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de Carvalho IM, De Matheo LL, Costa Júnior JFS, Borba CDM, von Krüger MA, Infantosi AFC, Pereira WCDA. Polyvinyl chloride plastisol breast phantoms for ultrasound imaging. ULTRASONICS 2016; 70:98-106. [PMID: 27153374 DOI: 10.1016/j.ultras.2016.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 05/11/2023]
Abstract
Ultrasonic phantoms are objects that mimic some features of biological tissues, allowing the study of their interactions with ultrasound (US). In the diagnostic-imaging field, breast phantoms are an important tool for testing performance and optimizing US systems, as well as for training medical professionals. This paper describes the design and manufacture of breast lesions by using polyvinyl chloride plastisol (PVCP) as the base material. Among the materials available for this study, PVCP was shown to be stable, durable, and easy to handle. Furthermore, it is a nontoxic, nonpolluting, and low-cost material. The breast's glandular tissue (image background) was simulated by adding graphite powder with a concentration of 1% to the base material. Mixing PVCP and graphite powder in differing concentrations allows one to simulate lesions with different echogenicity patterns (anechoic, hypoechoic, and hyperechoic). From this mixture, phantom materials were obtained with speed of sound varying from 1379.3 to 1397.9ms(-1) and an attenuation coefficient having values between 0.29 and 0.94dBcm(-1) for a frequency of 1MHz at 24°C. A single layer of carnauba wax was added to the lesion surface in order to evaluate its applicability for imaging. The images of the phantoms were acquired using commercial ultrasound equipment; a specialist rated the images, elaborating diagnoses representative of both benign and malignant lesions. The results indicated that it was possible to easily create a phantom by using low-cost materials, readily available in the market and stable at room temperature, as the basis of ultrasonic phantoms that reproduce the image characteristics of fatty breast tissue and typical lesions of the breast.
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Affiliation(s)
| | - Lucas Lobianco De Matheo
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Cecília de Melo Borba
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco Antonio von Krüger
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Ackermann S, Schoenenberger CA, Zanetti-Dällenbach R. Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions. Ultrasound Int Open 2016; 2:E83-9. [PMID: 27689181 DOI: 10.1055/s-0042-110657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/06/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings could provide additional information that would help determine further diagnostic steps in breast lesions. MATERIALS AND METHODS We conducted a retrospective study by exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimally invasive breast biopsy (MIBB) from January 2002 to December 2011. RESULTS The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%, respectively. In 506 BI-RADS 3 lesions, histology revealed 15 malignancies (2.4% malignancy rate), which corresponds to a false-negative rate (FNR) of 2.6%. Clinical evaluation and patient requests critically influenced the further diagnostic procedure, thereby prevailing over the recommendation given by the BI-RADS 3 classification. CONCLUSION Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures such as short-term follow-up or MIBB in patients with lesions classified as US-BI-RADS 3.
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Affiliation(s)
- S Ackermann
- Gynecology & Obstetrics, Hôpital de Morges, Morges, Switzerland
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Yoon JH, Kim MJ, Lee HS, Kim SH, Youk JH, Jeong SH, Kim YM. Validation of the fifth edition BI-RADS ultrasound lexicon with comparison of fourth and fifth edition diagnostic performance using video clips. Ultrasonography 2016; 35:318-26. [PMID: 27184655 PMCID: PMC5040135 DOI: 10.14366/usg.16010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate the positive predictive value (PPV) and the diagnostic performance of the ultrasonographic descriptors in the fifth edition of BI-RADS, comparing with the fourth edition using video clips. Methods From September 2013 to July 2014, 80 breast masses in 74 women (mean age, 47.5±10.7 years) from five institutions of the Korean Society of Breast Imaging were included. Two radiologists individually reviewed the static and video images and analyzed the images according to the fourth and fifth edition of BI-RADS. The PPV of each descriptor was calculated and diagnostic performances between the fourth and fifth editions were compared. Results Of the 80 breast masses, 51 (63.8%) were benign and 29 (36.2%) were malignant. Suspicious ultrasonographic features such as irregular shape, non-parallel orientation, angular or spiculated margins, and combined posterior features showed higher PPV in both editions (all P<0.05). No significant differences were found in the diagnostic performances between the two editions (all P>0.05). The area under the receiver operating characteristics curve was higher in the fourth edition (0.708 to 0.690), without significance (P=0.416). Conclusion The fifth edition of the BI-RADS ultrasound lexicon showed comparable performance to the fourth edition and can be useful in the differential diagnosis of breast masses using ultrasonography.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostastistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Hye Jeong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Masumoto N, Kadoya T, Amioka A, Kajitani K, Shigematsu H, Emi A, Matsuura K, Arihiro K, Okada M. Evaluation of Malignancy Grade of Breast Cancer Using Perflubutane-Enhanced Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1049-1057. [PMID: 26895755 DOI: 10.1016/j.ultrasmedbio.2015.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/13/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Whether the contrast effects of perflubutane on contrast-enhanced ultrasonography can predict the malignancy grade of breast cancer is unknown. We analyzed associations between perfusion parameters created from time-intensity curves based on enhancement intensity and temporal changes in contrast-enhanced ultrasonography and clinicopathologic factors in 100 consecutive patients with invasive breast cancer. Values of perfusion parameters were significantly greater in estrogen receptor-negative than -positive tumors (peak intensity, p = 0.0002; ascending slope, p = 0.006; area under the curve, p = 0.0006). Variations in the peak intensity of Ki-67 were significantly correlated in all tumors (r = 0.54, p < 0.0001) and in luminal (r = 0.43, p = 0.0002), human epidermal growth factor receptor type 2-positive (r = 0.47, p = 0.047) and triple-negative (r = 0.55, p = 0.043) tumors. Perfusion parameters on contrast-enhanced ultrasonography can provide excellent predictive value for high-grade malignancy and might help to determine appropriate therapeutic strategies.
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Affiliation(s)
- Norio Masumoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ai Amioka
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keiko Kajitani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hideo Shigematsu
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akiko Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Matsuura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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The Japanese Breast Cancer Society clinical practice guidelines for screening and imaging diagnosis of breast cancer, 2015 edition. Breast Cancer 2016; 23:357-66. [PMID: 27052720 DOI: 10.1007/s12282-016-0674-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/11/2015] [Indexed: 12/21/2022]
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Shan J, Alam SK, Garra B, Zhang Y, Ahmed T. Computer-Aided Diagnosis for Breast Ultrasound Using Computerized BI-RADS Features and Machine Learning Methods. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:980-8. [PMID: 26806441 DOI: 10.1016/j.ultrasmedbio.2015.11.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 05/18/2023]
Abstract
This work identifies effective computable features from the Breast Imaging Reporting and Data System (BI-RADS), to develop a computer-aided diagnosis (CAD) system for breast ultrasound. Computerized features corresponding to ultrasound BI-RADs categories were designed and tested using a database of 283 pathology-proven benign and malignant lesions. Features were selected based on classification performance using a "bottom-up" approach for different machine learning methods, including decision tree, artificial neural network, random forest and support vector machine. Using 10-fold cross-validation on the database of 283 cases, the highest area under the receiver operating characteristic (ROC) curve (AUC) was 0.84 from a support vector machine with 77.7% overall accuracy; the highest overall accuracy, 78.5%, was from a random forest with the AUC 0.83. Lesion margin and orientation were optimum features common to all of the different machine learning methods. These features can be used in CAD systems to help distinguish benign from worrisome lesions.
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Affiliation(s)
- Juan Shan
- Department of Computer Science, Seidenberg School of Computer Science and Information Systems, Pace University, New York, New York, USA.
| | - S Kaisar Alam
- Improlabs Pte Ltd, Valley Point, Singapore; Computational Biomedicine Imaging and Modeling Center (CBIM), Rutgers University, Piscataway, New Jersey, USA; Department of Electrical & Electronic Engineering, Islamic University of Technology, Gazipur, Bangladesh
| | - Brian Garra
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA; Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Yingtao Zhang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Tahira Ahmed
- Washington DC Veterans Affairs Medical Center, Washington, DC, USA
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Should the hyperechogenic halo around malignant breast lesions be included in the measurement of tumor size? Breast Cancer Res Treat 2016; 156:311-7. [DOI: 10.1007/s10549-016-3758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 11/25/2022]
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Elverici E, Barça AN, Aktaş H, Özsoy A, Zengin B, Çavuşoğlu M, Araz L. Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol 2016; 21:189-94. [PMID: 25835079 DOI: 10.5152/dir.2014.14103] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to evaluate ultrasonography (US) findings for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions using BI-RADS US lexicon and determine the positive and negative predictive values (PPV and NPV) of US with respect to biopsy results. METHODS Sonograms of 186 BI-RADS 4 nonpalpable breast lesions with a known diagnosis were reviewed retrospectively. The morphologic features of all lesions were described using BI-RADS lexicon and the lesions were subcategorized into 4A, 4B, and 4C on the basis of the physician's level of suspicion. Lesion descriptors and biopsy results were correlated. Pathologic results were compared with US features. PPVs of BI-RADS subcategories 4A, 4B, and 4C were calculated. RESULTS Of 186 lesions, 38.7% were malignant and 61.2% were benign. PPVs according to subcategories 4A, 4B, and 4C were 19.5%, 41.5%, and 74.3%, respectively. Microlobulated, indistinct, and angular margins, posterior acoustic features, and echo pattern were nonspecific signs for nonpalpable BI-RADS 4 lesions. Typical signs of malignancy were irregular shape (PPV, 66%), spiculated margin (PPV, 80%) and nonparallel orientation (PPV, 58.9%). Typical signs of benign lesions were oval shape (NPV, 77.1%), circumscribed margin (NPV, 67.5%), parallel orientation (NPV, 70%), and abrupt interface (NPV, 67.6%). CONCLUSION BI-RADS criteria are not sufficient for discriminating between malignant and benign lesions, and biopsy is required. Subcategories 4A, 4B, and 4C are useful in predicting the likelihood of malignancy. However, objective and clear subclassification rules are needed.
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Affiliation(s)
- Eda Elverici
- Department of Radiology, Numune Training and Research Hospital, Ankara, Turkey.
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Lee YJ, Choi SY, Kim KS, Yang PS. Variability in Observer Performance Between Faculty Members and Residents Using Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, Fifth Edition (2013). IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e28281. [PMID: 27853492 PMCID: PMC5106650 DOI: 10.5812/iranjradiol.28281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/07/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Abstract
Background Ultrasonography (US) is a useful tool for breast imaging, yet is highly operator-dependent. Objectives We evaluated inter-observer variability and performance discrepancies between faculty members and radiology residents when describing breast lesions, by the fifth edition of breast imaging reporting and data system (BI-RADS)-US lexicon, and then attempted to identify whether inter-observer variability could be improved after one education session. Patients and Methods In total, 50 malignant lesions and 70 benign lesions were considered in our retrospective study. Two faculty members, two senior residents, and two junior residents separately assessed the US images. After the first assessment, the readers received one education session, and then reassessed the images in a random order. Inter-observer variability was measured using the kappa coefficient (κ). Performance discrepancy was evaluated by receiver operating characteristic (ROC) curves. Results For the faculty members, fair-to-good agreement was obtained in all descriptors and final assessment, while for residents, poor-to-moderate agreement was obtained. The areas under the ROC curves were 0.78 for the faculty members, 0.59 for the senior residents, and 0.52 for the junior residents, respectively. Diagnostic performance was significantly higher in the faculty members than the senior and junior residents (P = 0.0001 and < 0.0001, respectively). After one education session, the agreement in the final assessment was one level higher in the faculty members and senior residents, yet in the senior residents, the degree of agreement was still only fair. Moreover, in the junior residents, there was no improvement. Conclusion Investigative assessment of breast US by residents is inadvisable. We recommend continued professional resident training to improve the degree of agreement and performance.
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Affiliation(s)
- Youn Joo Lee
- Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - So Young Choi
- Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kyu Sun Kim
- Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea
| | - Po Song Yang
- Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
- Corresponding author: Po Song Yang, Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea. Tel: +82-422209700, Fax: +82-422209087, E-mail:
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Sudarshan VK, Mookiah MRK, Acharya UR, Chandran V, Molinari F, Fujita H, Ng KH. Application of wavelet techniques for cancer diagnosis using ultrasound images: A Review. Comput Biol Med 2015; 69:97-111. [PMID: 26761591 DOI: 10.1016/j.compbiomed.2015.12.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/12/2015] [Accepted: 12/11/2015] [Indexed: 02/01/2023]
Abstract
Ultrasound is an important and low cost imaging modality used to study the internal organs of human body and blood flow through blood vessels. It uses high frequency sound waves to acquire images of internal organs. It is used to screen normal, benign and malignant tissues of various organs. Healthy and malignant tissues generate different echoes for ultrasound. Hence, it provides useful information about the potential tumor tissues that can be analyzed for diagnostic purposes before therapeutic procedures. Ultrasound images are affected with speckle noise due to an air gap between the transducer probe and the body. The challenge is to design and develop robust image preprocessing, segmentation and feature extraction algorithms to locate the tumor region and to extract subtle information from isolated tumor region for diagnosis. This information can be revealed using a scale space technique such as the Discrete Wavelet Transform (DWT). It decomposes an image into images at different scales using low pass and high pass filters. These filters help to identify the detail or sudden changes in intensity in the image. These changes are reflected in the wavelet coefficients. Various texture, statistical and image based features can be extracted from these coefficients. The extracted features are subjected to statistical analysis to identify the significant features to discriminate normal and malignant ultrasound images using supervised classifiers. This paper presents a review of wavelet techniques used for preprocessing, segmentation and feature extraction of breast, thyroid, ovarian and prostate cancer using ultrasound images.
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Affiliation(s)
- Vidya K Sudarshan
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, 599489, Singapore
| | | | - U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, 599489, Singapore; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Malaysia; Department of Biomedical Engineering, School of Science and Technology, SIM University, 599491, Singapore
| | - Vinod Chandran
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane QLD 4000, Australia
| | - Filippo Molinari
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - Hamido Fujita
- Faculty of Software and Information Science, Iwate Prefectural University (IPU), Iwate 020-0693, Japan
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Malaysia
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Kim SY, Park JS, Koo HR. Combined Use of Ultrasound Elastography and B-Mode Sonography for Differentiation of Benign and Malignant Circumscribed Breast Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1951-1959. [PMID: 26384609 DOI: 10.7863/ultra.14.11027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/04/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of combined B-mode sonography and ultrasound elastography for differentiation between benign and malignant breast masses with circumscribed margins. METHODS We analyzed 109 pathologically proven circumscribed breast masses. Two radiologists retrospectively reviewed B-mode sonograms and elastograms in consensus. Based on the American College of Radiology Breast Imaging Reporting and Data System, we determined categories of the masses on B-mode sonography. Elastographic scores were assessed by a 3-point scale (negative, 0; equivocal, 1; and positive, 2). When the elastographic score for a lesion was 0 or 2, we downgraded or upgraded the B-mode category, respectively; thus, the reclassified Breast Imaging Reporting and Data System category was defined as the "reclassification category." Mean category values for benign and malignant lesions were compared by a Student t test. The diagnostic performance of B-mode, elastographic, and reclassification assessments was compared by receiver operating characteristic curve analysis. RESULTS The mean B-mode category (2.5 versus 1.7), elastographic score (1.7 versus 0.8), and reclassification category (3.2 versus 1.6) were significantly higher in malignant than benign lesions (P < .001). The area under the curve for reclassification assessment was significantly higher than that for B-mode sonography (0.916 versus 0.795; P < .05). With a cutoff value between 1 and 2, the specificity was increased from 26.5% to 42.9% after reclassification. CONCLUSIONS For differentiation between benign and malignant circumscribed breast masses, combined use of B-mode sonography and elastography could provide a better diagnostic performance than B-mode sonography alone.
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Affiliation(s)
- Soo-Yeon Kim
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea (S.-Y.K.); and Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea (J.S.P., H.R.K.)
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea (S.-Y.K.); and Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea (J.S.P., H.R.K.).
| | - Hye Ryoung Koo
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea (S.-Y.K.); and Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea (J.S.P., H.R.K.)
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Zheng FY, Yan LX, Huang BJ, Xia HS, Wang X, Lu Q, Li CX, Wang WP. Comparison of retraction phenomenon and BI-RADS-US descriptors in differentiating benign and malignant breast masses using an automated breast volume scanner. Eur J Radiol 2015; 84:2123-9. [DOI: 10.1016/j.ejrad.2015.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
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Quantitative breast mass classification based on the integration of B-mode features and strain features in elastography. Comput Biol Med 2015; 64:91-100. [DOI: 10.1016/j.compbiomed.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 12/21/2022]
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Song SE, Cho N, Chu A, Shin SU, Yi A, Lee SH, Kim WH, Bae MS, Moon WK. Undiagnosed Breast Cancer: Features at Supplemental Screening US. Radiology 2015; 277:372-80. [PMID: 26069925 DOI: 10.1148/radiol.2015142960] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively investigate the reasons for and features of undiagnosed cancers at previous supplemental screening ultrasonography (US) in women who subsequently received a diagnosis of breast cancer. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the requirement to obtain informed patient consent. The study consisted of 230 women (median age, 49 years; age range, 29-81 years) with 230 pairs of US examinations (prior and subsequent examinations) performed between December 2003 and August 2013 who were found to have cancer (median interval, 12 months; range, 2-24 months). The authors compared the clinical-pathologic features of patients with negative findings on prior images with those of patients with visible findings on prior images. Findings visible at prior US were classified as actionable or underthreshold by means of a blinded review by five radiologists. Lesions classified as Breast Imaging Reporting and Data System category 4 or 5 by fewer than three readers were determined to be underthreshold. Reasons for undiagnosed cancers and their imaging features were analyzed. RESULTS Among the 230 prior US examinations, 72 (31.3%) showed visible findings and 158 (68.7%) showed negative findings. High-nuclear-grade cancers and triple-negative cancers were more common in patients with negative findings than in those with visible findings (P = .023 and P = .006, respectively). Blinded review revealed that 57 of the 72 visible findings (79%) were actionable. Misinterpretation (39% [28 of 72 lesions]) and multiple distracting lesions (17% [12 of 72 lesions]) were the two most common reasons for missing these actionable findings, which showed more noncircumscribed margins than did underthreshold findings (P = .028). CONCLUSION At supplemental screening breast US, close attention should be paid to the presence of a margin that is not circumscribed, and multiple lesions should be separately assessed to reduce the number of missed breast cancers.
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Affiliation(s)
- Sung Eun Song
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Nariya Cho
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Ajung Chu
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Sung Ui Shin
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Ann Yi
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Su Hyun Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Won Hwa Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Min Sun Bae
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
| | - Woo Kyung Moon
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.)
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Shen S, Zhou Y, Xu Y, Zhang B, Duan X, Huang R, Li B, Shi Y, Shao Z, Liao H, Jiang J, Shen N, Zhang J, Yu C, Jiang H, Li S, Han S, Ma J, Sun Q. A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women. Br J Cancer 2015; 112:998-1004. [PMID: 25668012 PMCID: PMC4366890 DOI: 10.1038/bjc.2015.33] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China. However, its efficacy and cost comparing with mammography has not been evaluated in randomised trials. Methods: At 14 breast centres across China during 2008–2010, 13 339 high-risk women aged 30–65 years were randomised to be screened by mammography alone, ultrasound alone, or by both methods at enrolment and 1-year follow-up. Results: A total of 12 519 and 8692 women underwent the initial and second screenings, respectively. Among the 30 cancers (of which 15 were stage 0/I) detected, 5 (0.72/1000) were in the mammography group, 11 (1.51/1000) in the ultrasound group, and 14 (2.02/1000) in the combined group (P=0.12). In the combined group, ultrasound detected all the 14 cancers, whereas mammography detected 8, making ultrasound more sensitive (100 vs 57.1%, P=0.04) with a better diagnostic accuracy (0.999 vs 0.766, P=0.01). There was no difference between mammography and ultrasound in specificity (100 vs 99.9%, P=0.51) and positive predictive value (72.7 vs 70.0% P=0.87). To detect one cancer, the costs of ultrasound, mammography, and combined modality were $7876, $45 253, and $21 599, respectively. Conclusions: Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women.
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Affiliation(s)
- S Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
| | - Y Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
| | - Y Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
| | - B Zhang
- Department of Breast Surgery, Cancer Institute & Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - X Duan
- Department of Breast Surgery, First Hospital affiliated to Peking University, 7 Xishenku, Xicheng District, Beijing 100034, China
| | - R Huang
- Department of Breast Surgery, Maternity & Child Care Center of Qinhuangdao, 452 Hongqi Road, Qinhuangdao, Hebei 066000, China
| | - B Li
- Department of Breast Surgery, Beijing Hospital affiliated to Ministry of Health, 1 Dahua Road, Dongcheng District, Beijing 100005, China
| | - Y Shi
- Department of Breast Surgery, ShanXi Traditional Medicine Hospital, 46 Bingzhouxi Street, Taiyuan, Shanxi 030012, China
| | - Z Shao
- Department of Breast Surgery, Cancer Hospital affiliated to Fudan University, 270 Dong'an Road, Xuhui District, Shanghai 200032, China
| | - H Liao
- Department of Breast Surgery, Yingbin Hospital of Yancheng, Yingbinnan Road, Yancheng, Jiangsu 224005, China
| | - J Jiang
- Department of Breast Surgery, Southwest Hospital affiliated to the Third Military Medical University, 30 Tanyanzheng Street, Chongqing, 400038, China
| | - N Shen
- Department of Women Health, Population and Family Planning Service Center of Zhuhai, 2 Jilian Road, Zhuhai, Guangdong 519000, China
| | - J Zhang
- Department of Breast Surgery, Cancer Hospital affiliated to Tianjin Medical University, Huanhuxi Road, Hexi District, Tianjin 300060, China
| | - C Yu
- Department of Breast Surgery, Chinese 307 Hospital affiliated to the People's Liberation Army, 8 Dongda Street, Fengtai District, Beijing 100071, China
| | - H Jiang
- Department of Breast Surgery, Beijing Chaoyang Hospital affiliated to the Capital Medical University, 8 Gongtinan Road, Chaoyang District, Beijing 100043, China
| | - S Li
- Department of Breast Surgery, General Hospital affiliated to Beijing Military Area Command, 5 Nanmencang, Dongcheng District, Beijing 100700, China
| | - S Han
- Department of Epidemiology and Medical Statistics, Institute of Basic Medical Science, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
| | - J Ma
- Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Q Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
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Elastography ultrasound for breast lesions: fat-to-lesion strain ratio vs gland-to-lesion strain ratio. Eur Radiol 2014; 24:3171-7. [PMID: 25182624 DOI: 10.1007/s00330-014-3366-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/27/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of the fat-to-lesion strain ratio (FLR) and gland-to-lesion strain ratio (GLR) in the diagnosis of breast lesions. METHODS This was an institutional ethics committee approved prospective study. One hundred and ninety-three breast lesions in 193 women (mean age, 46.03 ± 13.60 years, range 18-82 years) were examined with conventional and elastographic US. Both the FLR and GLR of the lesions were calculated. The elasticity scores of the lesions were also evaluated using the five-point elasticity scoring system. For diagnostic performance, the sensitivity, specificity and receiver operating characteristic (ROC) analysis were obtained. RESULTS Seventy lesions were malignant and 123 were benign. Both the FLR and GLR of the lesions were significantly higher in malignant cases than in benign ones (P < 0.001 for both). The Az values for the FLR (0.847) and the elasticity score (0.829) were significantly higher than that for the GLR (0.752) (P = 0.009, P = 0.029, respectively). However, there was no significant difference in the Az value between the FLR and the elasticity score (P = 0.443). CONCLUSION The FLR yielded better diagnostic performance than GLR in breast lesions; the fatty tissue was better than glandular tissue as the reference normal tissue for calculating strain ratio in breast elastography. KEY POINTS FLR was higher than GLR in both malignant and benign breast lesions. Both FLR and GLR were higher in malignant than in benign breast lesions. FLR yielded better diagnostic performance than GLR in breast lesions.
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67
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Cheung RM. Sonographic Confirmation of Bilateral Invasive Ductal Carcinoma Undetected on Mammogram. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314545494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Invasive ductal carcinoma of the breast is cancer that originates in the ducts and subsequently invades the fatty tissue of the breast outside the duct. It is the most common form of breast cancer, representing 80% of all breast cancers. Invasive ductal carcinoma has the potential to metastasize via the bloodstream and lymph nodes, making early diagnosis critical. In the case presented, a rare instance of bilateral primary invasive ductal carcinoma is discussed: It was identified by magnetic resonance imaging, and it was visualized, confirmed, and located by sonography; yet, it was undetected by mammography.
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Klotz T, Boussion V, Kwiatkowski F, Dieu-de Fraissinette V, Bailly-Glatre A, Lemery S, Boyer L. Shear wave elastography contribution in ultrasound diagnosis management of breast lesions. Diagn Interv Imaging 2014; 95:813-24. [DOI: 10.1016/j.diii.2014.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Fleury EDFC, Assunção-Queiros MDCGA, Roveda D. Breast carcinomas: variations in sonoelastographic appearance. BREAST CANCER-TARGETS AND THERAPY 2014; 6:135-43. [PMID: 25177152 PMCID: PMC4128690 DOI: 10.2147/bctt.s66110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background This study assessed factors influencing the sonoelastographic presentation of breast carcinoma. Methods A prospective collaborative study was conducted by the Santa Casa de São Paulo and CTC-Center, on 540 breast lesions in women referred for percutaneous breast biopsy. Eighty-four carcinomas showing lesions on ultrasonography were included. These lesions were classified into four sonoelastographic scores, where scores of 1, 2, and 3 were considered false-negative, and a score of 4 was considered true-positive. Scores were compared against histopathologic results, which were divided into two groups, ie, soft lesions (group 1) and hard lesions (group 2). False-negative and true-positive results were also assessed for variation according to patient age and mean lesion diameter. Results Of the 84 lesions studied, nine yielded false-negative results on sonoelastography and 75 yielded true-positive results. In terms of histopathologic classification, eight were assigned to group 1 and 76 to group 2. The chi-squared test showed a correlation between sonoelastographic scores and histopathologic lesion type. No statistically significant differences were observed according to patient age or largest lesion diameter. Conclusion Our results revealed an association between sonoelastographic presentation of breast lesions and histology. False-negative results on sonoelastography were influenced by histologic type of lesion and not by lesion size or patient age.
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Affiliation(s)
| | | | - Decio Roveda
- Faculdade de Cências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
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Tozaki M, Isomoto I, Kojima Y, Kubota K, Kuroki Y, Ohnuki K, Ohsumi S, Mukai H. The Japanese Breast Cancer Society Clinical Practice Guideline for screening and imaging diagnosis of breast cancer. Breast Cancer 2014; 22:28-36. [DOI: 10.1007/s12282-014-0557-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/16/2014] [Indexed: 12/21/2022]
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71
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Elastic free energy drives the shape of prevascular solid tumors. PLoS One 2014; 9:e103245. [PMID: 25072702 PMCID: PMC4114546 DOI: 10.1371/journal.pone.0103245] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022] Open
Abstract
It is well established that the mechanical environment influences cell functions in health and disease. Here, we address how the mechanical environment influences tumor growth, in particular, the shape of solid tumors. In an in vitro tumor model, which isolates mechanical interactions between cancer tumor cells and a hydrogel, we find that tumors grow as ellipsoids, resembling the same, oft-reported observation of in vivo tumors. Specifically, an oblate ellipsoidal tumor shape robustly occurs when the tumors grow in hydrogels that are stiffer than the tumors, but when they grow in more compliant hydrogels they remain closer to spherical in shape. Using large scale, nonlinear elasticity computations we show that the oblate ellipsoidal shape minimizes the elastic free energy of the tumor-hydrogel system. Having eliminated a number of other candidate explanations, we hypothesize that minimization of the elastic free energy is the reason for predominance of the experimentally observed ellipsoidal shape. This result may hold significance for explaining the shape progression of early solid tumors in vivo and is an important step in understanding the processes underlying solid tumor growth.
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Incremental value of real-time ultrasound elastography in differentiating breast masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Jung HK, Moon HJ, Kim MJ, Kim EK. Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up. Ultrasonography 2014; 33:200-5. [PMID: 25038810 PMCID: PMC4104957 DOI: 10.14366/usg.14011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose: To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up. Methods: We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20). Results: Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor). Conclusion: US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.
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Affiliation(s)
- Hyun Kyung Jung
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Efficacy of Sonazoid (Perflubutane) for Contrast-Enhanced Ultrasound in the Differentiation of Focal Breast Lesions: Phase 3 Multicenter Clinical Trial. AJR Am J Roentgenol 2014; 202:W400-7. [DOI: 10.2214/ajr.12.10518] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology 2013; 269:701-12. [PMID: 23962417 DOI: 10.1148/radiol.13122829] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively validate predefined breast ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) category 3 criteria in a multicenter setting in an elevated-risk population. MATERIALS AND METHODS The American College of Radiology Imaging Network 6666 database was reviewed for prospectively defined BI-RADS category 3 lesions. Patient characteristics, lesion US features at initial detection, and work-up recommendations were analyzed with descriptive statistics. Exact 95% confidence intervals (CIs) were given, where appropriate. Lesion reference standard was biopsy or a minimum of 1-year follow-up. In addition, malignancy rate for lesions that had at least 2 years of follow-up data or that had biopsy data was calculated. RESULTS Of 2662 participants, 519 (19.5%) had 745 BI-RADS category 3 lesions (25.5% of 2916 US lesions other than simple cysts), with a median size of 7 mm (range, 2-135 mm). The number of new BI-RADS category 3 lesions decreased with year 2-3 screening, but the percentage of new BI-RADS category 3 lesions was stable at 26.4% (506 of 1920 lesions), 23.6% (142 of 601 lesions), and 24.6% (97 of 395 lesions), respectively. Of 745 BI-RADS category 3 lesions, 124 (16.6%) were ultimately sampled for biopsy. Six malignancies (0.8% of BI-RADS category 3 lesions; 95% confidence interval [CI]: 0.3%, 1.7%) occurred in five (1.0%) of 519 participants: Five malignancies were invasive (median size, 10 mm; size range, 2-18 mm), and one was node positive. When the analysis is limited to lesions with at least 2-year follow-up or biopsy, the malignancy rate among BI-RADS category 3 lesions is 0.9% (95% CI: 0.3%, 2.0%). Three malignant BI-RADS category 3 lesions were sampled for biopsy because of a suspicious change at follow-up (two N0 lesions, one each at 6- and 12-month follow-up; one N1 lesion at 24-month follow-up), one was sampled for biopsy because of an upgrade after additional mammography (NX), one was found at mastectomy for another cancer (N0), and one was found at prophylactic contralateral mastectomy in the same patient (NX). CONCLUSION As BI-RADS category 3 lesions have a low malignancy rate (0.8%; 95% CI: 0.3%, 1.7%) and only 0.1% of the cancers had suspicious changes at 6-month follow-up and only one (17%; 95% CI: 0.4%, 64%) of six malignancies were node positive at detection (24-month follow-up), a recommendation of 1-year diagnostic follow-up may be appropriate for BI-RADS category 3 lesions detected at screening US. Online supplemental material is available for this article.
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Affiliation(s)
- Richard G Barr
- From Radiology Consultants, 250 DeBartolo Pl, Bldg B, Youngstown, OH 44512 (R.G.B.); Center for Statistical Sciences, Brown University, Providence, RI (Z.Z., J.B.C.); Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (E.B.M.); and Department of Radiology, Magee-Women's Hospital of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B.)
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Carbone M, Condino S, Mattei L, Forte P, Ferrari V, Mosca F. Anthropomorphic ultrasound elastography phantoms - characterization of silicone materials to build breast elastography phantoms. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:492-4. [PMID: 23365936 DOI: 10.1109/embc.2012.6345975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper a mechanical characterization of low cost and simply available materials to build efficient anthropomorphic ultrasound elastography phantoms is described. The class of silicone materials was selected because of their deformability, durability and the possibility of reproducing specific tissue properties and shapes. Innovative formulations of silicone mixtures with echogenic and/or softening additives were tested. The proposed models have good acoustic properties and tactile feedback; moreover they are durable and do not require special storage since they do not dehydrate or decompose over time.
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Affiliation(s)
- Marina Carbone
- EndoCAS – Center for Computer Assisted Surgery, University of Pisa, 56124 Pisa, Italy.
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Elverici E, Zengin B, Nurdan Barca A, Didem Yilmaz P, Alimli A, Araz L. Interobserver and Intraobserver Agreement of Sonographic BIRADS Lexicon in the Assessment of Breast Masses. IRANIAN JOURNAL OF RADIOLOGY : A QUARTERLY JOURNAL PUBLISHED BY THE IRANIAN RADIOLOGICAL SOCIETY 2013; 10:122-7. [PMID: 24348596 PMCID: PMC3857973 DOI: 10.5812/iranjradiol.10708] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/13/2013] [Accepted: 03/04/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND BI-RADS was first developed in 1993 for mammography and in 2003 it was redesigned for ultrasonography (US). If the observer agreement is high, the method used in the classification of lesion would be reproducible. OBJECTIVES The aim of this study is to evaluate the inter- and intraobserver agreement of sonographic BI-RADS lexicon in the categorization and feature characterization of nonpalpable breast lesions. PATIENTS AND METHODS We included 223 patients with 245 nonpalpable breast lesions who underwent ultrasound-guided wire needle localization. Two radiologists retrospectively described each lesion using sonographic BI-RADS descriptors and final assessment. The observers were blinded to mammographic images, medical history and pathologic results. Inter- and intraobserver agreement was assessed using Kappa (κ) agreement coefficient. RESULTS The interobserver agreement for sonographic descriptors changed between fair and substantial. The highest agreement was detected for mass orientation (κ=0.66). The lowest agreement was found in the margin (κ=0.33). The interobserver agreement for BI-RADS final category was found as fair (κ=0.35). The intraobserver agreement for sonographic descriptors changed between substantial and almost perfect. The intraobserver agreement of BI-RADS result category was found as substantial for observer 1 (κ=0.64) and excellent for observer 2 (κ=0.83). CONCLUSION Our results demonstrated that each observer was self-consistent in interpreting US BI-RADS classification, while interobserver agreement was relatively poor. Although it has been ten years since the description of sonographic BI-RADS lexicon, further training and periodic performance evaluations would probably help to achieve better agreement among radiologists.
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Affiliation(s)
- Eda Elverici
- Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Betul Zengin
- Department of Radiology, Yozgat State Hospital, Yozgat, Turkey
| | - Ayse Nurdan Barca
- Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | | | - Aysegul Alimli
- Department of Radiology, Yozgat State Hospital, Yozgat, Turkey
| | - Levent Araz
- Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Jalalian A, Mashohor SB, Mahmud HR, Saripan MIB, Ramli ARB, Karasfi B. Computer-aided detection/diagnosis of breast cancer in mammography and ultrasound: a review. Clin Imaging 2013; 37:420-6. [DOI: 10.1016/j.clinimag.2012.09.024] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 09/25/2012] [Accepted: 09/28/2012] [Indexed: 11/25/2022]
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Aho M, Irshad A, Ackerman SJ, Lewis M, Leddy R, Pope TL, Campbell AS, Cluver A, Wolf BJ, Cunningham JE. Correlation of sonographic features of invasive ductal mammary carcinoma with age, tumor grade, and hormone-receptor status. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:10-17. [PMID: 22996916 PMCID: PMC4527309 DOI: 10.1002/jcu.21990] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/13/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To determine whether presenting sonographic features of invasive ductal carcinomas (IDC) are associated with patient age, tumor histologic grade, and hormonal receptor status. METHODS Sonographic features of 101 consecutive cases of IDC seen at ultrasound were retrospectively assessed based on the BI-RADS criteria of posterior acoustic appearance, tumor margins, and echogenicity. Associations between sonographic features and tumor characteristics were statistically evaluated with attention to patient age. RESULTS IDC with shadowing compared with unchanged posterior acoustic appearance were significantly more likely to be of low histologic grade (Odds Ratio [OR] = 5.00; p < 0.05) and estrogen receptor (ER) -positive (OR = 10.00; p < 0.05). Conversely, posterior enhancement was associated with ER-negative status (OR = 4.45; p < 0.01), particularly among patients younger than 60 years of age (OR = 5.36, p < 0.05). Circumscribed tumors were more often high grade, particularly among older women (p < 0.01), and hormone receptor--negative regardless of age group. Among older women, tumors with mixed echogenicity tended to be high grade and progesterone receptor--negative (p values < 0.05). Noncircumscribed borders were observed for all tumors with posterior shadowing, and 97% of such tumors were also ER positive. CONCLUSIONS Sonographic features were significantly associated with tumor grade and hormone receptor status, with some differences based on patient age. Specifically, the presence of posterior shadowing was associated with lower histologic grade and ER-positive status, especially in older patients. In contrast, we found that posterior acoustic enhancement was more commonly associated with ER-negative status, especially in younger patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Female
- Humans
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Ultrasonography, Mammary/methods
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Affiliation(s)
- Michael Aho
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina 29403, USA
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80
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Lee CI, Wells CJ, Bassett LW. Cost minimization analysis of ultrasound-guided diagnostic evaluation of probably benign breast lesions. Breast J 2012. [PMID: 23186174 DOI: 10.1111/tbj.12055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to compare direct health care costs for two competing diagnostic strategies for probably benign breast lesions detected by ultrasound in young women. We developed a decision analytic model and performed a cost minimization analysis comparing ultrasound-guided vacuum-assisted core biopsy and conservative short-term diagnostic ultrasound follow-up. Relative probabilities for diagnostic outcomes were derived from pooled analysis of the medical literature. Direct health care costs were estimated using United States national average figures from calendar year 2010. Deterministic sensitivity analyses were conducted, as well as a first-order Monte Carlo simulation to confirm cost differences between the two strategies. The conservative short-term imaging follow-up strategy ($639.55 average cost per patient) was the most economical strategy compared to immediate vacuum-assisted core biopsy ($879.55 average cost per patient). Sensitivity analyses demonstrated that the preferred strategy is most dependent on the probabilities of detecting change in appearance on follow-up ultrasound, having a benign finding on immediate core biopsy, and finding cancer on a biopsy triggered by an interval change in ultrasound appearance. The model was also sensitive to the costs of vacuum-assisted core biopsy and diagnostic ultrasound. Conservative imaging follow-up of BIRADS 3 breast masses by ultrasound is cost saving compared to immediate vacuum-assisted core biopsy, with a potential of saving more than one-third of overall costs associated with the diagnostic work-up of such lesions. Watchful waiting with short-term interval follow-up ultrasounds will spare women from unnecessary procedures and spare the United States health care system from unnecessary direct health care costs.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
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81
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Tozaki M, Isobe S, Sakamoto M. Combination of elastography and tissue quantification using the acoustic radiation force impulse (ARFI) technology for differential diagnosis of breast masses. Jpn J Radiol 2012; 30:659-70. [PMID: 22836905 DOI: 10.1007/s11604-012-0106-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/25/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE We evaluated the diagnostic performance of elastography and tissue quantification using acoustic radiation force impulse (ARFI) technology for differential diagnosis of breast masses. MATERIALS AND METHODS There were 161 mass lesions. First, lesion correspondence on ARFI elastographic images to those on the B-mode images was evaluated: no findings on ARFI images (pattern 1), lesions that were bright inside (pattern 2), lesions that were dark inside (pattern 4), lesions that contained both bright and dark areas (pattern 3). In addition, pattern 4 was subdivided into 4a (dark area same as B-mode lesion) and 4b (dark area larger than lesion). Next, shear wave velocity (SWV) was measured using virtual touch tissue quantification. RESULTS There were 13 pattern 1 lesions and five pattern 2 lesions; all of these lesions were benign, whereas all pattern 4b lesions (n = 43) were malignant. When the value of 3.59 m/s was chosen as the cutoff value, the combination of elastography and tissue quantification showed 91 % (83-91) sensitivity, 93 % (65-70) specificity, and 92 % (148-161) accuracy. CONCLUSION The combination of elastography and tissue quantification is thought to be a promising ultrasound technique for differential diagnosis of breast-mass lesions.
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Affiliation(s)
- Mitsuhiro Tozaki
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.
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82
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Jales RM, Sarian LO, Peralta CFA, Torresan R, Marussi EF, Alvares BR, Derchain S. Complex breast masses: assessment of malignant potential based on cyst diameter. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:581-587. [PMID: 22441915 DOI: 10.7863/jum.2012.31.4.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to assess whether cyst diameter might contribute to the prediction of malignancy in complex breast masses. METHODS In this cross-sectional study, we identified 48 breast masses that had sonographic features suggestive of benign breast lesions (oval shape, circumscribed margins, parallel axis, and abrupt limits). However, these masses were classified as Breast Imaging Reporting and Data System (BI-RADS) category 4 because of the presence of at least 1 cyst (complex echogenicity). All breast masses were biopsied (25 core needle and 23 core needle and excision). Subsequent histologic analysis was performed, and 12 malignancies (25%) were identified. Mammographic features were reviewed. Different sonographic measurements (largest diameters of the mass and cyst and vascular pattern) were assessed for the detection of malignancy. RESULTS Among the sonographic features, the vascular pattern, ie, the detection of blood flow (present in the lesion [P >.99] or present immediately adjacent to the lesion [P = .46]), was not associated with malignancy, whereas the largest mass and cyst dimensions had significantly positive correlations (P = .02; P < .001, respectively) with tumor malignancy. In receiver operating characteristic curve analysis, the point with the highest sum of sensitivity and specificity corresponded to a maximum cyst diameter of 8 mm (sensitivity, 67%; specificity, 86%). The positive and negative predictive values at that cutoff point were 61% and 86%, respectively. The area under the curve was 0.772. In this study, all masses with cysts smaller than 3 mm in diameter (7 cases) were benign, and all masses with cysts larger than 13 mm in diameter (4 cases) were malignant. CONCLUSIONS Cyst diameter is a good predictor of malignancy in complex breast masses, which, except for the presence of internal cysts, would be otherwise classified as BI-RADS category 3.
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Affiliation(s)
- Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-Unicamp, PO Box 6111, Campinas, 13083-970 São Paulo-SP, Brazil.
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83
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Bai M, Du L, Gu J, Li F, Jia X. Virtual touch tissue quantification using acoustic radiation force impulse technology: initial clinical experience with solid breast masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:289-294. [PMID: 22298873 DOI: 10.7863/jum.2012.31.2.289] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the clinical usage of Virtual Touch tissue quantification (VTQ; Siemens Medical Solutions, Mountain View, CA) implementing sonographic acoustic radiation force impulse technology for differentiation between benign and malignant solid breast masses. METHODS A total of 143 solid breast masses were examined with VTQ, and their shear wave velocities (SWVs) were measured. From all of the masses, 30 were examined by two independent operators to evaluate the reproducibility of the results of VTQ measurement. All masses were later surgically resected, and the histologic results were correlated with the SWV results. A receiver operating characteristic curve was calculated to assess the diagnostic performance of VTQ. RESULTS A total of 102 benign lesions and 41 carcinomas were diagnosed on the basis of histologic examination. The VTQ measurements performed by the two independent operators yielded a correlation coefficient of 0.885. Applying a cutoff point of 3.065 m/s, a significant difference (P < .001) was found between the SWVs of the benign (mean ± SD, 2.25 ± 0.59 m/s) and malignant (5.96 ± 2.96 m/s) masses. The sensitivity, specificity, and area under the receiver operating characteristic curve for the differentiation were 75.6%, 95.1%, and 85.6%, respectively. When the repeated non-numeric result X.XX of the SWV measurements was designated as an indicator of malignancy, the sensitivity, specificity, and accuracy were 63.4%, 100%, and 89.5%. CONCLUSIONS Virtual Touch tissue quantification can yield reproducible and quantitative diagnostic information on solid breast masses and serve as an effective diagnostic tool for differentiation between benign and malignant solid masses.
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Affiliation(s)
- Min Bai
- Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Rd, 200086 Shanghai, China
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84
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Category assessment based on 3D volume data acquired by automated breast ultrasonography. Jpn J Radiol 2011; 30:185-91. [PMID: 22180186 DOI: 10.1007/s11604-011-0028-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/05/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the validity of categorization of ultrasonographic findings using automated breast ultrasonography (US). MATERIALS AND METHODS Bilateral whole-breast US was performed using an automated breast volume scanner (ABVS) in 400 women. The 3D data were evaluated using the ABVS workstation, and final assessment categories were recorded based on the following criteria. Irregular-shaped masses with a spiculated margin or echogenic halo were defined as category 5. Solid masses with one of the three suspicious findings (no circumscribed margin, no parallel orientation, and microcalcifications) were defined as category 4a, and masses with two or more suspicious findings were defined as category 4b. For non-mass lesions, localized hypoechoic areas with one of the three suspicious findings (segmental distribution, ductal change, and microcalcifications) were defined as category 4a. Localized hypoechoic areas with two or three suspicious findings were defined as category 4b or 5, respectively. RESULTS Malignancy was confirmed histologically in 57 women (invasive, n = 38; in situ, n = 19). The rate of malignant findings was 0.6% (1/168) in category 3, 12% (15/129) in category 4a, 53% (31/59) in category 4b and 100% (10/10) in category 5. CONCLUSION Categorization of ultrasonographic findings using automated breast US are useful for predicting the likelihood of malignancy.
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85
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Tozaki M, Fukuma E. Pattern classification of ShearWave™ Elastography images for differential diagnosis between benign and malignant solid breast masses. Acta Radiol 2011; 52:1069-75. [PMID: 22013011 DOI: 10.1258/ar.2011.110276] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND ShearWave™ Elastography (SWE) provides a quantitative measurement of tissue stiffness and may improve characterization of breast masses. However, the significance of Young's modulus measurements and appropriate SWE evaluation criteria has not been established yet. PURPOSE To assess the usefulness of the pattern classification and Young's modulus measurements in the differential diagnosis between benign and malignant solid breast masses. MATERIAL AND METHODS Ninety-six patients (age range 18-84 years, mean 54 years) with 100 solid breast masses who underwent tissue sampling after a US examination were analyzed. We tried to create a visual pattern classification based on the SWE images. After classifying the visual patterns, the Young's modulus of the lesions was measured in every case. RESULTS It was possible to classify the images into four patterns by the visual evaluation: no findings (coded blue homogeneously; Pattern 1), vertical stripe pattern artifacts (Pattern 2), a localized colored area at the margin of the lesion (Pattern 3), and heterogeneously colored areas in the interior of the lesion (Pattern 4). There were 17 Pattern 1 lesions, 14 Pattern 2 lesions, 20 Pattern 3 lesions, and 49 Pattern 4 lesions. When Patterns 1 and 2 were assumed to be benign, and Patterns 3 and 4 were assumed to be malignant, the sensitivity and specificity were 91.3% (63/69) and 80.6% (25/31), respectively. The mean Young's modulus measurements of the benign and the malignant lesions were 42 kPa and 146 kPa, respectively (P < 0.0001). No significant differences were found between benign and malignant lesions in Pattern 3. In Pattern 4, however, the Young's modulus of the benign lesions (50 kPa) was lower than the smallest Young's modulus of malignant lesions (61 kPa). CONCLUSION The visual pattern classification and adding Young's modulus measurements may improve characterization of solid breast masses.
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Affiliation(s)
- Mitsuhiro Tozaki
- Division of Breast Imaging, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Eisuke Fukuma
- Division of Breast Imaging, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
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86
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Taylor K, Britton P, O'Keeffe S, Wallis MG. Quantification of the UK 5-point breast imaging classification and mapping to BI-RADS to facilitate comparison with international literature. Br J Radiol 2011; 84:1005-10. [PMID: 22011830 PMCID: PMC3473699 DOI: 10.1259/bjr/48490964] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/07/2011] [Accepted: 01/20/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The UK 5-point breast imaging scoring system, recently formalised by the Royal College of Radiologists Breast Group, does not specify the likelihood of malignancy in each category. The breast imaging and reporting data system (BI-RADS) is widely used throughout North America and much of Europe. The main purpose of this study is to quantify the cancer likelihood of each of the UK 5-point categories and map them to comparable BI-RADS categories to facilitate comparison with North American and European literature and publication of UK research abroad. METHODS During the 8 year study period, mammogram and ultrasound results were UK scored and the percentage of cancer outcomes within each group calculated. These were then compared with the percentage incidence of the BI-RADS categories. RESULTS Of 23 741 separate assessment episodes, 15 288 mammograms and 10 642 ultrasound examinations were evaluated. There was a direct correlation between UK scoring and BI-RADS for categories 1 and 5. UK Score 2 lipomas and simple cysts correlated with BI-RADS 2, with the remaining UK Score 2 lesions (mostly fibroadenomas) assigned to BI-RADS 3. BI-RADS 4 incorporates a wide range of cancer risk (2-95%) with subdivisions a, b and c indicating increasing, but unspecified, likelihood of malignancy. UK Score 3 correlated with BI-RADS 4 a/b and UK Score 4 corresponded with BI-RADS 4c. CONCLUSION This study quantifies the cancer likelihood of the UK scoring and maps them to parallel BI-RADS categories, with equivalent cancer risks. This facilitates the ability to share UK research data and clinical practice on an international scale.
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Affiliation(s)
- K Taylor
- Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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87
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Tozaki M, Fukuma E. Does power Doppler ultrasonography improve the BI-RADS category assessment and diagnostic accuracy of solid breast lesions? Acta Radiol 2011; 52:706-10. [PMID: 21596798 DOI: 10.1258/ar.2011.110039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Power Doppler ultrasonography (US) is used in addition to B-mode US as a tool for the differential diagnosis between benign and malignant lesions. However, there are few data showing how useful power Doppler US is for BI-RADS category assessment. PURPOSE To assess how much power Doppler US contributed to increasing the category diagnosis from Breast Imaging Reporting and Data System (ACR BI-RADS(®)-US) category 3 to category 4. MATERIAL AND METHODS A total of 2426 patients (age range 16-91 years, mean 52 years) who underwent B-mode and power Doppler breast US using a linear 10-MHz transducer were analyzed. We devised integrated US category classification (BI-RADS-Integral) based on BI-RADS descriptors and vascularity. Masses with a circumscribed margin, parallel orientation, and negative vascularity on power Doppler US were defined as category 3. Irregular-shaped masses with a spiculated margin or echogenic halo were defined as category 5. Masses with one of the four suspicious findings (no circumscribed margin, no parallel orientation, microcalcifications, and positive vascularity) were defined as category 4a, and masses with two or more suspicious findings were defined as category 4b. RESULTS There were 98 breast cancer cases, and the average sizes of invasive and non-invasive cancers were 15 mm and 18 mm, respectively. The frequency of breast cancer according to category was: 0.4% (3/714) of the category 3 cases, 2.7% (7/256) in category 4a, 64% (47/73) in category 4b, and 100% (41/41) in category 5. Among the cases with a category 4a mass lesion, there were 183 lesions whose category diagnosis had been raised from category 3 to category 4a based on the Doppler blood flow findings alone, and 3 (1.6%) of those lesions were breast cancer. All three of them were ductal carcinoma in situ (DCIS) cases. When the cut-off point was placed between category 3 and category 4, BI-RADS-Integral and BI-RADS-US without power Doppler had a sensitivity of 96.9% and 93.9%, respectively, specificity of 72.1% and 90.4%, respectively, and accuracy of 74.4% and 90.7%, respectively. CONCLUSION The presence of Doppler blood flow increases the malignancy pick-up rate, but at the expense of a significant decrease in specificity and diagnostic accuracy and an increase in biopsy rate.
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Affiliation(s)
| | - Eisuke Fukuma
- Division of Breast Surgery, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
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88
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89
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Yoon JH, Kim MJ, Moon HJ, Kwak JY, Kim EK. Subcategorization of ultrasonographic BI-RADS category 4: positive predictive value and clinical factors affecting it. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:693-9. [PMID: 21458145 DOI: 10.1016/j.ultrasmedbio.2011.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 02/01/2011] [Accepted: 02/18/2011] [Indexed: 05/14/2023]
Abstract
The objective of this study was to evaluate the positive predictive value (PPV) in ultrasonographically (US)-detected breast lesions of BI-RADS category 4a, 4b and 4c and to find how various clinical factors influenced the PPV of category 4. A total of 2142 women with 2430 breast lesions diagnosed on US as BI-RADS category 4 and underwent biopsy were included. Among them, 452 (18.6%) were pathologically confirmed as malignancy. PPV of each US BI-RADS subcategory was 7.6% (149/1963) for category 4a, 37.8% (68/180) for category 4b and 81.9% (235/287) for category 4c. Several clinical factors were more significantly seen in malignancy of category 4a and 4b, whereas none of the factors showed significance in category 4c. Subcategorization of category 4 is a feasible method in predicting malignancy in which patients' age, lack of multiplicity and symptoms affected the PPV of category 4 lesions.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
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90
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Navarro B, Ubeda B, Vallespí M, Wolf C, Casas L, Browne JL. Role of elastography in the assessment of breast lesions: preliminary results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:313-321. [PMID: 21357553 DOI: 10.7863/jum.2011.30.3.313] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purposes of this study were to evaluate the diagnostic utility of elastography in differentiating benign from malignant breast lesions and compare it with conventional sonography. METHODS A total of 124 breast lesions (59 malignant and 65 benign) were examined with B-mode sonography and subsequently with elastography. Conventional sonographic findings were classified according to the American College of Radiology Breast Imaging Reporting and Data System for sonography, and elastographic images were assigned an elasticity score of 1 to 5 (1-3, benign; 4 and 5, malignant) according to the Ueno classification. Cytologic diagnoses obtained from fine-needle aspiration and histopathologic results from a core-needle biopsy or surgical biopsy were used as reference standards. Statistical analysis included sensitivity, specificity, and positive and negative predictive values for both elastography and conventional sonography. RESULTS B-mode sonography had sensitivity of 96.6% (95% confidence interval, 93.3%-99.9%), specificity of 76.9% (69.2%-84.6%), a positive predictive value of 79.2% (72.1%-86.2%), and a negative predictive value of 96.2% (92.4%-99.9%), compared with sensitivity of 69.5% (60.5%-78.5%), specificity of 83.1% (76.3%-89.8%), a positive predictive value of 78.9% (70.6%-87.1%), and a negative predictive value of 75.0% (67.4%-82.6%) for elastography. Elastography showed less sensitivity but higher specificity than conventional sonography. CONCLUSIONS Our results show that elastography may be useful as a complementary technique in addition to conventional sonography in the characterization of breast lesions because it increases the diagnostic specificity, thus reducing the false-positive rate.
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Affiliation(s)
- Beatriz Navarro
- Gynecologic Diagnostic Imaging Unit, Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
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91
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Sohn YM, Kim MJ, Kwak JY, Moon HJ, Kim SJ, Kim EK. Breast ultrasonography in young Asian women: analyses of BI-RADS final assessment category according to symptoms. Acta Radiol 2011; 52:35-40. [PMID: 21498323 DOI: 10.1258/ar.2010.100250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast ultrasound is the major imaging modality in young women because it incurs no radiation exposure and dense breast tissue, which is common in young women, yields a high rate of false-negative results on mammography. PURPOSE To investigate the cancer rates of the sonographic BI-RADS categorization and histopathologic results according to the presence of symptoms in young Asian women. MATERIAL AND METHODS We included 811 young women under 30 years of age who underwent a breast ultrasound during the study period. The mean age of all subjects was 24.5 years (range 11-29 years). Histopathologic results were compared with the results after application of the BI-RADS categorization. RESULTS Sonographic findings were classified as category 1 (n=192), category 2 (n=81), category 3 (n=399), category 4 (n=134), and category 5 (n=5). The cancer rates for category 1, 2, 3, 4, and 5 were 0, 0, 0.3, 6.3, and 100% in the symptomatic group, respectively. For the asymptomatic group, the cancer rates were 0, 0, 0, 8.7, and 100%, respectively. More cancers were found in high-risk women (22.2%, 4/18) than in non-high-risk women (1.4%, 11/793). CONCLUSION BI-RADS categorization was helpful for predicting the probability of malignancy in young Asian women.
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Affiliation(s)
- Yu-Mee Sohn
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Soo Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
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92
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A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol 2010; 65:887-94. [DOI: 10.1016/j.crad.2010.06.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/17/2010] [Accepted: 06/02/2010] [Indexed: 12/21/2022]
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93
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Youk JH, Kim EK, Kim MJ, Kwak JY, Son EJ. Performance of hand-held whole-breast ultrasound based on BI-RADS in women with mammographically negative dense breast. Eur Radiol 2010; 21:667-75. [PMID: 20853108 DOI: 10.1007/s00330-010-1955-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/21/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the performance of breast ultrasound based on BI-RADS final assessment categories in women with mammographically negative dense breast. METHODS Of 3,820 cases with mammographically negative dense breast and subsequent hand-held bilateral whole-breast ultrasound, a total of 1,507 cases in 1,046 women who had biopsy or at least 2-year follow-up ultrasound constituted the basis of this retrospective study. Cancer rate of each sonographic BI-RADS category was determined and medical audit was performed separately in screening-general, screening-treated, and diagnostic group. RESULTS A total of 43 cases (2.9%) were confirmed as malignancy. Cancer rate among BI-RADS categories was significantly different (p < 0.0001). Among three groups, the cancer rate was significantly different (p < 0.0001) and the highest in diagnostic group (15.8%, 22 of 139). Abnormal interpretation rate, PPV of biopsy performed, cancer detection rate, and rate of early stage cancer, and the size of invasive cancer were significantly different among three groups and the highest in diagnostic group. Regarding cancer characteristics, the proportion of advanced cancer was the highest in diagnostic group. CONCLUSION Breast ultrasound based on BI-RADS as an adjunctive to negative mammography can be useful for predicting malignancy in women with dense breast.
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Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea
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Raza S, Goldkamp AL, Chikarmane SA, Birdwell RL. US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management. Radiographics 2010; 30:1199-213. [DOI: 10.1148/rg.305095144] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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95
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Moon HJ, Kim MJ, Kwak JY, Yoon JH, Kim SJ, Sohn YM, Kim EK. Malignant lesions initially categorized as probably benign breast lesions: retrospective review of ultrasonographic, clinical and pathologic characteristics. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:551-559. [PMID: 20350681 DOI: 10.1016/j.ultrasmedbio.2010.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/14/2010] [Accepted: 01/25/2010] [Indexed: 05/29/2023]
Abstract
The primary objective of this study was to review the ultrasonographic features of BI-RADS category 3 ("probably benign") lesions that eventually proved to be malignant. A second objective was to investigate their clinical and pathologic features according to their palpability and time of biopsy. Thirty-two (0.8%) of 4000 women with lesions that were initially classified as "probably benign" proved to be malignant and formed the study group. The most common reason for a false negative assessment on ultrasound was a failure to recognize suspicious margin characteristics (28 of 32 malignancies, 87.5%). Malignancy was more frequent in palpable (2.4%, 21 of 859) than nonpalpable lesions (0.4%, 11 of 3141, p < 0.001). There was no statistical difference in the mean age, mean size of lesions, or tumor stage between patients who underwent early biopsy (n = 19) or biopsy after 6 months (n = 13). Twenty-nine of the lesions (90.6%) were retrospectively recategorized as BI-RADS 4, which calls for early biopsy. BI-RADS 3 lesions require especially careful assessment.
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Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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96
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Baek SE, Kim MJ, Kim EK, Youk JH, Lee HJ, Son EJ. Effect of clinical information on diagnostic performance in breast sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1349-1356. [PMID: 19778881 DOI: 10.7863/jum.2009.28.10.1349] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to assess whether the clinical information (CI) of patients affects the degree of suspicion for malignancy by radiologists performing breast sonography. METHODS We included 150 breast lesions in 144 patients who underwent breast sonography and sonographically guided core needle biopsy. A pathologic diagnosis was available for all 150 breast lesions: 78 (52%) were malignant, and 72 (48%) were benign. Three radiologists retrospectively reviewed the sonograms of all lesions twice at 8-week intervals first without any CI for the patients (first review) and then with CI such as patient age, palpability, and personal history of risk factors for breast cancer (second review). The reviewers categorized the final assessment according to the American College of Radiology Breast Imaging Reporting and Data System. We compared diagnostic performance such as sensitivity and specificity and the degree of suspicion for malignancy between the image reviews with and without CI. RESULTS In the second review, sensitivity was improved in all 3 reviewers (94.0 to 99.2%; P < .05), and specificity was decreased (39.8 to 30.8%; P = .04). There was a significant increase of suspicion for malignancy with the patients' CI (P < .05). CONCLUSIONS Clinical information about a patient's breast cancer history and clinical presentation with a palpable mass can increase the suspicion for malignancy on sonography and the sensitivity of sonographic interpretation.
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Affiliation(s)
- Song-Ee Baek
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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97
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Nascimento JHRD, Silva VDD, Maciel AC. Acurácia dos achados ultrassonográficos do câncer de mama: correlação da classificação BI-RADS® e achados histológicos. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: O objetivo geral do estudo é avaliar a acurácia da ultrassonografia (BI-RADS) no diagnóstico do câncer de mama, e os objetivos específicos, descrever a frequência de apresentação dos diferentes achados ultrassonográficos e a avaliação da concordância entre observadores. MATERIAIS E MÉTODOS: Exames de 110 pacientes encaminhados para biópsia, com diagnóstico prévio de nódulos, foram reanalisados independentemente por dois médicos especialistas utilizando a nomenclatura do BI-RADS. Os achados histológicos foram utilizados como padrão-ouro. A acurácia dos achados foi determinada. As diferenças nos grupos de comparação foram analisadas com teste qui-quadrado para variáveis categóricas e a concordância entre os médicos foi calculada por meio da estatística kappa (κ). RESULTADOS: Cento e dez massas mamárias foram avaliadas pelo ultrassom, sendo que 76 (69%) foram benignas e 34 (30,9%), malignas. Foram observados, entre os radiologistas, sensibilidade variando entre 70,5% e 82,3%, valor preditivo negativo entre 81,1% e 87,5%, valor preditivo positivo entre 42,1% e 45,1%, especificidade entre 56,58% e 55,2% e acurácia entre 60,9% e 63,6%. Na avaliação entre observadores foi obtida concordância global considerada moderada (κ= 0,50). CONCLUSÃO: O BI-RADS 4ª edição é um acurado sistema para auxiliar os médicos na descrição das lesões mamárias e na tomada de condutas.
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Affiliation(s)
| | | | - Antonio Carlos Maciel
- Santa Casa de Misericórdia de Porto Alegre; Hospital de Clínicas de Porto Alegre, Brasil
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98
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[Diagnostic accuracy and interobserver variability in the BI-RADS ultrasound system]. RADIOLOGIA 2009; 51:477-86. [PMID: 19604529 DOI: 10.1016/j.rx.2009.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 02/23/2009] [Accepted: 03/02/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the predictive values and the interobserver variability of the descriptors and diagnostic categories of the BI-RADS- Ultrasound system and its usefulness for predicting malignancy in solid breast nodules. MATERIAL AND METHODS We evaluated 601 consecutive solid nodules in 554 patients studied with ultrasound. All ultrasound examinations were performed by one of the three radiologists that participated in the study and the static images were reviewed by all three radiologists independently; radiologists were blind to the clinical history and to the findings at mammography and at histological study. RESULTS The descriptors that best predicted benignity were circumscribed margins and oval shape (NPV, > 96%), parallel orientation (NPV, 84%-91%), and abrupt interface (NPV, 81%-90%). The descriptors that best predicted malignancy were spiculated margins (PPV, 77%-85%), echogenic halo (PPV, 61%-71%), and nonparallel orientation (PPV, 53%-54%). Interobserver concordance was good for lesion shape (kappa=0.61), circumscribed margins (kappa=0.65), and calcifications (kappa=0.63). The descriptors that presented the highest prognostic values for malignancy were spiculated margins (OR=14.68-10.45) and nonparallel orientation (OR=3.95-6.17). Final assessment category 3 yielded an excellent NPV for all three radiologists (99%-100%). The interobserver concordance was good for category 5 (kappa=0.77) and for category 3 (kappa=0.68); it was moderate for category 4 (kappa=0.59). CONCLUSIONS The BI-RADS- Ultrasound system helps differentiate benign breast lesions from malignant ones and has a good or moderate interobserver concordance. Final assessment category 3 yielded an excellent negative predictive value, making it possible to avoid biopsies in lesions in this category.
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Lévy L. Comment décrire et classer une lésion en échographie du sein en 2009 ? IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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100
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Fleury EFC, Rinaldi JF, Piato S, Fleury JCV, Roveda Junior D. Appearance of breast masses on sonoelastography with special focus on the diagnosis of fibroadenomas. Eur Radiol 2009; 19:1337-46. [PMID: 19159934 DOI: 10.1007/s00330-008-1285-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 12/06/2008] [Indexed: 12/21/2022]
Abstract
The aim of this study was to show and correlate the imaging features of breast masses, especially fibroadenomas, using sonoelastography. Two hundred thirty-five patients with 302 breast lesions referred for core needle biopsy participated in the study. All lesions appearing as solid masses on conventional US were included. Out of the included lesions (270), 115 (42.6%) corresponded to histologically confirmed fibroadenomas and 155 (57.4%) to lesions with histologically confirmed diagnoses other than fibroadenomas. These were further subdivided into fibrocystic changes, lesions with low malignancy potential, and malignant lesions. Fibroadenomas were also divided according to histological presentation into three subgroups to allow comparative study based on elastographic scores. All lesions were classified using a four-point scoring system based on ultrasound elastography imaging characteristics. Different presentations were observed for elastographic scores according to histological presentation of fibroadenomas, whereby fibroadenomas with benign characteristics tended to have elastographic classification similar to fibrocystic changes, and complex and hypercellular fibroadenomas had classifications similar to harder lesions. Fibroadenomas are generally classified as category 3 in the BI-RADS lexicon and are the most commonly found lesions in breast biopsies. Sonoelastography can provide additional information to conventional studies and be used as an auxiliary tool in assessing these masses in clinical practice.
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Affiliation(s)
- Eduardo F C Fleury
- Faculty of Medicine, Santa Casa de Misericordia de São Paulo, São Paulo, SP, Brasil.
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