A PILOT STUDY FOR EVALUATION OF ROLE OF B-MODE ULTRASOUND AND STRAIN ELASTOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT BREAST MASSES
DOI:
https://doi.org/10.22159/ajpcr.2021.v14i7.42378Keywords:
Breast lump, Elastography, Strain ratio, Breast imaging reporting and data systemAbstract
Background: Early detection of malignant lesions is critical key stone for the successful management of breast cancer. Conventional B-mode ultrasound although could not replace the histopathology which is still gold standard, plays an important role in the diagnostic pathways by using the Breast Imaging Reporting and Data System (BIRADS) lexicon (standardized by American College of Radiology [ACR]). Although characterization of solid breast masses by sonography has improved greatly since the early 1990s, specificity remains low and a large number of biopsies result in benign diagnosis. Strain elastography and strain ratio (SR) are recent techniques which may help in increasing the specificity of ultrasound.
Methods: The present study was a pilot study aimed to establish a correlation between B-mode ultrasound and strain elastography in differentiating benign and malignant breast masses and to compare the results of B- mode ultrasound and Strain Elastography with fine-needle aspiration cytology/ biopsy findings. It was a prospective study conducted in the Department of Radio-diagnosis of Rajindra Hospital, Patiala. A total of 40 patients who presented with the complaint of palpable breast lump were evaluated with B-Mode Ultrasonography (USG) and Strain elastography (using elastography score [ES] and SR).
Results: The study group (40 patients with breast lumps) comprised 38 (95%) female patients and 2 (5%) male patients. Among the group 29 were benign and 11 were malignant. Fibroadenoma followed by fibrocystic disease was the most common benign pathologies and invasive ductal carcinoma followed by Ductal Carcinoma in situ was the most common malignant pathologies. Sensitivity, specificity, and diagnostic accuracy of B-Mode USG in diagnosing palpable breast lump are 72.7%, 86.2%, and 82.5%, respectively, while that of strain elastography in diagnosing palpable breast lump are 81.8%, 93.10%, and 90.0%, respectively. Using strain ratio (SR) only the sensitivity, specificity, and diagnostic accuracy was found to be 93.1%, 100%, and 95% better than B-Mode USG and shear elastography alone separately and combined. The mean SR for a benign mass is 2.00±0.97 and for a malignant mass is 5.40±1.55.
Conclusion: Ultrasound elastography (using ES) has a higher sensitivity, specificity and diagnostic accuracy in differentiating benign and malignant breast masses then B mode USG (using BIRADS). Using SR alone has shown better sensitivity, specificity, and diagnostic accuracy but its standalone or in combination diagnostic application has to be followed up with further studies.
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References
Klein S. Evaluation of palpable breast masses. Am Fam Physician 2005;71:1731-8.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49. DOI: https://doi.org/10.3322/caac.21660
Moukhtar FZ, ElMaati AA. Real-time tissue elastography combined with BIRADS-US classification system for improving breast lesion evaluation. Egypt J Radiol Nuclear Med 2014;45:1021-8. DOI: https://doi.org/10.1016/j.ejrnm.2014.05.007
Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: Use of sonography to distinguish between benign and malignant lesions. Radiology 1995;196:123-34. DOI: https://doi.org/10.1148/radiology.196.1.7784555
Mainiero MB, Goldkamp A, Lazarus E, Livingston L, Koelliker SL, Schepps B, et al. Characterization of breast masses with sonography: Can biopsy of some solid masses be deferred? J Ultrasound Med 2005;24:161-7. DOI: https://doi.org/10.7863/jum.2005.24.2.161
Lee WJ, Chu JS, Huang CS, Chang MF, Chang KJ, Chen KM. Breast cancer vascularity: Color Doppler sonography and histopathology study. Breast Cancer Res Treat 1996;37:291-8. DOI: https://doi.org/10.1007/BF01806510
Goddi A, Bonardi M, Alessi S. Breast elastography: A literature review. J Ultrasound 2012;15:192-8. DOI: https://doi.org/10.1016/j.jus.2012.06.009
Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: Clinical application of us elastography for diagnosis. Radiology 2006;239:341-50. DOI: https://doi.org/10.1148/radiol.2391041676
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;17:558-63. DOI: https://doi.org/10.1016/j.acra.2009.12.006
Imtiaz S. Breast elastography: A new paradigm in diagnostic breast imaging. Appl Radiol 2018;47:14-9. DOI: https://doi.org/10.37549/AR2467
Schwab F, Redling K, Siebert M, Schötzau A, Schoenenberger CA, Zanetti-Dällenbach R. Inter-and intra-observer agreement in ultrasound BI-RADS classification and real-time elastography Tsukuba score assessment of breast lesions. Ultrasound Med Biol 2016;42:2622-9. DOI: https://doi.org/10.1016/j.ultrasmedbio.2016.06.017
MedCalc®. Statistical Software Version 20.006. Ostend, Belgium: MedCalc Software Ltd. Available from: https://www.medcalc.org; 2021.
Sadigh G, Carlos RC, Neal CH, Dwamena BA. Accuracy of quantitative ultrasound elastography for differentiation of malignant and benign breast abnormalities: A meta-analysis. Breast Cancer Res Treat 2012;134:923-31. DOI: https://doi.org/10.1007/s10549-012-2020-x
Sandhu DS, Sandhu S, Karwasra RK, Marwah S. Profile of breast cancer patients at a tertiary care hospital in north India. Indian J Cancer 2010;47:16-22. DOI: https://doi.org/10.4103/0019-509X.58853
Somdatta P, Baridalyne N. Awareness of breast cancer in women of an urban resettlement colony. Indian J Cancer 2008;45:149-53. DOI: https://doi.org/10.4103/0019-509X.44662
Nigam M, Nigam B. Triple assessment of breast-gold standard in mass screening for breast cancer diagnosis. IOSR J Dent Med Sci 2013;7:1-7. DOI: https://doi.org/10.9790/0853-0730107
Phurailatpam AS, Prasad CS, Kishore Kumar BN, Hegde P. Evaluation of mammography, sonomammography in correlation with fine needle aspiration of breast lumps. Int J Biol Med Res 2014;5:4370-6.
Costantini M, Belli P, Lombardi R, Franceschini G, Mulè A, Bonomo L. Characterization of solid breast masses: Use of the sonographic breast imaging reporting and data system lexicon. J Ultrasound Med 2006;25:649-59. DOI: https://doi.org/10.7863/jum.2006.25.5.649
Hong AS, Rosen EL, Soo MS, Baker JA. BI-RADS for sonography: Positive and negative predictive values of sonographic features. AJR Am J Roentgenol 2005;184:1260-5. DOI: https://doi.org/10.2214/ajr.184.4.01841260
Hao SY, Jiang QC, Zhong WJ, Zhao XB, Yao JY, Li LJ, et al. Ultrasound elastography combined with BI-RADS-US classification system: Is it helpful for the diagnostic performance of conventional ultrasonography? Clin Breast Cancer 2016;16:e33-41. DOI: https://doi.org/10.1016/j.clbc.2015.10.003
Yeo SH, Kim GR, Lee SH, Moon WK. Comparison of ultrasound elastography and color Doppler ultrasonography for distinguishing small triple-negative breast cancer from fibroadenoma. J Ultrasound Med 2018;37:2135-46. DOI: https://doi.org/10.1002/jum.14564
Ranjkesh M, Hajibonabi F, Seifar F, Tarzamni MK, Moradi B, Khamnian Z. Diagnostic value of elastography, strain ratio, and elasticity to B-mode ratio and color Doppler ultrasonography in breast lesions. Int J Gen Med 2020;13:215-24. DOI: https://doi.org/10.2147/IJGM.S247980
Özel D, Özel BD. Evaluating the role of strain ratio elastography in determining malignancy potential and calculating objective BIRADS US scores using ultrasonography and elastography features. Pol J Radiol 2018;83:e268-74. DOI: https://doi.org/10.5114/pjr.2018.76790
Bojanic K, Katavic N, Smolic M, Peric M, Kralik K, Sikora M, et al. Implementation of elastography score and strain ratio in combination with B-mode ultrasound avoids unnecessary biopsies of breast lesions. Ultrasound Med Biol 2017;43:804-16. DOI: https://doi.org/10.1016/j.ultrasmedbio.2016.11.019
Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol 2020;215:108427. DOI: https://doi.org/10.1016/j.clim.2020.108427
Gheonea IA, Stoica Z, Bondari S. Differential diagnosis of breast lesions using ultrasound elastography. Indian J Radiol Imaging 2011;21:301-5. DOI: https://doi.org/10.4103/0971-3026.90697
Li L, Zhou X, Zhao X, Hao S, Yao J, Zhong W, et al. B-mode ultrasound combined with color Doppler and strain elastography in the diagnosis of non-mass breast lesions: A prospective study. Ultrasound Med Biol 2017;43:2582-90. DOI: https://doi.org/10.1016/j.ultrasmedbio.2017.07.014
Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: Prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology 2013;269:701-12. DOI: https://doi.org/10.1148/radiol.13122829
Alhabshi SM, Rahmat K, Abdul Halim N, Aziz S, Radhika S, Gan GC, et al. Semi-quantitative and qualitative assessment of breast ultrasound elastography in differentiating between malignant and benign lesions. Ultrasound Med Biol 2013;39:568-78. DOI: https://doi.org/10.1016/j.ultrasmedbio.2012.10.016
Menezes R, Sardessai S, Furtado R, Sardessai M. Correlation of strain elastography with conventional sonography and FNAC/biopsy. J Clin Diagn Res 2016;10:5-10. DOI: https://doi.org/10.7860/JCDR/2016/20239.8177
Arslan S, Öncü F, Eryılmaz MA, Durmaz MS, Altunkeser A, Ünlü Y. Advantages of b-mode ultrasound combined with strain elastography in differentiation of idiopathic granulomatous mastitis from malignant breast lesions. Turk J Med Sci 2018;48:16-23. DOI: https://doi.org/10.3906/sag-1708-34
Chen YL, Chen JJ, Chang C, Gao Y, Wu J, Yang WT, et al. Sclerosing adenosis: Ultrasonographic and mammographic findings and correlation with histopathology. Mol Clin Oncol 2017;6:157-62. DOI: https://doi.org/10.3892/mco.2016.1108
Li LJ, Zeng H, Ou B, Luo BM, Xiao XY, Zhong WJ, et al. Ultrasonic elastography features of phyllodes tumors of the breast: A clinical research. PLoS One 2014;9:e85257. DOI: https://doi.org/10.1371/journal.pone.0085257
Khanduri S, Khan M, Shukla A, Khan S, Ali I, Ahmad ZS, et al. Characterization of breast lesions using a novel combined approach of ultrasonography and elastography prior to invasive procedures: Are new age modalities set to replace the diagnostic giant? Cureus 2019;11:e4954. DOI: https://doi.org/10.7759/cureus.4954
Huang M, Jiang T, Zhao Q, You Q, Tian G, Wang B. Breast adenoid cystic carcinoma: Report of a case with emphasis on routine sonographic findings and shear wave elastography. J Med Ultrason 2001 2018;45:181-4. DOI: https://doi.org/10.1007/s10396-017-0786-5
Ichikawa K, Mizukami Y, Takayama T, Takemura A, Miyati T, Taniya T. A case of adenoid cystic carcinoma of the breast. J Med Ultrason 2001 2007;34:193-6. DOI: https://doi.org/10.1007/s10396-007-0157-8
Tang W, Peng WJ, Gu YJ, Zhu H, Jiang TT, Li C. Imaging manifestation of adenoid cystic carcinoma of the breast. J Comput Assist Tomogr 2015;39:523-30. DOI: https://doi.org/10.1097/RCT.0000000000000236
Jin FL, Du J, Guo Y. Strain elastography features in invasive breast cancer: Relationship between stiffness and pathological factors. Int J Clin Exp Med 2017;10:13290-7.
Meyer JE, Amin E, Lindfors KK, Lipman JC, Stomper PC, Genest D.Medullary carcinoma of the breast: Mammographic and US appearance. Radiology 1989;170:79-82. DOI: https://doi.org/10.1148/radiology.170.1.2642350
Choi JJ, Kang BJ, Kim SH, Lee JH, Jeong SH, Yim HW, et al. Role of sonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer. J Ultrasound Med 2011;30:429-36. DOI: https://doi.org/10.7863/jum.2011.30.4.429
Mu WJ, Zhong WJ, Yao JY, Li LJ, Peng YL, Wang Y, et al.Ultrasonic elastography research based on a multicenter study: Adding strain ratio after 5-point scoring evaluation or not. PloS one 2016;11:e0148330. DOI: https://doi.org/10.1371/journal.pone.0148330
Yerli H, Yilmaz T, Kaskati T, Gulay H. Qualitative and semiquantitative evaluations of solid breast lesions by sonoelastography. J Ultrasound Med 2011;30:179-86. DOI: https://doi.org/10.7863/jum.2011.30.2.179
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