Can strain elastography combined with ultrasound breast imaging reporting and data system be a more effective method in the differentiation of benign and malignant breast lesions?

Interobserver and intermethod variability in data interpretation of breast strain elastography in suspicious breast lesions

Background/aim

Strain elastography has the disadvantage of being operator-dependent. Interobserver variability is observed during image acquisition and interpretation. This study aimed to analyze the interobserver and intermethod variability of strain elastography in image interpretation and evaluate the diagnostic performance combining elasticity score and strain ratio with ultrasonography.

Materials and methods

A retrospective study was conducted on 70 breast lesions evaluated with B-mode ultrasonography and strain elastography. B-mode ultrasonography findings, elasticity scores, and strain ratio values were evaluated using static images by two radiologists. BI-RADS assessment of the lesions and the decision of both observers as to whether the biopsy was required using B-mode ultrasonography, and the combined ultrasonography+elasticity score, and the combined ultrasonography+elasticity score+strain ratio were compared with the histopathological results. Also, the interobserver agreement was analyzed for all the combinations.

Results

There was very good agreement (weighted κ = 0.865) between the observers for the elasticity scores. Very good agreement was observed between the observers for BI-RADS assessments using the combined ultrasonography+elasticity score and the combined ultrasonography+elasticity score+strain ratio (weighted κ = 0.848, and 0.902, respectively). Area under the curve of B-mode ultrasonography, the combined B-mode ultrasonography+elasticity score, and the combined B-mode ultrasonography+elasticity score+strain ratio, were calculated as 0.859, 0.866, and 0.916 for observer 1, and 0.851, 0.829, and 0.916 for observer 2, respectively. There were no statistically significant differences between the observers’ diagnostic performances in any of the combinations (P = 0.703, 0.067, and 0.972, respectively).

Conclusion

In the evaluation and further assessment of breast lesions, semiquantitative strain ratio calculation may help improve diagnostic accuracy by reducing interpretational variety, when used together with B-mode ultrasonography and elasticity scoring, especially for inexperienced individuals.

Design and Implementation of a Heating Treatment System for Vitiligo Skin Disease Based on Medical Ultrasound

Vitiligo is relatively common clinically. It is an acquired and persistent skin and mucosal pigment depigmentation disease. As a noninvasive and nonradioactive treatment, high-energy ultrasound has been applied to skin diseases of vitiligo. Treatment achieved good clinical results. This article analyzes the structure of the original medical ultrasound system for vitiligo and finds the deficiencies and missing components of the system. On the basis of the original design scheme, a new structural scheme was designed, which solved the shortcomings of the original system and added missing parts. Subsequently, according to actual application requirements and specific component performance, the schematic design, including audio and video input, output and storage, DDR3, Ethernet, and the design of key circuits, such as power supply modules, are specifically introduced. Later, in the PCB design, the contents including stacking, layout, routing, and simulation of key signals were introduced in detail. The design includes a probe excitation signal generation module, excitation signal parameter control module, high voltage and temperature monitoring module, and corresponding power conversion module. This paper is mainly to develop a vitiligo skin disease heating treatment array system based on the principle of both cost and performance. This paper is based on the nonrigid registration algorithm of the FFD model and HPV interpolation and the nonrigid registration algorithm combining shape information and SIFT method. In the focused ultrasound treatment system, the image-guided positioning and monitoring functions are realized. Studies have shown that when the peak voltage of the transmitter circuit is 55 V, the sound power is 0.28 W. It can be seen that the transmitting circuit system designed in this article is a relatively stable and reliable system, which is suitable for the ultrasound treatment of vitiligo skin diseases.

Diagnostic Value of Elastography, Strain Ratio, and Elasticity to B-Mode Ratio and Color Doppler Ultrasonography in Breast Lesions

Purpose

The aim of this study was to investigate the sensitivity, specificity, and diagnostic accuracy of sonoelastography (SE), strain ratio (SR), elasticity to B-mode (E/B) ratio, and color Doppler ultrasonography (US) in suspected breast lesions.

Materials and Methods

This prospective study was conducted on women referred to Alzahra university hospital of Tabriz for annual screening of breast cancer between May 2017 and December 2018. B-mode US, SE, and color Doppler imaging were conducted in females with suspected mammography reports. The lesions in B-mode were classified according to the Breast Imaging Reporting and Data System (B-RADS). The results of SE imaging were graded based on five-grade SE score. SR and E/B ratio of each lesion were also analyzed in SE images. Color Doppler findings were categorized from 0 (no visible vessel) to 2 (> two vessels) based on the vascularity of the tumor. Pathology results were used as the gold standard to measure the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and diagnostic accuracy of each modality.

Results

One-hundred and ten breast lesions of 104 women aged 42.05±10.33 years were included in the study. Seventy-seven of the lesions were benign and 3 were malignant. Sensitivity and specificity of 97.0% and 77.9% for B-mode US, 93.9% and 87.0% for SE score, 81.8% and 66.2% for color Doppler US, 72.7% and 77.6% for E/B ratio (cutoff: 1.05), and 77.3% and 79.6% for SR (cutoff: 1.90) were obtained, respectively. Addition of SE score to B-mode US increased the sensitivity to 93.9%, specificity to 93.5%, and AUC from 0.95 to 0.97. Cumulative color Doppler US with B-mode US did not enhance the diagnostic accuracy of B-mode US.

Conclusion

SE was more effective than color Doppler US for distinguishing malignant from benign breast lesion. Among the three different SE features, five-grade SE score was superior to E/B ratio and SR.