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. 2020 Sep 5;29(2):89-93.
doi: 10.4103/JMU.JMU_32_20. eCollection 2021 Apr-Jun.

Utility of Ultrasound Strain Elastography to Differentiate Benign from Malignant Lesions of the Breast

Vikrant Kanagaraju  1 , B Dhivya  1 , B Devanand  1 , V Maheswaran  1
Affiliations

Utility of Ultrasound Strain Elastography to Differentiate Benign from Malignant Lesions of the Breast

Vikrant Kanagaraju et al. J Med Ultrasound. .

Abstract

Background: The purpose of this study was to determine the utility and diagnostic performance of strain elastography (SE) in differentiating benign from malignant lesions of the breast.

Methods: In this prospective study, 50 palpable breast masses in 50 patients were examined by mammography, B-mode ultrasound (US) and SE. Lesions were categorized using Breast Imaging Reporting and Data System (BIRADS) scoring based on mammographic and sonographic features. Elasticity scores were assessed on a five-point scale based on the distribution of strain, and the lesion size on SE imaging and B-mode (elasticity imaging/B mode [EI/B] ratio) was compared. Findings were correlated with the BIRADS assessment and diagnostic performance of sonoelastography was evaluated taking histopathology as reference standard.

Results: Histopathology revealed 29 (58%) malignant and 21 (42%) benign lesions. Infiltrative ductal carcinoma and fibroadenoma were the most common malignant and benign lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE was 100%, 76.1%, 85.2%, 100%, and 90%, respectively. Higher elasticity score was significantly associated with malignant histopathology (P < 0.00001). The mean EI/B ratio for malignant lesions was 1.36 ± 0.24 while that of benign lesions was 1.03 ± 0.30 (P = 0.000).

Conclusion: Real-time SE of the breast, with its superior sensitivity and specificity, could provide improved characterization of benign and malignant breast masses compared with mammography and conventional US. Due to greater diagnostic accuracy, SE can be an effective adjunctive tool to B-mode US in predicting malignancy of breast, as well as in reducing the need for biopsies in benign breast lesions.

Keywords: Breast; elasticity imaging technique; sonoelastography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) B-mode ultrasound showing ill-defined hypoechoic lesion which was categorized as Breast Imaging Reporting and Data System category 4. (b) With strain elastography, entire hypoechoic lesion is deformable and evenly shaded green as surrounding breast tissue, corresponding to elasticity score 1. Histopathology was suggestive of nonspecific mastitis
Figure 2
Figure 2
(a) B-mode ultrasound showing poorly marginated round hypoechoic lesion categorized as Breast Imaging Reporting and Data System category 3. (b) Strain elastographic image showing deformability of the peripheral portion of the lesion with stiff tissue in the center corresponding to elasticity score 3. Histopathology was suggestive of fibroadenoma
Figure 3
Figure 3
(a) B-mode ultrasound showing ill-defined hypoechoic lesion categorized as Breast Imaging Reporting and Data System 4. (b) With strain elastography, entire lesion is stiff, corresponding to elasticity score 4. Histopathology was suggestive of calcified fibroadenoma
Figure 4
Figure 4
(a) B-mode ultrasound showing ill-defined hypoechoic lesion categorized as Breast Imaging Reporting and Data System 5. (b) With strain elastography, entire lesion and surrounding area are stiff, corresponding to elasticity score 5. Histopathology was suggestive of infiltrative ductal carcinoma
See this image and copyright information in PMC

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