Added value of strain elastography in the characterisation of breast lesions: A prospective study

Background Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion. Purpose To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US). Methods In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis. Results Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%. Conclusion Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.

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Comparison of the SRmax, SRave, and color map of strain-elastography in differentiating malignant from benign breast lesions

Acta Radiologica ◽

10.1177/0284185118773510 ◽

2018 ◽

Vol 60 (1) ◽

pp. 28-34

Author(s):

Jin Hee Moon ◽

Sung Hye Koh ◽

Sun-Young Park ◽

Ji-Young Hwang ◽

Ji Young Woo

Keyword(s):

Statistical Significance ◽

Roc Curves ◽

Strain Ratio ◽

Breast Lesions ◽

Strain Elastography ◽

Average Value ◽

Maximum Value ◽

Significant Difference ◽

Malignant Breast ◽

Color Map

Background The maximum value of the strain ratio (SR) is a newly developed measure in strain-elastography. Purpose To prospectively compare the diagnostic performance of three different measures of strain-elastography, the maximum value of the SR (SRmax), the average value of the SR (SRave), and the color map, for differentiating benign and malignant breast lesions. Material and Methods We obtained the SRmax and SRave of 314 lesions from 290 patients with the tissue to nodule SR and color map using a five-degree scoring system. The diagnostic performances of the SRmax, SRave, and color map were compared after obtaining the area under the receiver operating characteristic (ROC) curves (AUCs) of each parameter. Results The AUC of the SRmax (0.7674) was larger than the AUCs of the SRave (0.7138) and color map (0.6324), with statistical significance ( P = 0.0383 for SRmax vs. SRave, P = 0.0000 for SRmax vs. color map). The AUC of the SRave was larger than that of the color map; however, there was no significant difference. The optimal cut-off point of the SRmax that balanced the sensitivity (91.12%) and specificity (50.81%) was 5.16. Conclusion The SRmax is a more reliable diagnostic tool than the SRave and color map for differentiating benign and malignant breast lesions.

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ROLE OF ULTRASOUND STRAIN ELASTOGRAPHY FOR THE EVALUATION OF BREAST LESIONS

10.36106/gjra/2105109 ◽

2020 ◽

pp. 4-6

Author(s):

Deoyani S Sarjare ◽

Arti Anand ◽

Soumya Agrawal ◽

Shanas K. P. ◽

Sandhya Yeshwante

Keyword(s):

Predictive Value ◽

Breast Biopsy ◽

Mammographic Screening ◽

P Value ◽

Breast Lesions ◽

Chi Square ◽

Cross Sectional ◽

Strain Elastography ◽

Malignant Breast ◽

Breast Lumps

Introduction: Ultrasound (US) elastography is an emerging technique that can be used during breast US examination. Guidelines recommend mammographic screening and US for diagnosis of breast cancer. The specificity of these techniques is not high enough to prevent unnecessary biopsies. Hence there is need for a more specific technique to overcome this problem. This study aimed to evaluate the value of strain elastography (SE) for breast lesions. Materials and Methods: In this cross sectional observational study over 18 months, 60 women with palpable breast lumps were evaluated with conventional US and SE. Results obtained were correlated with histopathological findings for statistical analysis. Result: A statistically significant correlation was found between SE and histopathological outcome with a p value of 0.03(<0.05). The positive predictive value (PPV) was 76.92% and the negative predictive value (NPV) was 76.47% with Chi square= 8.4. Conclusion: Ultrasound with SE can substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses.

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Evaluation of red blood cell parameters provided by the UF-5000 urine auto-analyzer in patients with glomerulonephritis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0287 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Genki Mizuno ◽

Masato Hoshi ◽

Kentaro Nakamoto ◽

Masayo Sakurai ◽

Kazuko Nagashima ◽

...

Keyword(s):

Positive Predictive Value ◽

Iga Nephropathy ◽

Negative Predictive Value ◽

Predictive Value ◽

Blood Cells ◽

Area Under The Curve ◽

Cell Parameters ◽

Significant Difference ◽

Low Sensitivity ◽

Cardinal Symptom

Abstract Objectives The microscopic examination of hematuria, a cardinal symptom of glomerulonephritis (GN), is time-consuming and labor-intensive. As an alternative, the fully automated urine particle analyzer UF-5000 can interpret the morphological information of the glomerular red blood cells (RBCs) using parameters such as UF-5000 small RBCs (UF-%sRBCs) and Lysed-RBCs. Methods Hematuria samples from 203 patients were analyzed using the UF-5000 and blood and urine chemistries to determine the cut-off values of RBC parameters for GN and non-glomerulonephritis (NGN) classification and confirm their sensitivity to the IgA nephropathy and non-IgA nephropathy groups. Results The UF-%sRBCs and Lysed-RBCs values differed significantly between the GN and NGN groups. The cut-off value of UF-%sRBCs was >56.8% (area under the curve, 0.649; sensitivity, 94.1%; specificity, 38.1%; positive predictive value, 68.3%; and negative predictive value, 82.1%), while that for Lysed-RBC was >4.6/μL (area under the curve, 0.708; sensitivity, 82.4%; specificity, 56.0%; positive predictive value, 72.6%; and negative predictive value, 69.1%). Moreover, there was no significant difference in the sensitivity between the IgA nephropathy and non-IgA nephropathy groups (87.1 and 89.8% for UF-%sRBCs and 83.9 and 78.4% for Lysed-RBCs, respectively). In the NGN group, the cut-off values showed low sensitivity (56.0% for UF-%sRBCs and 44.0% for Lysed-RBCs). Conclusions The RBC parameters of the UF-5000, specifically UF-%sRBCs and Lysed-RBCs, showed good cut-off values for the diagnosis of GN.

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Combining Virtual Touch Tissue Imaging and BI-RADS May Improve Solid Breast Lesion Evaluation

Breast Care ◽

10.1159/000456026 ◽

2017 ◽

Vol 12 (2) ◽

pp. 97-100 ◽

Cited By ~ 1

Author(s):

Size Wu ◽

Xiaojing Cui ◽

Li Huang ◽

Xuefei Bai

Keyword(s):

Predictive Value ◽

Area Under The Curve ◽

Ultrasound Elastography ◽

Tissue Imaging ◽

Imaging Method ◽

Breast Lesions ◽

Combined Use ◽

Sensitivity Specificity ◽

Solid Lesions ◽

Virtual Touch Tissue Imaging

Background: Ultrasound elastography (UE) is a novel imaging method. The purpose of this study was to determine the utility of Virtual Touch tissue imaging in the evaluation of solid breast lesions. Patients and Methods: 209 breast solid lesions in 192 patients that had been evaluated using ultrasound (US) and UE were reviewed and analyzed. Results: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for UE, US, and US plus UE in the differentiation of malignant from benign breast lesions were 80.8, 75.6, 77.9, 73.1, and 82.8% for UE, 87.2, 86.1, 86.6, 83.7, and 89.2% for US, and 92.5, 86.9, 89.5, 85.3, and 93.4% for US plus UE. There were significant differences between UE and US plus UE (all p < 0.05). Except for accuracy, there were no significant differences between UE and US or US and US plus UE (all p > 0.05). The area under the curve obtained from the ROC curve for UE, US, and US plus UE in differentiating malignant from benign lesions was 0.845, 0.884, and 0.922, respectively. Conclusion: The UE scoring system is not superior to BI-RADS in the sonographic evaluation of solid breast lesions. Combined use may improve the performance.

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Value of Strain Elastography Ultrasound in Differentiation of Benign and Malignant Breast Masses with Histopathological Correlation

Journal of Cancer and Tumor International ◽

10.9734/jcti/2020/v10i130119 ◽

2020 ◽

pp. 17-25

Author(s):

Mahbuba Azim Moonmoon ◽

M. N. Rubaia Islam Bony ◽

Md. Ubaidul Islam ◽

Parbati Devnath ◽

Nahid Safrin

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Treatment Plan ◽

Strain Ratio ◽

Cross Sectional ◽

Breast Masses ◽

Validity Test ◽

Strain Elastography ◽

Malignant Breast

Introduction: Breast cancer is currently one of the leading causes of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. Elastography has shown potential in differentiating benign from malignant breast tumors. Objective: To evaluate the usefulness of Strain Elastography ultrasound in differentiation of benign and malignant breast masses taken histopathology as Gold Standard. Methods: This cross-sectional study was carried out in the Department of Radiology and Imaging, BIRDEM, Dhaka, from July 2017 to June 2019. A total of 92 female patients with breast masses were enrolled in this study. Strain Elastography Ultrasound and histopathology were done in all these patients. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The validity test of B-mode ultrasonography for differentiation of benign and malignant breast mass has sensitivity 95.0%, specificity 71.2%, accuracy 81.5% and positive predictive value 71.7% and negative predictive value 94.9%. Strain Score has sensitivity 85.0%, specificity 92.3%, accuracy 89.1%, positive predictive value 89.5% and negative predictive value 88.9%. Strain ratio has sensitivity 87.5%, specificity 94.2%, accuracy 91.3%, positive predictive value 92.1% and negative predictive value 90.7%. The validity test of Combined (B-mode sonography and Elastography) has sensitivity 97.5%, specificity 96.2%, accuracy 96.7%, positive predictive value 95.1% and negative predictive value 98.0%. The areas under the curve (AUCs) from the receiver operating characteristic (ROC) curves were 0.948 for ACR-BIRADS classification, 0.986 for Strain Score, 0.956 for Strain Ratio and 0.990 for combination. Conclusion: The combination of strain elastography with B-mode ultrasonography has the potential to improve the differentiation of benign and malignant breast masses.

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201Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

Nuklearmedizin ◽

10.1055/s-0038-1629848 ◽

1997 ◽

Vol 36 (08) ◽

pp. 282-288 ◽

Cited By ~ 8

Author(s):

T. Atasever ◽

A. Özdemir ◽

I. Öznur ◽

N. I. Karabacak ◽

N. Gökçora ◽

...

Keyword(s):

Final Diagnosis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Breast Cancers ◽

Combined Use ◽

Malignant Breast ◽

Malignant Lesions ◽

Benign Breast Lesions ◽

Palpable Breast ◽

Metastatic Sites

Summary Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

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Added value of diffusion-weighted MRI in assessment of pleural lesions

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00557-3 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Youssriah Yahia Sabri ◽

Ikram Hamed Mahmoud ◽

Lamis Tarek El-Gendy ◽

Mohamed Raafat Abd El-Mageed ◽

Sally Fouad Tadros

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Value ◽

Added Value ◽

Adc Value ◽

Pleural Diseases ◽

Conventional Mri ◽

Malignant Lesions

Abstract Background There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions. Results Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001). Conclusion Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

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Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04366-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

E. J. de Raaij ◽

H. Wittink ◽

J. F. Maissan ◽

P. Westers ◽

R. W. J. G. Ostelo

Keyword(s):

Prognostic Factors ◽

Pain Intensity ◽

Musculoskeletal Pain ◽

Physical Functioning ◽

Predictive Value ◽

Illness Perceptions ◽

Illness Perception ◽

Added Value ◽

Poor Recovery ◽

Significant Difference

Abstract Background Musculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We were interested in the added predictive value of baseline IPs, over and above the known generic prognostic factors, on clinical recovery from MSP. Also, it is hypothesized there may be overlap between IPs and domains covered by the Four-Dimensional Symptom Questionnaire (4DSQ), measuring distress, depression, anxiety and somatization. The aim of this study is twofold; 1) to assess the added predictive value of IPs for poor recovery and 2) to assess differences in predictive value for poor recovery between the Brief Illness Perception Questionnaire - Dutch Language Version (Brief IPQ-DLV) and the 4DSQ. Methods An eligible sample of 251 patients with musculoskeletal pain attending outpatient physical therapy were included in a multi-center longitudinal cohort study. Pain intensity, physical functioning and Global Perceived Effect were the primary outcomes. Hierarchical logistic regression models were used to assess the added value of baseline IPs for predicting poor recovery. To investigate the performance of the models, the levels of calibration (Hosmer-Lemeshov test) and discrimination (Area under the Curve (AUC)) were assessed. Results Baseline ‘Treatment Control’ added little predictive value for poor recovery in pain intensity [Odds Ratio (OR) 0.80 (Confidence Interval (CI) 0.66–0.97), increase in AUC 2%] and global perceived effect [OR 0.78 (CI 0.65–0.93), increase in AUC 3%]. Baseline ‘Timeline’ added little predictive value for poor recovery in physical functioning [OR 1.16 (CI 1.03–1.30), increase in AUC 2%]. There was a non-significant difference between AUCs in predictive value for poor recovery between the Brief IPQ-DLV and the 4DSQ. Conclusions Based on the findings of this explorative study, assessing baseline IPs, over and above the known generic prognostic factors, does not result in a substantial improvement in the prediction of poor recovery. Also, no recommendations can be given for preferring either the 4DSQ or the Brief IPQ-DLV to assess psychological factors.

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Reanalysis and External Validation of a Decision Tree Model for Detecting Unrecognized Diabetes in Rural Chinese Individuals

International Journal of Endocrinology ◽

10.1155/2017/3894870 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Zhong Xin ◽

Lin Hua ◽

Xu-Hong Wang ◽

Dong Zhao ◽

Cai-Guo Yu ◽

...

Keyword(s):

Decision Tree ◽

Predictive Value ◽

Early Stage ◽

Current Model ◽

External Validation ◽

Area Under The Curve ◽

Decision Tree Model ◽

Tree Model ◽

Chinese Adult ◽

Significant Difference

We reanalyzed previous data to develop a more simplified decision tree model as a screening tool for unrecognized diabetes, using basic information in Beijing community health records. Then, the model was validated in another rural town. Only three non-laboratory-based risk factors (age, BMI, and presence of hypertension) with fewer branches were used in the new model. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) for detecting diabetes were calculated. The AUC values in internal and external validation groups were 0.708 and 0.629, respectively. Subjects with high risk of diabetes had significantly higher HOMA-IR, but no significant difference in HOMA-B was observed. This simple tool will help general practitioners and residents assess the risk of diabetes quickly and easily. This study also validates the strong associations of insulin resistance and early stage of diabetes, suggesting that more attention should be paid to the current model in rural Chinese adult populations.

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