Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions.
Purpose
To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women.
Material and Methods
Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors.
Results
Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography (P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography (P = 0.390).
Conclusion
In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.
YoukJHKimEK. Supplementary screening sonography in mammographically dense breast: pros and cons. Korean J Radiol2010; 11: 589–593.
2.
GreenbergJSJavittMCKatzenJet al.Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. Am J Roentgenol2014; 203: 687–693.
3.
American College of Radiology, BI-RADS Committee. ACR BI-RADS breast imaging and reporting data system: breast imaging atlas, Reston, VA: American College of Radiology, 2003.
4.
D’OrsiCSicklesEMendelsonEet al.ACR BI-RADS Atlas, Breast Imaging Reporting and Data System, Reston, VA: American College of Radiology, 2013.
5.
LazarusEMainieroMBScheppsBet al.BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology2006; 239: 385–391.
6.
TanSMTehHSMancerJFet al.Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography–a clinical approach. Breast2008; 17: 252–257.
7.
ChoNLimJMoonWK. Usefulness of ultrasound elastography in reducing the number of Breast Imaging Reporting and Data System category 3 lesions on ultrasonography. Ultrasonography2014; 33: 98–104.
8.
WojcinskiSFarrokhAWeberSet al.Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS(R)-US classification system with sonoelastography. Ultraschall Med2010; 31: 484–491.
9.
LeeJHKimSHKangBJet al.Role and clinical usefulness of elastography in small breast masses. Acad Radiol2011; 18: 74–80.
10.
IkedaKOgawaYTakiiMet al.A role for elastography in the diagnosis of breast lesions by measuring the maximum fat lesion ratio (max-FLR) by tissue Doppler imaging. Breast Cancer2012; 19: 71–76.
11.
ChoNMoonWKParkJSet al.Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol2008; 9: 111–118.
12.
YoukJHSonEJGweonHMet al.Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments. Ultrasound Med Biol2014; 40: 2336–2344.
13.
AuFWGhaiSMoshonovHet al.Diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses: determination of the most discriminatory parameter. Am J Roentgenol2014; 203: W328–336.
14.
LiuDHuangYTianDet al.Value of sonographic bidirectional arterial flow combined with elastography for diagnosis of breast imaging reporting and data system category 4 breast masses. J Ultrasound Med2015; 34: 759–766.
15.
LeeSHChangJMKimWHet al.Added value of shear-wave elastography for evaluation of breast masses detected with screening US imaging. Radiology2014; 273: 61–69.
16.
KoKHJungHKKimSJet al.Potential role of shear-wave ultrasound elastography for the differential diagnosis of breast non-mass lesions: preliminary report. Eur Radiol2014; 24: 305–311.
17.
KimSJKoEYShinJHet al.Application of sonographic BI-RADS to synchronous breast nodules detected in patients with breast cancer. Am J Roentgenol2008; 191: 653–658.
18.
KimEKKoKHOhKKet al.Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography. Am J Roentgenol2008; 190: 1209–1215.
19.
NakashimaKShiinaTSakuraiMet al.JSUM ultrasound elastography practice guidelines: breast. J Med Ultrason (2001)2013; 40: 359–391.
20.
BarrRGNakashimaKAmyDet al.WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast. Ultrasound Med Biol2015; 41: 1148–1160.
21.
ItohAUenoETohnoEet al.Breast disease: clinical application of US elastography for diagnosis. Radiology2006; 239: 341–350.
22.
HooleyRJGreenbergKLStackhouseRMet al.Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology2012; 265: 59–69.
23.
BergWAZhangZLehrerDet al.Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA2012; 307: 1394–1404.
24.
WeigertJSteenbergenS. The Connecticut experiment: the role of ultrasound in the screening of women with dense breasts. Breast Journal2012; 18: 517–522.
25.
NelsonHDPappasMCantorAet al.Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force Recommendation. Ann Int Med2016; 164: 256–267.
26.
BergWABandosAIMendelsonEBet al.Ultrasound as the primary screening test for breast cancer: analysis from ACRIN 6666. J Natl Cancer Inst2016; 108: djv367–djv367.
27.
MoonHJJungIParkSJet al.Comparison of cancer yields and diagnostic performance of screening mammography vs. supplemental screening ultrasound in 4394 women with average risk for breast cancer. Ultraschall Med2015; 36: 255–263.
28.
BergWABlumeJDCormackJBet al.Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA2008; 299: 2151–2163.
29.
HamyASGiacchettiSAlbiterMet al.BI-RADS categorisation of 2,708 consecutive nonpalpable breast lesions in patients referred to a dedicated breast care unit. Eur Radiol2012; 22: 9–17.
30.
BarrRGZhangZCormackJBet al.Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology2013; 269: 701–712.
31.
SohnYMKimMJKwakJYet al.Breast ultrasonography in young Asian women: analyses of BI-RADS final assessment category according to symptoms. Acta Radiol2011; 52: 35–40.
32.
YoonJHKimMJMoonHJet al.Subcategorization of ultrasonographic BI-RADS category 4: positive predictive value and clinical factors affecting it. Ultrasound Med Biol2011; 37: 693–699.
33.
LeeSHChangJMChoNet al.Practice guideline for the performance of breast ultrasound elastography. Ultrasonography2014; 33: 3–10.
34.
HowellAAndersonASClarkeRBet al.Risk determination and prevention of breast cancer. Breast Cancer Res2014; 16: 446–446.
35.
AntoniouACCunninghamAPPetoJet al.The BOADICEA model of genetic susceptibility to breast and ovarian cancers: updates and extensions. Br J Cancer2008; 98: 1457–1466.
36.
EvansDGRHowellA. Breast cancer risk-assessment models. Breast Cancer Res2007; 9: 213–213.
