scholarly journals A PILOT STUDY FOR EVALUATION OF ROLE OF B-MODE ULTRASOUND AND STRAIN ELASTOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT BREAST MASSES

2021 ◽  
pp. 153-163
Author(s):  
SARYU GUPTA ◽  
MANPREET KAUR ◽  
AMARJIT KAUR ◽  
KULDEEP BHATIA
Keyword(s):  
Pilot Study ◽  
Diagnostic Accuracy ◽  
Ductal Carcinoma ◽  
Strain Ratio ◽  
Breast Lump ◽  
Breast Masses ◽  
Strain Elastography ◽  
Malignant Breast ◽  
Palpable Breast ◽  
Sensitivity Specificity

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.

scholarly journals Comparison of Mammography and Ultrasonography in Evaluation of Breast Masses

2019 ◽  
Vol 13 (2) ◽  
pp. 22-24
Author(s):  
Zebun Nahar ◽  
Md Enamul Kabir ◽  
Taharul Alam ◽  
Shamoli Yasmin ◽  
Maisha Naowar
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Breast Tumour ◽  
Military Hospital ◽  
Kappa Statistics ◽  
K Value ◽  
Breast Masses ◽  
Malignant Breast ◽  
Diagnostic Modalities ◽  
Sensitivity Specificity

Introduction: Breast cancer is the most common cancer and second leading cause of cancer deaths in women. Early detection, efficient and accurate diagnosis can reduce the mortality rate. Objectives: To compare the screening accuracy of mammography (MMG) and ultrasonography (USG) in suspected cases of breast masses. Material and Methods: This cross-sectional analytical study was carried out in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka from June 2016 to July 2017. A total of 100 clinically suspected case of breast masses aged from 20 to 75 years referred for MMG and USG was selected. Each patient underwent USG and MMG followed by a histopathological examination of the biopsy material taken from the lump lesion. Two cases histopathological report was not found. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of USG and MMG were compared with histopathology as the gold standard. In order to determine the agreement of diagnoses between USG and MMG, consistency analysis was performed using Kappa-statistics. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 58.8%, 98.4%, 77.8%, 85.0% and 83.6% and for MMG 92.0%, 84.5%, 67.6%, 96.8% and 84.7% respectively. Kappa-statistics shows that the two diagnostic modalities had a test agreement in 39.8% cases to differentiate malignant breast tumour from the benign one (k-value = 0.398, p > 0.05). Conclusion: Two diagnostic modalities USG and MMG had a fair agreement in the differentiation of malignant breast tumour from the benign. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 22-24

scholarly journals The spectrum of palpable breast lesions- A cytopathological study of 1193 cases

2021 ◽  
Vol 7 (3) ◽  
pp. 144-149
Author(s):  
Manasa GC ◽  
◽  
Sneha SP ◽  
Adicherla Govardhan ◽  
◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Female Breast Cancer ◽  
Care Hospital ◽  
Age Group ◽  
Breast Lump ◽  
Palpable Breast ◽  
Needle Aspiration Cytology ◽  
Sensitivity Specificity

Introduction- The vast majority of the lesions that occur in the breast are benign. Much concern isgiven to malignant lesions of the breast because female breast cancer has now surpassed lungcancer as the leading cause of global cancer incidence in 2020. Fine needle aspiration cytology(FNAC) has good sensitivity, specificity and accuracy in the diagnosis of both neoplastic and non-neoplastic breast lump thereby assisting in early diagnosis and further management. The currentstudy was done to study the incidence and the different cytomorphological patterns of palpablebreast lumps by FNAC and consequently compare the results with studies in the literature.Materials and methods- This is a retrospective study conducted from January 2018 to December2020 in a tertiary care hospital. The three-year data is obtained from the records maintained in theFNA clinic. The patients were counselled before the procedure and informed consent was taken.Results- A total of 1193 breast lump cases were analysed in this 3-year study, there were 19 malepatients all of them presented with gynaecomastia and 1177 female patients. The patient’s agegroup ranged from 12 to 86 years. The commonest age group with the lesions 31-40 yearscomprising 326 cases (27.32%) followed 21-30 years age group in the second place with 307 cases(25.7%). Conclusion- In this study the most common benign neoplastic and malignant neoplasticbreast lumps are fibroadenoma and infiltrating ductal carcinoma respectively. Fibrocystic disease ofthe breast is the most common non-neoplastic breast lump.

scholarly journals Added Value of a New Strain Elastography Technique in Conventional Ultrasound for the Diagnosis of Breast Masses: A Prospective Multicenter Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Qi Wei ◽  
Yu-Jing Yan ◽  
Ge-Ge Wu ◽  
Xi-Rong Ye ◽  
Fan Jiang ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Predictive Value ◽  
Breast Imaging ◽  
Strain Ratio ◽  
Added Value ◽  
Prospective Multicenter Study ◽  
Breast Masses ◽  
Strain Elastography ◽  
Conventional Ultrasound ◽  
Sensitivity Specificity

ObjectiveThis study aimed to explore the value of elasticity score (ES) and strain ratio (SR) combined with conventional ultrasound in distinguishing benign and malignant breast masses and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.MethodsThis prospective, multicenter study included 910 patients from nine different hospitals. The acquisition and analysis of conventional ultrasound and strain elastography (SE) were obtained by radiologists with more than 5 years of experience in breast ultrasound imaging. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of conventional ultrasound alone and combined tests with ES and/or SR were calculated and compared.ResultsThe optimal cutoff value of SR for differentiating benign from malignant masses was 2.27, with a sensitivity of 60.2% and a specificity of 84.8%. When combined with ES and SR, the AUC of the new BI-RADS classification increased from 0.733 to 0.824 (p < 0.001); the specificity increased from 48.1% to 68.5% (p < 0.001) without a decrease in the sensitivity (98.5% vs. 96.4%, p = 0.065); and the PPV increased from 52.2% to 63.7% (p < 0.001) without a loss in the NPV (98.2% vs. 97.1%, p = 0.327). All three combinations of conventional ultrasound, ES, and SR could reduce the biopsy rate of category 4a lesions without reducing the malignant rate of biopsy (from 100% to 68.3%, 34.9%, and 50.4%, respectively, all p < 0.001).ConclusionsSE can be used as a useful and non-invasive additional method to improve the diagnostic performance of conventional ultrasound by increasing AUC and specificity and reducing the unnecessary biopsy of BI-RADS 4a lesions.

scholarly journals Qualitative and quantitative strain and shear wave elastography paradigm in differentiation of breast lesions

2022 ◽  
Vol 53 (1) ◽  
Author(s):  
Roaa M. A. Shehata ◽  
Mostafa A. M. El-Sharkawy ◽  
Omar M. Mahmoud ◽  
Hosam M. Kamel
Keyword(s):  
Shear Wave ◽  
Diagnostic Performance ◽  
Strain Ratio ◽  
Breast Lesions ◽  
Breast Masses ◽  
Significant Difference ◽  
Malignant Breast ◽  
Malignant Lesions ◽  
The Mean ◽  
Sensitivity Specificity

Abstract Background Breast cancer is the most common life-threatening cancer in women worldwide. A high number of women are going through biopsy procedures for characterization of breast masses every day and yet 75% of the pathological results prove these masses to be benign. Ultrasound (US) elastography is a non-invasive technique that measures tissue stiffness. It is convenient for differentiating benign from malignant breast tumors. Our study aims to evaluate the role of qualitative ultrasound elastography scoring (ES), quantitative mass strain ratio (SR), and shear wave elasticity ratio (SWER) in differentiation between benign and malignant breast lesions. Results Among 51 female patients with 77 histopathologically proved breast lesions, 57 breast masses were malignant and 20 were benign. All patients were examined by B-mode ultrasound then strain and shear wave elastographic examinations using ultrasound machine (Logiq E9, GE Medical Systems) with 8.5–12 MHz high-frequency probes. Our study showed that ES best cut-off point > 3 with sensitivity, specificity, PPV, NPP, accuracy was 94.7%, 85%, 94.7%, 85%, 90.9%, respectively, and AUC = 0.926 at P < 0.001, mass SR the best cut-off point > 4.6 with sensitivity, specificity, PPV, NPP, accuracy was 96.5%, 80%, 93.2%, 88.9%, 92.2%, respectively, and AUC = 0.860 at P < 0.001, SWER the best cut-off value > 4.9 with sensitivity, specificity, PPV, NPP and accuracy was 91.2%, 80%, 92.9%, 76.2%, 93.5%, respectively, and AUC = 0.890 at P < 0.001. The mean mass strain ratio for malignant lesions is 10.1 ± 3.7 SD and for solid benign lesions 4.7 ± 4.3 SD (p value 0.001). The mean shear wave elasticity ratio for malignant lesions is 10.6 ± 5.4 SD and for benign (solid and cystic) lesions 3.6 ± 4.2 SD. Using ROC curve and Youden index, the difference in diagnostic performance between ES, SR and SWER was not significant in differentiation between benign and malignant breast lesions and also was non-significant difference when comparing them with conventional US alone. Conclusion ES, SR, and SWER have a high diagnostic performance in differentiating malignant from benign breast lesions with no statistically significant difference between them.

US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography

2020 ◽  
Author(s):  
Vito Cantisani ◽  
Emanuele David ◽  
Richard G. Barr ◽  
Maija Radzina ◽  
Valeria de Soccio ◽  
...  
Keyword(s):  
Shear Wave ◽  
Diagnostic Performance ◽  
Color Doppler ◽  
Shear Wave Elastography ◽  
Strain Ratio ◽  
Breast Lesions ◽  
Strain Elastography ◽  
Prospective Comparison ◽  
Malignant Breast ◽  
Sensitivity Specificity

Abstract Purpose To evaluate the diagnostic performance of strain elastography (SE) and 2 D shear wave elastography (SWE) and SE/SWE combination in comparison with conventional multiparametric ultrasound (US) with respect to improving BI-RADS classification results and differentiating benign and malignant breast lesions using a qualitative and quantitative assessment. Materials and Methods In this prospective study, 130 histologically proven breast masses were evaluated with baseline US, color Doppler ultrasound (CDUS), SE and SWE (Toshiba Aplio 500 with a 7–15 MHz wide-band linear transducer). Each lesion was classified according to the BIRADS lexicon by evaluating the size, the B-mode and color Doppler features, the SE qualitative (point color scale) and SE semi-quantitative (strain ratio) methods, and quantitative SWE. Histological results were compared with BIRADS, strain ratio (SR) and shear wave elastography (SWE) all performed by one investigator blinded to the clinical examination and mammographic results at the time of the US examination. The area under the ROC curve (AUC) was calculated to evaluate the diagnostic performance of B-mode US, SE, SWE, and their combination. Results Histological examination revealed 47 benign and 83 malignant breast lesions. The accuracy of SR was statistically significantly higher than SWE (sensitivity, specificity and AUC were 89.2 %, 76.6 % and 0.83 for SR and 72.3 %, 66.0 % and 0.69 for SWE, respectively, p = 0.003) but not higher than B-mode US (B-mode US sensitivity, specificity and AUC were 85.5 %, 78.8 %, 0.821, respectively, p = 1.000). Conclusion Our experience suggests that conventional US in combination with both SE and SWE is a valid tool that can be useful in the clinical setting, can improve BIRADS category assessment and may help in the differentiation of benign from malignant breast lesions, with SE having higher accuracy than SWE.

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

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.

scholarly journals Study of clinical, imaging and pathological assessment of breast lumps: an observational study

2020 ◽  
Vol 7 (5) ◽  
pp. 1452
Author(s):  
Sumedha Laul ◽  
Divish Saxena ◽  
Nitin Wasnik
Keyword(s):  
Final Diagnosis ◽  
Needle Aspiration ◽  
Age Group ◽  
Breast Lump ◽  
Aspiration Cytology ◽  
Malignant Breast ◽  
Palpable Breast ◽  
Needle Aspiration Cytology ◽  
Breast Lumps

Background: A palpable lump in a woman’s breast could be benign or malignant and it requires prompt evaluation to confirm or exclude cancer. This study aims to establish the correlation between clinical and radiological parameters for provisional diagnosis of breast lumps and the role of histopathology for final diagnosis of these breast lumps.Methods: Total 275 female patients with palpable breast lumps were included in the study, where a detailed history was recorded and clinical examination was done. All patients underwent ultrasonography of the breast along with fine needle aspiration cytology or histopathology, wherever indicated.Results: Benign breast lumps were found more commonly in 18-30 years of age group whereas malignant breast lumps were seen more commonly in the 41-60 years age group and the incidence increased with age. Fixity to skin was present in 5.1% and fixity to chest wall was present in 5.8% respectively, and all of these cases turned out to be malignant.Conclusions: Attributing factors for suspicion of malignant lumps are advanced age, fixity to surrounding structures, presence of ulceration and peau’d orange breast skin appearance. Although for confirmation of malignancy from a suspected breast lump requires either cytology or histopathology of the excised specimen.

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

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.

scholarly journals Role of triple assessment modalities in diagnosis of palpable breast lump

2018 ◽  
Vol 6 (10) ◽  
pp. 3435
Author(s):  
Ashwinkumar S. Gadhvi ◽  
Udit I. Gadhvi ◽  
Dhaval A. Bhimani ◽  
Darshil K. Rajgor
Keyword(s):  
Benign Lesion ◽  
Malignant Lesion ◽  
Breast Disease ◽  
Breast Lump ◽  
Size Number ◽  
Life Saving ◽  
Triple Assessment ◽  
Palpable Breast ◽  
Sensitivity Specificity

Background: One fourth of women suffer from breast disease in their lifetime. Carcinoma of breast is the second most common cancer in the world. Timely and accurate diagnosis of breast lump with early intervention can be life saving. There are various modalities for the diagnosis of breast lump such as USG, FNAC and Mammography, MRI etc. but none of them is perfect. There are numerous reports suggesting that if the results of clinical assessment, mammography and FNAC are all combined, the diagnostic accuracy is nearly 100%. Furthermore, these techniques also provide information about tumor size, number, extent and grade preoperatively.Methods: Study was randomized, prospective, observational and longitudinal including 100 patients, selected according to inclusion criteria.Results: The sensitivity, specificity and accuracy of triple test in present study were 98.68%, 87.5%, and 96% respectively. Out of 100, 76 patients were confirmed as having benign lesion and 24 patients having malignant lesion by histopathology examination.Conclusions: Results of triple assessment are same as the results by histopathology examination in majority of cases. It is highly accurate, can be used as a confirmatory diagnostic tool for breast lump, thus there is no need to perform diagnostic open biopsy for breast lump.

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