Importance of Superb Microvascular Imaging in Differentiation of Malignant Breast Lesions From Benign 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.

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Section Discrepancy and Diagnostic Performance of Breast Lesions in Two-dimensional Ultrasound by Dynamic Videos versus Static Images

BIO Integration ◽

10.15212/bioi-2021-0021 ◽

2021 ◽

Author(s):

Dinghong Yang ◽

Xiaoyun Xiao ◽

Haohu Wang ◽

Huan Wu ◽

Wei Qin ◽

...

Keyword(s):

Breast Imaging ◽

Diagnostic Performance ◽

Architectural Distortion ◽

Breast Lesions ◽

Two Dimensional ◽

Benign Lesions ◽

Static Image ◽

Malignant Breast ◽

Static Images ◽

Malignant Lesions

Background: Benign or malignant breast lesions with typical ultrasonic characteristics could be easily and correctly diagnosed with two-dimensional ultrasound (2D US). However, diagnosis of atypical lesions remains a challenge. Most atypical lesions have different ultrasonographic features with probe direction variation. Thus, the interpretation of ultrasonographic features based on static images empirically collected by sonographers might be inaccurate. We aimed to investigate the section discrepancy and diagnostic performance of breast lesions in 2D US by dynamic videos versus static images.Methods: Static images and dynamic videos based on two perpendicular planes of 468 breast lesions were collected and evaluated. The Breast Imaging and Reporting Data System (BI-RADS®) US lexicon was used. Category 3 was used as the cut-off point, and section discrepancy was defined as two perpendicular planes showing different BI-RADS categories (3 versus 4A, 4B, 4C, and 5).Results: This retrospective study included 315 benign and 153 malignant lesions. There were 53 and 50 lesions with section discrepancy during static and dynamic observations, respectively. The proportion of benign lesions with section discrepancy was significantly higher than that of malignant lesions (P < 0.05) either in dynamic or static observation, and the contingency coefficient was 0.2 between section discrepancy and histopathology. Duct changes were more clearly depicted in dynamic videos than in static images (P < 0.05) both in malignant and benign lesions. Calcification and architectural distortion were more sensitively detected by dynamic videos than with static images (P < 0.05) in malignant lesions. The interpretation of “margin” significantly differed in benign lesions between static images and dynamic videos (P < 0.05). The areas under the curve of static image-horizontal, static image-sagittal, dynamic video-horizontal, and dynamic video-sagittal were 0.807, 0.820, 0.837, and 0.846, respectively. The specificities of dynamic videos were higher than those of static images (P < 0.05).Conclusion: Breast lesions have section discrepancy in 2D US. Observations based on dynamic videos could more accurately reflect lesion features and increase the specificity of US in the differentiation of atypical breast lesions.

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Superb Microvascular Imaging Technology Can Improve the Diagnostic Efficiency of the BI-RADS System

Frontiers in Oncology ◽

10.3389/fonc.2021.634752 ◽

2021 ◽

Vol 11 ◽

Author(s):

Siman Cai ◽

Hongyan Wang ◽

Xiaoyan Zhang ◽

Li Zhang ◽

Qingli Zhu ◽

...

Keyword(s):

Diagnostic Sensitivity ◽

Breast Lesions ◽

Diagnostic Efficiency ◽

Training Set ◽

Diagnostic Efficacy ◽

Conventional Ultrasound ◽

Superb Microvascular Imaging ◽

Malignant Lesions ◽

Sensitivity Specificity ◽

Microvascular Imaging

BackgroundTo explore whether superb microvascular imaging (SMI)SMI can improve the diagnostic efficiency by evaluating the vascular index (VI) and vascular architecture (VA) in breast lesions.MethodsThis is a retrospective study of data collected prospectively for research use. Taking 225 consecutive cases of breast lesions from November 2016 to December 2017 as a training set, the VI values and VA types of benign and malignant lesions were calculated based on the pathological results. Taking 238 consecutive cases of breast lesions from January 2018 to October 2018 as the verification set, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated to compare the diagnostic efficacy.ResultsThe training set included 225 breast lesions and the validation set 238 breast lesions. The VI value in the malignant group (10.3 ± 8.0) was significantly higher than that in the benign group (4.3 ± 5.0)(P<0.001). A VI value of 4.05 was used as the diagnostic threshold for differentiating benign from malignant lesions, with a sensitivity of 80.5%, a specificity of 61.9%, an accuracy of 71.1%, a PPV of 62.9%, a NPV of 76.9%, and an area under the curve of 0.758 (0.696-0.819). There was a significant difference in the types of benign and malignant VA (P < 0.001), and the PPV of the root hair-like and crab claw-like VAs were 93.9% and 100.0%, respectively. The diagnostic sensitivity, specificity, accuracy, PPV, NPV and area under the AUC curve were 58.0%, 98.2%, 97.0%, 70.3% and 0.781, respectively (95%CI: 0.719-0.844). SMI combined with conventional ultrasound improved the diagnostic specificity (70.0% vs. 90.0%), accuracy (87.4% vs. 96.6%), and PPV (82.5% vs. 93.2%) without decreasing the diagnostic sensitivity (99.3%), yielded higher diagnostic performance with the area under the ROC curve was 0.941 (95%CI: 0904-0.979) compared with conventional US alone (P < 0.001).ConclusionA VI value 4.05 is a cut-off value with good diagnostic efficacy. The residual root-like and crab claw-like VAs are the characteristic VAs of malignant lesions. Conventional ultrasound combined with the VI and VA can improve the diagnostic specificity, accuracy and PPV without reducing the diagnostic sensitivity.

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Ultrasound elastography evaluation of breast masses with FNAC and/or histopathological correlation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184903 ◽

2018 ◽

Vol 6 (12) ◽

pp. 4034 ◽

Cited By ~ 1

Author(s):

Shyam Chhadi ◽

Tulsi Chhadi ◽

Kamlesh Bagde

Keyword(s):

Sensitivity And Specificity ◽

Pearson Correlation ◽

Area Under The Curve ◽

Ultrasound Elastography ◽

Breast Lesions ◽

Benign Lesions ◽

Breast Masses ◽

Histopathological Correlation ◽

Malignant Breast ◽

Palpable Breast

Background: Breast cancer is the most frequently diagnosed cancer amongst women worldwide. Ultrasound elastography is a non-invasive method for determining tissue mechanical properties and seems to be compensating for the deficiencies of conventional USG. We aimed to evaluate the sensitivity and specificity of ultrasound elastography in detection and characterization of various breast masses and study its role in differentiating benign and malignant breast masses with FNAC and/or histopathological correlation.Methods: A total of 126 patients with breast lesions confirmed on USG were enrolled for the study, out of which 10 were lost to follow-up and excluded. Consecutive patients presenting with palpable breast lesions were assessed with conventional B-mode USG. Those confirmed to have breast lesion were then assessed with Strain Elastography (SE). FNAC was used for histopathological confirmation of malignant lesions. The benign lesions were diagnosed by a combination of FNAC and biopsy and were followed up for 6 months.Results: There were 56 (48.3%) malignant and 60 (51.7%) benign lesions. A sensitivity of 83.9% and a specificity of 91.7% was obtained for elasticity score when cut-off value of 3.5 was used (area under the curve- 0.924, 95% CI- 0.869 to 0.979, p-0.0001). Sensitivity of 91.1% and specificity of 88.3% was obtained for SR scores, when a cut off of 2.94 was used (area under the curve- 0.969, 95% CI- 0.943-0.995, p-0.0001). The Pearson correlation coefficient for elasticity scores and SR values was 0.936, indicating very good agreement (correlation) between the two methods.Conclusions: Ultrasound elastography is a simple and rapid method that can improve the sensitivity and specificity of USG and can decrease the rate of unnecessary biopsies.

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Immunohistochemical Expression of p63 in Benign and Malignant Breast Lesions

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48358.15526 ◽

2021 ◽

Author(s):

Abhishek Saini ◽

Swaran Kaur Saluja ◽

MK Garg ◽

Deepti Agarwal ◽

Amrita Kulhria ◽

...

Keyword(s):

Breast Cancer ◽

Myoepithelial Cells ◽

Normal Breast ◽

High Morbidity ◽

Breast Lesions ◽

Benign Lesions ◽

Medical College ◽

Malignant Breast ◽

Malignant Lesions

Introduction: Breast carcinoma demands attention as it causes high morbidity and mortality. It is important to recognise benign lesions to distinguish them from in situ and invasive breast cancer and to assess a patient’s risk of developing breast cancer, so that the most appropriate treatment modality for each case can be established. The p63 has been characterised as a reliable marker of myoepithelial cells of lactiferous duct. It is exclusively expressed in myoepithelial cells of normal breast tissue. Hence, p63 can be of great help in the differential diagnosis involving benign lesions. Also, p63 may aid in distinguishing benign from malignant lesions. Aim: To study the Immunohistochemistry (IHC) expression of p63 in benign and malignant breast lesions. Materials and Methods: The prospective study was conducted on 76 breast specimens for a period of one year, from 1st December 2018 to 30th November 2019 in the Department of Pathology, Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India. IHC assessment for p63 nuclear protein was performed. The intensity of p63 expression was evaluated as continuous positive, discontinuous positive and negative. The extent was scored on the basis of percentage of positive cells and assigned a score of negative (0%), 1 (<25%), 2 (26-90%) and 3 (91-100%). Results: Out of 76 cases, 38 cases were diagnosed as benign and 38 cases as malignant. IHC staining with p63 showed nuclear positivity in all benign lesions. Among malignant lesions, four were positive and 34 were negative. Conclusion: According to the above results, p63 is a very useful IHC marker in diagnosing difficult cases, cases of carcinoma in situ, borderline cases and cases with inconclusive histomorphological diagnosis.

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