Details
Category: Volume 05 Issue 12 December 2017
Hits: 1419

Title: Differentiation of Solid Breast Masses into Benign and Malignant by Using Gray Scale Ultrasonography and Strain Elastography

Authors: Anjali Pravinkumar Wasadikar, Manoj Baburao Jadhav, Varsha Jagannath Rote-Kaginalkar, Pravinkumar Prabhakar Wasadikar, Pankaj Satyanarayan Jha

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.38

Abstract

Objectives: The purpose of this study was to evaluate diagnostic performance of grayscale ultrasonography and strain elastography in distinguishing between benign and malignant solid breast masses, with cytological and histopathological results as reference standard.

Materials and Methods: Total 100 solid palpable breast masses in 100 women with mean age 38.95 years were studied using BI-RADS (Breast Imaging Recording and Data System) lexicon and strain ratio (SR) in the same settings and categorized into benign and malignant groups. Comparative analysis of sonographic parameters and strain ratio was done with cytological and histopathological diagnosis. Statistical analysis included sensitivity, specificity, and positive and negative predictive values for both gray scale ultrasonography and strain ratio.

Results: Cytological and histopathological diagnosis revealed 62 benign and 38 malignant lesions.  Gray scale ultrasonography had sensitivity of 92.11%, specificity of 83.87%, positive predictive value of 77.78 % and negative predictive value of 94.55 %.  For strain ratio, the mean ± standard deviation was6.16±2.92 for malignant lesions and 2.41±1.65 for benign lesions (p <0.001).  By using best cut-off of 3 between benign and malignant, sensitivity of 89.47%, specificity of 85.48%, positive predictive value of 79.07%, and negative predictive value of 92.98% obtained for strain ratio.

Conclusion: By combining gray scale ultrasonography and strain elastography the number of false results can be reduced with increase in overall yield of examination and subsequent reduction of unnecessary biopsies.

Keywords: Breast; Gray scale ultrasonography; Strain ratio; Neoplasm

References

  1. Dumitrescu R, Cotarla I. Understanding breast cancer risk-where do we stand in 2005? J cellular and molecular medicine 2005; 9:208-221
  2. Yi A, Cho N, Chang JM, Koo HR, La Yun B, Moon WK. Sonoelastography for 1,786 nonpalpable breast masses: diagnostic value in the decision to biopsy. Eur Radiol 2012; 22:1033-1040
  3. Schaefer FK, Heer I, Schaefer PJ, Mundhenke C, Osterholz S, Order BM, et al. Breast ultrasound elastography: results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol 2011; 77:450-456
  4. Scaperrotta G, Ferranti C, Costa C, Mariani L, Marchesini M, Suman L, et al. Role of sonoelastography in non-palpable breast lesions. Eur Radiol 2008; 18:2381-2389
  5. American College of Radiology. Breast imaging reporting and data system ultrasound. In: American College of Radiology,ed. Breast imaging reporting and data system, 4th ed. Reston,VA: American College of Radiology, 2003
  6. Chao TC, Lo YF, Chen SC, Chen MF. Prospective sonographic study of 3093 breast tumors. J Ultrasound Med 1999; 18:363-370
  7. Zhi H, Ou B, Luo B.M, Feng X, Wen Y.L, Yang H.Y. Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions. J Ultrasound Med 2007; 26:807-815
  8. McNicholas MM, Mercer PM, Miller JC, McDermott EW, O'Higgins NJ, MacErlean DP. Color Doppler sonography in the evaluation of palpable breast masses. AJR Am J Roentgenol 1993; 161:765-771
  9. Choi HY, Kim HY, Baek SY, Kang BC, Lee SW. Significance of resistive index in color Doppler ultrasonogram: differentiation between benign and malignant breast masses. Clin Imaging 1999; 23:284-288
  10. 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; 196:123-134
  11. Hong AS, Rosen EL, Soo MS, Baker JA. BI-RADS for Sonography: Positive and negative predictive values of sonographic features. AJR 2005; 184:1260-1265
  12. Melania C, Paolo B, Roberta L, Gianluca F, Antonino M, Lorenzo B. Characterization of solid breast masses and use of the sonographic Breast Imaging Reporting and Data System Lexicon. J Ultrasound Med 2006; 25:649-659
  13. Mary SS, Jay AB,d Eric LR . Sonographic Detection and Sonographically Guided Biopsy of Breast Microcalcifications’ Breast Imaging. AJR 2003;180: 941-948
  14. Tardivon A, El Khoury C, Thibault F, Wyler A, Barreau B, Neuenschwander S. Elastography of the breast: a prospective study of 122 lesions. J Radiol ;2007; 88: 657-662
  15. Cho N, Moon WK, Kim HY, Chang JM, Park SH, Lyou CY. Sonoelastographic strain index for differentiation of benign and malignant nonpalpable breast masses. J Ultrasound Med. 2010; 29:1-7
  16. Zhao QL, Ruan LT, Zhang H, Yin YM, Duan SX. Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method. Eur J Radiol. 2012; 81:3245-3249
  17. Gheonea IA, Stoica Z, Bondari S. Differential diagnosis of breast lesions using ultrasound elastography. Indian J Radiol Imaging 2011; 21:301-305
  18. Hiltawsky KM, Kruger M, Starke C, Heuser L, Ermert H, Jensen A. Freehand ultrasound elastography of breast lesions: clinical results. Ultrasound Med Biol 2001; 27: 1461–1469
  19. Hui Zhi, Bing Ou, Bao-Ming Luo, Xia Feng, Yan-Ling Wen, Hai-Yun Yang, Comparison of Ultrasound Elastography, Mammography, and Sonography in the Diagnosis of Solid Breast Lesions. J Ultrasound Med 2007; 26:807– 815
  20. Redling K, Schwab F, Siebert M, Schötzau A, Zanetti-Dällenbach R. Elastography Complements Ultrasound as Principle Modality in Breast Lesion Assessment. Gynecol Obstet Invest 2017; 82:119-124

Corresponding Author

Dr Anjali Pravinkumar Wasadikar

39, Ulkanagari, Near Omprakash Mandir, Garkheda area, Aurangabad, Maharashtra -431001, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.   Phone: +919767400925