9.
[http://dx.doi.org/10.1038/bjc.2012.253] [PMID: 22691969]
[28]
You JY, Suh HJ, Kim Y, Jun JK, Ojeda-Fournier H, Ko K. Follow-up Outcomes of Benign Pathology Initially Assigned as Breast Imaging Reporting and Data System Category 4A and 3. J Breast Cancer 2017; 20(3): 304-9.
[http://dx.doi.org/10.4048/jbc.2017.20.3.304] [PMID: 28970857]
[29]
Seo M, Ahn HS, Park SH, et al. Comparison and Combination of Strain and Shear Wave Elastography of Breast Masses for Differentiation of Benign and Malignant Lesions by Quantitative Assessment: Preliminary Study. J Ultrasound Med 2018; 37(1): 99-109.
[http://dx.doi.org/10.1002/jum.14309] [PMID: 28688156]
[30]
Barr RG, Zhang Z. Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography. Radiology 2015; 275(1): 45-53.
[http://dx.doi.org/10.1148/radiol.14132404] [PMID: 25426770]
[31]
Barr RG, Destounis S, Lackey LB II, Svensson WE, Balleyguier C, Smith C. Evaluation of breast lesions using sonographic elasticity imaging: a multicenter trial. J Ultrasound Med 2012; 31(2): 281-7.
[http://dx.doi.org/10.7863/jum.2012.31.2.281] [PMID: 22298872]
[32]
Hong M, Kim H. Intra- and Interobserver Reproducibility of Shear Wave Elastography for Evaluation of the Breast Lesions. J Korean Soc Radiol 2017; 76(3): 198-205.
[http://dx.doi.org/10.3348/jksr.2017.76.3.198]
[33]
Yoon JH, Kim MH, Kim EK, Moon HJ, Kwak JY, Kim MJ. Interobserver variability of ultrasound elastography: how it affects the diagnosis of breast lesions. AJR Am J Roentgenol 2011; 196(3): 730-6.
[http://dx.doi.org/10.2214/AJR.10.4654] [PMID: 21343520]


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Article Details

VOLUME: 17
ISSUE: 6
Year: 2021
Published on: 30 December, 2020
Page: [767 - 774]
Pages: 8
DOI: 10.2174/1573405616666201231102606

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