Second-Look Ultrasound Using Shear-Wave Elastography in MRI-Suspected Locoregional Recurrence of Breast Carcinoma

Abstract Purpose To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma. Materials and Methods SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2 mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy. Results Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had Elmax values ranging from 128 to 199 kPa, and 50 % of benign lesions had Elmax values ranging from 65 to 169 kPa. The cut-off value of 171.2 kPa for Elmax shows a sensitivity of 59 % and specificity of 78.4 % for carcinoma recurrence, area under the curve 0.706 (CI95 % 0.6–0.81), P = 0.001. In univariate logistic models, restricted diffusion and stiffness on SWE, Elmax > 171.2 kPa, were shown as significant recurrence predictors. In the multivariate model, restricted diffusion remains significant independent recurrence predictor. With a recurrence prevalence of 43 %, the test sensitivity is 95 % (CI95 % 81–99 %) and the specificity is 75 % (CI95 % 60–85 %). Conclusion Stiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.

Download Full-text

The Potential of Shear Wave Elastography to Reduce Unnecessary Biopsies in Breast Cancer Diagnosis: An International, Diagnostic, Multicenter Trial

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1543-6156 ◽

2021 ◽

Author(s):

Michael Golatta ◽

André Pfob ◽

Christopher Büsch ◽

Thomas Bruckner ◽

Zaher Alwafai ◽

...

Keyword(s):

Breast Cancer ◽

Shear Wave ◽

Cancer Diagnosis ◽

Shear Wave Elastography ◽

Breast Cancer Diagnosis ◽

Multicenter Trial ◽

Breast Ultrasound ◽

Histopathologic Evaluation ◽

International Data ◽

Malignant Lesions

Abstract Purpose In this prospective, multicenter trial we evaluated whether additional shear wave elastography (SWE) for patients with BI-RADS 3 or 4 lesions on breast ultrasound could further refine the assessment with B-mode breast ultrasound for breast cancer diagnosis. Materials and Methods We analyzed prospective, multicenter, international data from 1288 women with breast lesions rated by conventional 2 D B-mode ultrasound as BI-RADS 3 to 4c and undergoing 2D-SWE. After reclassification with SWE the proportion of undetected malignancies should be < 2 %. All patients underwent histopathologic evaluation (reference standard). Results Histopathologic evaluation showed malignancy in 368 of 1288 lesions (28.6 %). The assessment with B-mode breast ultrasound resulted in 1.39 % (6 of 431) undetected malignancies (malignant lesions in BI-RADS 3) and 53.80 % (495 of 920) unnecessary biopsies (biopsies in benign lesions). Re-classifying BI-RADS 4a patients with a SWE cutoff of 2.55 m/s resulted in 1.98 % (11 of 556) undetected malignancies and a reduction of 24.24 % (375 vs. 495) of unnecessary biopsies. Conclusion A SWE value below 2.55 m/s for BI-RADS 4a lesions could be used to downstage these lesions to follow-up, and therefore reduce the number of unnecessary biopsies by 24.24 %. However, this would come at the expense of some additionally missed cancers compared to B-mode breast ultrasound (rate of undetected malignancies 1.98 %, 11 of 556, versus 1.39 %, 6 of 431) which would, however, still be in line with the ACR BI-RADS 3 definition (< 2 % of undetected malignancies).

Download Full-text

Simultaneous comparison between strain and shear wave elastography of breast masses for the differentiation of benign and malignant lesions by qualitative and quantitative assessments

Breast Cancer ◽

10.1007/s12282-019-00985-0 ◽

2019 ◽

Vol 26 (6) ◽

pp. 792-798 ◽

Cited By ~ 5

Author(s):

Tomoyuki Fujioka ◽

Mio Mori ◽

Kazunori Kubota ◽

Yuka Kikuchi ◽

Leona Katsuta ◽

...

Keyword(s):

Shear Wave ◽

Shear Wave Elastography ◽

Breast Masses ◽

Qualitative And Quantitative ◽

Malignant Lesions ◽

Simultaneous Comparison ◽

Quantitative Assessments

Download Full-text

Sonographic Findings of Additional Malignant Lesions in Breast Carcinoma Seen by Second Look Ultrasound

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.82338 ◽

2011 ◽

Vol 1 ◽

pp. 34 ◽

Cited By ~ 15

Author(s):

Ana Delgado Laguna ◽

S Jimenez Arranz ◽

V Quintana Checa ◽

S Alonso Roca ◽

D Expósito Jiménez ◽

...

Keyword(s):

Breast Carcinoma ◽

Primary Lesion ◽

Resonance Imaging ◽

Double Blind ◽

Additional Lesion ◽

Second Look ◽

The Us ◽

Malignant Lesions ◽

Magnetic Resonance Imaging Mri ◽

Us Findings

Objective: The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis. Materials and Methods: A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion. Results: Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm. Conclusions: Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.

Download Full-text

Usefulness of Elastography for the Evaluation of Subcentimeter Solid Breast Nodules

Applied Sciences ◽

10.3390/app11041409 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1409

Author(s):

Florentina Guzmán-Aroca ◽

Yésica Martínez-Paredes ◽

Juan de Dios Berná-Serna ◽

Ana Azahara García-Ortega ◽

Juan de Dios Berná-Mestre ◽

...

Keyword(s):

Shear Wave ◽

Correct Diagnosis ◽

Shear Wave Elastography ◽

Accurate Diagnosis ◽

Breast Lesions ◽

Diagnostic Strategy ◽

Benign Lesions ◽

Ultrasound Study ◽

Malignant Breast ◽

Malignant Lesions

The accurate diagnosis of subcentimeter lesions is controversial, and therefore a standardized diagnosis algorithm is needed. The objective of the present work was to study the value of the elastography patterns obtained through the use of the shear wave elastography (SWE) technique with respect to histopathology for the evaluation of nodular breast lesions ≤1 cm. A retrospective study was conducted which included 65 sub-centimeter lesions from 57 patients with an average age of 45.6 ± 11.9. For all the cases, a B-mode ultrasound study, shear wave elastography, and a posterior anatomopathological study were conducted. The lesions had a diameter greater than 7.5 ± 1.7 mm (range: 4–9 mm). Through elastography, the distribution of the patterns was: cyst artifact (n = 13), pattern 1 (n = 4), pattern 2 (n = 31), pattern 3 (n = 13), and pattern 4 (n = 4). Of the 65 lesions, 15 were cysts, 46 were solid benign lesions, and 3 were malignant lesions. The sensitivity of the elastography was 75%, with a specificity of 98.46% and a correct diagnosis in 96.92% of the cases (n = 63). The results from this study show the usefulness of SWE for the evaluation of sub-centimeter breast lesions. In addition, this diagnostic strategy helps with the differential diagnosis between benign and malignant lesions and contributes to the early detection of malignant breast lesions.

Download Full-text

The value of peri-lesional tissue stiffness and stiff rim sign in the differential diagnosis between benign and malignant breast lesions

10.21203/rs.2.10742/v1 ◽

2019 ◽

Author(s):

wen-tao Kong ◽

yin Wang ◽

wei-jun Zhou ◽

yi-dang Zhang ◽

xiao-ming Zhuang ◽

...

Keyword(s):

Shear Wave ◽

Diagnostic Performance ◽

Breast Lesion ◽

Elasticity Modulus ◽

Shear Wave Elastography ◽

Surrounding Tissue ◽

Pathological Examination ◽

Breast Lesions ◽

Tissue Stiffness ◽

Malignant Lesions

Abstract Background Shear wave elastography (SWE) is an important method in the diagnosis of breast lesions. The purpose of this study was to evaluate the value of tissue stiffness around breast lesion and stiff rim sign for the differentiation of benign and malignant lesions. Methods 192 patients (mean age, 44.6 ± 13.6 years) with 199 breast lesions proven by pathological examination underwent shear wave elastography (SWE). We first observed if there was a stiff rim sign. Then the shell around the breast lesion on SWE was automatically drawn by machine, with width of 1mm, 2mm and 3mm. Elasticity modulus of the lesion and surrounding tissue were recorded, including maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin) and elasticity ratio (shell/lesion ratio). The optimal thresholds of elasticity modulus were calculated according to receiver operating characteristic (ROC) curve. Results There were 75 malignant lesions and 124 benign lesions. The average Emax, Emean of lesion and shell were significantly higher in the malignant group than in the benign group (P<0.05). The optimal cut-off value of Emax for diagnosing malignant lesion was 101.7 Kpa, with a sensitivity of 66.3% and specificity of 87.9%. The optimal cut-off value of Emean was 29.1 Kpa, with a sensitivity of 65.3% and specificity of 79.8%. The stiff rim sign had a highest diagnostic performance for malignancy than other elastic parameters, with an accuracy of 88.4%. However, measuring peritumoral tissue stiffness can achieve a relatively high sensitivity, whereas specificity was not improved significantly. Conclusion The stiffness of tissue surrounding breast malignancy was significantly higher than benign lesion. Stiff rim sign has the potential to improve the diagnostic performance of breast lesions.

Download Full-text