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Huang JX, Liu FT, Sun L, Ma C, Fu J, Wang XY, Huang GL, Zhang YT, Pei XQ. Comparing shear wave elastography of breast tumors and axillary nodes in the axillary assessment after neoadjuvant chemotherapy in patients with node-positive breast cancer. LA RADIOLOGIA MEDICA 2024; 129:1143-1155. [PMID: 39060887 PMCID: PMC11322251 DOI: 10.1007/s11547-024-01848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Accurately identifying patients with axillary pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients remains challenging. PURPOSE To compare the feasibility of shear wave elastography (SWE) performed on breast tumors and axillary lymph nodes (LNs) in predicting the axillary status after NAC. MATERIALS AND METHODS This prospective study included a total of 319 breast cancer patients with biopsy-proven positive node who received NAC followed by axillary lymph node dissection from 2019 to 2022. The correlations between shear wave velocity (SWV) and pathologic characteristics were analyzed separately for both breast tumors and LNs after NAC. We compared the performance of SWV between breast tumors and LNs in predicting the axillary status after NAC. Additionally, we evaluated the performance of the most significantly correlated pathologic characteristic in breast tumors and LNs to investigate the pathologic evidence supporting the use of breast or axilla SWE. RESULTS Axillary pCR was achieved in 51.41% of patients with node-positive breast cancer. In breast tumors, there is a stronger correlation between SWV and collagen volume fraction (CVF) (r = 0.52, p < 0.001) compared to tumor cell density (TCD) (r = 0.37, p < 0.001). In axillary LNs, SWV was weakly correlated with CVF (r = 0.31, p = 0.177) and TCD (r = 0.29, p = 0.213). No significant correlation was found between SWV and necrosis proportion in breast tumors or axillary LNs. The predictive performances of both SWV and CVF for axillary pCR were found to be superior in breast tumors (AUC = 0.87 and 0.85, respectively) compared to axillary LNs (AUC = 0.70 and 0.74, respectively). CONCLUSION SWE has the ability to characterize the extracellular matrix, and serves as a promising modality for evaluating axillary LNs after NAC. Notably, breast SWE outperform axilla SWE in determining the axillary status in breast cancer patients after NAC.
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Affiliation(s)
- Jia-Xin Huang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- Department of Liver Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Feng-Tao Liu
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, China
| | - Lu Sun
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Chao Ma
- Department of Pathology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Jia Fu
- Department of Pathology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xue-Yan Wang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Gui-Ling Huang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yu-Ting Zhang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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Zhou P, Xiao Y, Zhou X, Fang J, Zhang J, Liu J, Guo L, Zhang J, Zhang N, Chen K, Zhao C. Mapping Spatiotemporal Heterogeneity in Multifocal Breast Tumor Progression by Noninvasive Ultrasound Elastography-Guided Mass Spectrometry Imaging Strategy. JACS AU 2024; 4:465-475. [PMID: 38425919 PMCID: PMC10900218 DOI: 10.1021/jacsau.3c00589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Spatiotemporal heterogeneity of tumors provides an escape mechanism for breast cancer cells, which can obstruct the investigation of tumor progression. While molecular profiling obtained from mass spectrometry imaging (MSI) is rich in biochemical information, it lacks the capacity for in vivo analysis. Ultrasound diagnosis has a high diagnostic accuracy but low chemical specificity. Here, we describe a noninvasive ultrasound elastography (UE)-guided MSI strategy (UEg-MSI) that integrates physical and biochemical characteristics of tumors acquired from both in vivo and in vitro imaging. Using UEg-MSI, both elasticity histopathology metabolism "fingerprints" and reciprocal crosstalk are revealed, indicating the intact, multifocal spatiotemporal heterogeneity of spontaneous tumorigenesis of the breast from early, middle, and late stages. Our results demonstrate a gradual increase in malignant degree of primary focus in cervical and thoracic mammary glands. This progression is characterized by increased stiffness according to elasticity scores, histopathological changes from hyperplasia to increased nests of neoplastic cells and necrotic areas, and regional metabolic heterogeneity and reprogramming at the spatiotemporal level. De novo fatty acid (FA) synthesis focused on independent (such as ω-9 FAs) and dependent (such as ω-6 FAs) dietary FA intake in the core cancerous nest areas in the middle and late stages of tumor or in the peripheral microareas in the early stage of the tumor. SM-Cer signaling pathway and GPs biosynthesis and degradation, as well as glycerophosphoinositol intensity, changed in multiple characteristic microareas. The UEg-MSI strategy holds the potential to expand MSI applications and enhance ultrasound-mediated cancer diagnosis. It offers new insight into early cancer discovery and the occurrence of metastasis.
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Affiliation(s)
- Peng Zhou
- Bionic
Sensing and Intelligence Center, Institute of Biomedical and Health
Engineering, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Department
of Ultrasound, First Affiliated Hospital of Shenzhen University Health
Science Center, Shenzhen Second People’s
Hospital, Shenzhen 518009, China
| | - Yu Xiao
- Department
of Thyroid and Breast department, First Affiliated Hospital of Shenzhen
University, Shenzhen Second People’s
Hospital, Shenzhen 518009, China
| | - Xin Zhou
- Bionic
Sensing and Intelligence Center, Institute of Biomedical and Health
Engineering, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jinghui Fang
- Department
of Ultrasound, First Affiliated Hospital of Shenzhen University Health
Science Center, Shenzhen Second People’s
Hospital, Shenzhen 518009, China
| | - Jingwen Zhang
- Department
of Ultrasound, First Affiliated Hospital of Shenzhen University Health
Science Center, Shenzhen Second People’s
Hospital, Shenzhen 518009, China
| | - Jianjun Liu
- Shenzhen
Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline
of Health Toxicology (2020-2024), Shenzhen
Center for Disease Control and Prevention, 518054, Shenzhen, China
| | - Ling Guo
- Shenzhen
Key Laboratory of Epigenetics and Precision Medicine for Cancers,
National Cancer Center/National Clinical Research Center for Cancer/Cancer
Hospital & Shenzhen Hospital, Chinese
Academic of Medical Sciences & Peking Union Medical College, Shenzhen 518172, China
| | - Jiuhong Zhang
- Shenzhen
Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline
of Health Toxicology (2020-2024), Shenzhen
Center for Disease Control and Prevention, 518054, Shenzhen, China
| | - Ning Zhang
- College
of Chemistry and Chemical Engineering, Dezhou
University, Dezhou 253026, Shandong, China
| | - Ke Chen
- Key
Laboratory of Resources Conversion and Pollution Control of the State
Ethnic Affairs Commission, College of Resources and Environmental
Science, South-Central Minzu University, Wuhan 430074, China
| | - Chao Zhao
- Bionic
Sensing and Intelligence Center, Institute of Biomedical and Health
Engineering, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Department
of Ultrasound, First Affiliated Hospital of Shenzhen University Health
Science Center, Shenzhen Second People’s
Hospital, Shenzhen 518009, China
- Shenzhen
Key Laboratory of Precision Diagnosis and Treatment of Depression, Shenzhen Institute of Advanced Technology, Chinese
Academy of Sciences, Shenzhen 518055, China
- University
of Chinese Academy of Sciences, Beijing 100049, China
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Wang S, Lan Z, Wan X, Liu J, Wen W, Peng Y. Correlation between Baseline Conventional Ultrasounds, Shear-Wave Elastography Indicators, and Neoadjuvant Therapy Efficacy in Triple-Negative Breast Cancer. Diagnostics (Basel) 2023; 13:3178. [PMID: 37891999 PMCID: PMC10605864 DOI: 10.3390/diagnostics13203178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
In patients with triple-negative breast cancer (TNBC)-the subtype with the poorest prognosis among breast cancers-it is crucial to assess the response to the currently widely employed neoadjuvant treatment (NAT) approaches. This study investigates the correlation between baseline conventional ultrasound (US) and shear-wave elastography (SWE) indicators and the pathological response of TNBC following NAT, with a specific focus on assessing predictive capability in the baseline state. This retrospective analysis was conducted by extracting baseline US features and SWE parameters, categorizing patients based on postoperative pathological grading. A univariate analysis was employed to determine the relationship between ultrasound indicators and pathological reactions. Additionally, we employed a receiver operating characteristic (ROC) curve analysis and multivariate logistic regression methods to evaluate the predictive potential of the baseline US indicators. This study comprised 106 TNBC patients, with 30 (28.30%) in a nonmajor histological response (NMHR) group and 76 (71.70%) in a major histological response (MHR) group. Following the univariate analysis, we found that T staging, dmax values, volumes, margin changes, skin alterations (i.e., thickening and invasion), retromammary space invasions, and supraclavicular lymph node abnormalities were significantly associated with pathological efficacy (p < 0.05). Combining clinical information with either US or SWE independently yielded baseline predictive abilities, with AUCs of 0.816 and 0.734, respectively. Notably, the combined model demonstrated an improved AUC of 0.827, with an accuracy of 76.41%, a sensitivity of 90.47%, a specificity of 55.81%, and statistical significance (p < 0.01). The baseline US and SWE indicators for TNBC exhibited a strong relationship with NAT response, offering predictive insights before treatment initiation, to a considerable extent.
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Affiliation(s)
| | | | | | | | | | - Yulan Peng
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Wai Nan Guo Xue Xiang 37, Chengdu 610041, China; (S.W.); (Z.L.); (X.W.); (J.L.); (W.W.)
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Albakr A, Ben-Israel D, Yang R, Kruger A, Alhothali W, Al Towim A, Lama S, Ajlan A, Riva-Cambrin J, Prada F, Al-Habib A, Sutherland GR. Ultrasound Elastography in Neurosurgery: Current Applications and Future Perspectives. World Neurosurg 2023; 170:195-205.e1. [PMID: 36336268 DOI: 10.1016/j.wneu.2022.10.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Similar to clinical palpation, Ultrasound elastography (USE) helps distinguish between tissues by providing information on their elasticity. While it has been widely explored and has been applied to many body organs, USE has not been studied as extensively for application in neurosurgery. The current systematic review was performed to identify articles related to the use of interoperative USE in neurosurgery. METHODS Search included MEDLINE(R) database. Only original peer-reviewed full-text articles were included. No language or publication year restrictions were imposed. Two independent reviewers assessed the search results for relevance. The identified articles were screened by title, abstract, and full-text review. RESULTS Seventeen articles were included in the qualitative analysis and 13 articles were related to oncology, epilepsy (n = 3), and spine (n = 1). In oncology, USE was found useful in defining tumor stiffness, aiding surgical planning, detecting residual tumors, discriminating between tumor and brain tissue, and differentiating between different tumors. In epilepsy, USE could improve the detection of epileptogenic foci, thereby enhancing the prospect of complete and safe resection. The application in spinal surgery was limited to demonstrating that a compressed spinal cord is stiffer than the decompressed one. CONCLUSIONS USE was found to be a safe, quick, portable, and economic tool that was a useful intraoperative adjunct to provide information corresponding to a variety of neurosurgical diseases, at different stages of surgery. This review describes the current intraoperative neurosurgical applications of USE, the concept of elasticity, and different USE modalities as well as the technical challenges, limitations, and possible future implications.
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Affiliation(s)
- Abdulrahman Albakr
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - David Ben-Israel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Runze Yang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alexander Kruger
- Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Wajda Alhothali
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Al Towim
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Sanju Lama
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Garnette R Sutherland
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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Wiacek A, Oluyemi E, Myers K, Ambinder E, Bell MAL. Coherence Metrics for Reader-Independent Differentiation of Cystic From Solid Breast Masses in Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:256-268. [PMID: 36333154 PMCID: PMC9712258 DOI: 10.1016/j.ultrasmedbio.2022.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
Traditional breast ultrasound imaging is a low-cost, real-time and portable method to assist with breast cancer screening and diagnosis, with particular benefits for patients with dense breast tissue. We previously demonstrated that incorporating coherence-based beamforming additionally improves the distinction of fluid-filled from solid breast masses, based on qualitative image interpretation by board-certified radiologists. However, variable sensitivity (range: 0.71-1.00 when detecting fluid-filled masses) was achieved by the individual radiologist readers. Therefore, we propose two objective coherence metrics, lag-one coherence (LOC) and coherence length (CL), to quantitatively determine the content of breast masses without requiring reader assessment. Data acquired from 31 breast masses were analyzed. Ideal separation (i.e., 1.00 sensitivity and specificity) was achieved between fluid-filled and solid breast masses based on the mean or median LOC value within each mass. When separated based on mean and median CL values, the sensitivity/specificity decreased to 1.00/0.95 and 0.92/0.89, respectively. The greatest sensitivity and specificity were achieved in dense, rather than non-dense, breast tissue. These results support the introduction of an objective, reader-independent method for automated diagnoses of cystic breast masses.
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Affiliation(s)
- Alycen Wiacek
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Eniola Oluyemi
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kelly Myers
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Emily Ambinder
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Muyinatu A Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
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Fitzjohn J, Zhou C, Chase JG. Breast cancer diagnosis using frequency decomposition of surface motion of actuated breast tissue. Front Oncol 2022; 12:969530. [DOI: 10.3389/fonc.2022.969530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
This paper presents a computationally simple diagnostic algorithm for breast cancer using a non-invasive Digital Image Elasto Tomography (DIET) system. N=14 women (28 breasts, 13 cancerous) underwent a clinical trial using the DIET system following mammography diagnosis. The screening involves steady state sinusoidal vibrations applied to the free hanging breast with cameras used to capture tissue motion. Image reconstruction methods provide surface displacement data for approximately 14,000 reference points on the breast surface. The breast surface was segmented into four radial and four vertical segments. Frequency decomposition of reference point motion in each segment were compared. Segments on the same vertical band were hypothesised to have similar frequency content in healthy breasts, with significant differences indicating a tumor, based on the stiffness dependence of frequency and tumors being 4~10 times stiffer than healthy tissue. Twelve breast configurations were used to test robustness of the method. Optimal breast configuration for the 26 breasts analysed (13 cancerous, 13 healthy) resulted in 85% sensitivity and 77% specificity. Combining two opposite configurations resulted in correct diagnosis of all cancerous breasts with 100% sensitivity and 69% specificity. Bootstrapping was used to fit a smooth receiver operator characteristic (ROC) curve to compare breast configuration performance with optimal area under the curve (AUC) of 0.85. Diagnostic results show diagnostic accuracy is comparable or better than mammography, with the added benefits of DIET screening, including portability, non-invasive screening, and no breast compression, with potential to increase screening participation and equity, improving outcomes for women.
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Spadaccini M, Koleth G, Emmanuel J, Khalaf K, Facciorusso A, Grizzi F, Hassan C, Colombo M, Mangiavillano B, Fugazza A, Anderloni A, Carrara S, Repici A. Enhanced endoscopic ultrasound imaging for pancreatic lesions: The road to artificial intelligence. World J Gastroenterol 2022; 28:3814-3824. [PMID: 36157539 PMCID: PMC9367228 DOI: 10.3748/wjg.v28.i29.3814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Early detection of pancreatic cancer has long eluded clinicians because of its insidious nature and onset. Often metastatic or locally invasive when symptomatic, most patients are deemed inoperable. In those who are symptomatic, multi-modal imaging modalities evaluate and confirm pancreatic ductal adenocarcinoma. In asymptomatic patients, detected pancreatic lesions can be either solid or cystic. The clinical implications of identifying small asymptomatic solid pancreatic lesions (SPLs) of < 2 cm are tantamount to a better outcome. The accurate detection of SPLs undoubtedly promotes higher life expectancy when resected early, driving the development of existing imaging tools while promoting more comprehensive screening programs. An imaging tool that has matured in its reiterations and received many image-enhancing adjuncts is endoscopic ultrasound (EUS). It carries significant importance when risk stratifying cystic lesions and has substantial diagnostic value when combined with fine needle aspiration/biopsy (FNA/FNB). Adjuncts to EUS imaging include contrast-enhanced harmonic EUS and EUS-elastography, both having improved the specificity of FNA and FNB. This review intends to compile all existing enhancement modalities and explore ongoing research around the most promising of all adjuncts in the field of EUS imaging, artificial intelligence.
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Affiliation(s)
- Marco Spadaccini
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Glenn Koleth
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - James Emmanuel
- Department of Gastroenterology and Hepatology, Queen Elizabeth, Kota Kinabalu 88200, Sabah, Malaysia
| | - Kareem Khalaf
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia 71122, Italy
| | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Hospital, Rozzano 20089, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Matteo Colombo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Benedetto Mangiavillano
- Digestive Endoscopy Unit, Division of Gasteroenterology, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
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Nonlinear Elasticity Assessment with Optical Coherence Elastography for High-Selectivity Differentiation of Breast Cancer Tissues. MATERIALS 2022; 15:ma15093308. [PMID: 35591642 PMCID: PMC9099511 DOI: 10.3390/ma15093308] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 12/05/2022]
Abstract
Soft biological tissues, breast cancer tissues in particular, often manifest pronounced nonlinear elasticity, i.e., strong dependence of their Young’s modulus on the applied stress. We showed that compression optical coherence elastography (C-OCE) is a promising tool enabling the evaluation of nonlinear properties in addition to the conventionally discussed Young’s modulus in order to improve diagnostic accuracy of elastographic examination of tumorous tissues. The aim of this study was to reveal and quantify variations in stiffness for various breast tissue components depending on the applied pressure. We discussed nonlinear elastic properties of different breast cancer samples excised from 50 patients during breast-conserving surgery. Significant differences were found among various subtypes of tumorous and nontumorous breast tissues in terms of the initial Young’s modulus (estimated for stress < 1 kPa) and the nonlinearity parameter determining the rate of stiffness increase with increasing stress. However, Young’s modulus alone or the nonlinearity parameter alone may be insufficient to differentiate some malignant breast tissue subtypes from benign. For instance, benign fibrous stroma and fibrous stroma with isolated individual cancer cells or small agglomerates of cancer cells do not yet exhibit significant difference in the Young’s modulus. Nevertheless, they can be clearly singled out by their nonlinearity parameter, which is the main novelty of the proposed OCE-based discrimination of various breast tissue subtypes. This ability of OCE is very important for finding a clean resection boundary. Overall, morphological segmentation of OCE images accounting for both linear and nonlinear elastic parameters strongly enhances the correspondence with the histological slices and radically improves the diagnostic possibilities of C-OCE for a reliable clinical outcome.
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9
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Gu JH, He C, Zhao QY, Jiang TA. Usefulness of new shear wave elastography in early predicting the efficacy of neoadjuvant chemotherapy for patients with breast cancer: where and when to measure is optimal? Breast Cancer 2022; 29:478-486. [PMID: 35038129 DOI: 10.1007/s12282-021-01327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND The aim of this study was to investigate the diagnosis performance of new shear wave elastography (sound touch elastography, STE) in the prediction of neoadjuvant chemotherapy (NAC) response at an early stage in breast cancer patients and to determine the optimal measurement locations around the lesion in different ranges. METHODS One hundred and eight patients were analyzed in this prospective study from November 2018 to December 2020. All patients completed NAC treatment and underwent STE examination at three time points [the day before NAC (t0); the day before the second course (t1); the day before third course (t2)]. The stiffness of the whole lesion (G), 1-mm shell (S1) and 2-mm shell (S2) around the lesion was expressed by STE parameters. The relative changes (∆stiffness) of STE parameters after the first and second course of NAC were calculated and shown as the variables [Δ(t1) and Δ(t2)]. The diagnostic accuracy of STE was evaluated by means of receiver operating characteristic curve analysis. RESULTS The ∆stiffness (%) including ∆Gmean(t2), ∆S1mean(t2) and ∆S2mean(t2) all showed significant differences between pathological complete response (pCR) and non-pCR groups. ∆S2mean(t2) displayed the best predictive performance for pCR (AUC = 0.842) with an ideal ∆stiffness threshold value - 26%. CONCLUSIONS Measuring the relative changes in the stiffness of surrounding tissue or entire lesion with STE holds promise for effectively predicting the response to NAC at its early stage for breast cancer patients and ∆stiffness of shell 2 mm after the second course of NAC may be a potential prediction parameter.
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Affiliation(s)
- Jiong-Hui Gu
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Chang He
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Qi-Yu Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Breast Tumour Classification Using Ultrasound Elastography with Machine Learning: A Systematic Scoping Review. Cancers (Basel) 2022; 14:cancers14020367. [PMID: 35053531 PMCID: PMC8773731 DOI: 10.3390/cancers14020367] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Breast cancer is one of the most common cancers among women globally. Early and accurate screening of breast tumours can improve survival. Ultrasound elastography is a non-invasive and non-ionizing imaging approach to characterize lesions for breast cancer screening, while machine learning techniques could improve the accuracy and reliability of computer-aided diagnosis. This review focuses on the state-of-the-art development and application of the machine learning model in breast tumour classification. Abstract Ultrasound elastography can quantify stiffness distribution of tissue lesions and complements conventional B-mode ultrasound for breast cancer screening. Recently, the development of computer-aided diagnosis has improved the reliability of the system, whilst the inception of machine learning, such as deep learning, has further extended its power by facilitating automated segmentation and tumour classification. The objective of this review was to summarize application of the machine learning model to ultrasound elastography systems for breast tumour classification. Review databases included PubMed, Web of Science, CINAHL, and EMBASE. Thirteen (n = 13) articles were eligible for review. Shear-wave elastography was investigated in six articles, whereas seven studies focused on strain elastography (5 freehand and 2 Acoustic Radiation Force). Traditional computer vision workflow was common in strain elastography with separated image segmentation, feature extraction, and classifier functions using different algorithm-based methods, neural networks or support vector machines (SVM). Shear-wave elastography often adopts the deep learning model, convolutional neural network (CNN), that integrates functional tasks. All of the reviewed articles achieved sensitivity ≥80%, while only half of them attained acceptable specificity ≥95%. Deep learning models did not necessarily perform better than traditional computer vision workflow. Nevertheless, there were inconsistencies and insufficiencies in reporting and calculation, such as the testing dataset, cross-validation, and methods to avoid overfitting. Most of the studies did not report loss or hyperparameters. Future studies may consider using the deep network with an attention layer to locate the targeted object automatically and online training to facilitate efficient re-training for sequential data.
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Majithia J, Haria P, Popat P, Katdare A, Chouhan S, Gala KB, Kulkarni S, Thakur M. Fat necrosis: A consultant's conundrum. Front Oncol 2022; 12:926396. [PMID: 36873302 PMCID: PMC9978799 DOI: 10.3389/fonc.2022.926396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/21/2022] [Indexed: 02/18/2023] Open
Abstract
Fat necrosis of the breast is a benign non-suppurative inflammation of the adipose tissue and often mimics breast cancers, posing a diagnostic challenge for the clinician and radiologist. It has a myriad of appearances on different imaging techniques, ranging from the pathognomic oil cyst and benign dystrophic calcifications to indeterminate focal asymmetries, architectural distortions, and masses. A combination of different modalities can assist a radiologist in reaching a logical conclusion to avoid unnecessary interventions. The aim of this review article was to provide a comprehensive literature on the various imaging appearances of fat necrosis in the breast. Although a purely benign entity, the imaging appearances on mammography, contrast-enhanced mammography, ultrasound, and magnetic resonance imaging can be quite misleading, especially in post-therapy breasts. The purpose is to provide a comprehensive and all-inclusive review on fat necrosis with a proposed algorithm allowing a systematic approach to diagnosis.
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Affiliation(s)
| | - Purvi Haria
- Radiology Department, Tata Memorial Hospital, Mumbai, India
| | - Palak Popat
- Radiology Department, Tata Memorial Hospital, Mumbai, India
| | - Aparna Katdare
- Radiology Department, Tata Memorial Hospital, Mumbai, India
| | - Sonal Chouhan
- Radiology Department, Tata Memorial Hospital, Mumbai, India
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12
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Shao Y, Hashemi HS, Gordon P, Warren L, Wang J, Rohling R, Salcudean S. Breast Cancer Detection using Multimodal Time Series Features from Ultrasound Shear Wave Absolute Vibro-Elastography. IEEE J Biomed Health Inform 2021; 26:704-714. [PMID: 34375294 DOI: 10.1109/jbhi.2021.3103676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In shear wave absolute vibro-elastography (S-WAVE), a steady-state multi-frequency external mechanical excitation is applied to tissue, while a time-series of ultrasound radio-frequency (RF) data are acquired. Our objective is to determine the potential of S-WAVE to classify breast tissue lesions as malignant or benign. We present a new processing pipeline for feature-based classification of breast cancer using S-WAVE data, and we evaluate it on a new data set collected from 40 patients. Novel bi-spectral and Wigner spectrum features are computed directly from the RF time series and are combined with textural and spectral features from B-mode and elasticity images. The Random Forest permutation importance ranking and the Quadratic Mutual Information methods are used to reduce the number of features from 377 to 20. Support Vector Machines and Random Forest classifiers are used with leave-one-patient-out and Monte Carlo cross-validations. Classification results obtained for different feature sets are presented. Our best results (95% confidence interval, Area Under Curve = 95%1.45%, sensitivity = 95%, and specificity = 93%) outperform the state-of-the-art reported S-WAVE breast cancer classification performance. The effect of feature selection and the sensitivity of the above classification results to changes in breast lesion contours is also studied. We demonstrate that time-series analysis of externally vibrated tissue as an elastography technique, even if the elasticity is not explicitly computed, has promise and should be pursued with larger patient datasets. Our study proposes novel directions in the field of elasticity imaging for tissue classification.
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Wang J, Fan H, Zhu Y, Shen C, Qiang B. The value of automated breast volume scanner combined with virtual touch tissue quantification in the differential diagnosis of benign and malignant breast lesions: A comparative study with mammography. Medicine (Baltimore) 2021; 100:e25568. [PMID: 33879713 PMCID: PMC8078319 DOI: 10.1097/md.0000000000025568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/29/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the diagnostic value of automated breast volume scanner (ABVS) combined with virtual touch tissue quantification (VTQ) in the differential diagnosis of breast lesions.In this retrospective study, 183 patients (mean age, 49.8 ± 8.2 years) with 218 breast lesions underwent ABVS, VTQ, and mammography (MG). All lesions were confirmed by postoperative histopathology. A logistic regression model was constructed to generate a receiver operating characteristic (ROC) curve, calculate the area under the ROC curve (AUC), and compare and evaluate the diagnostic performance of ABVS, VTQ, MG, and ABVS combined with VTQ (ABVS-VTQ).The sensitivity, specificity, and accuracy of ABVS, VTQ, MG, and ABVS-VTQ in diagnosing breast lesions were 94.01% (110/117), 96.03% (97/101), and 94.95% (207/218); 80.34% (94/117), 94.05% (95/101), and 86.69% (189/218); 70.08% (82/117), 68.31% (69/101), and 69.26% (151/218); and 96.58% (113/117), 96.03% (97/101), and 96.33% (210/218), respectively. The AUC of ABVS-VTQ was higher than that of the other examinations alone. The detection rate of ABVS (100%, 218/218) was higher than that of MG (78.89%, 172/218), and the difference was statistically significant (χ2 = 51.426, P < .001).The combined application of ABVS and VTQ can improve the accuracy and specificity of the diagnosis and is a promising ultrasound method for the differential diagnosis of breast lesions.
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Affiliation(s)
- Junli Wang
- Department of Ultrasound, Wuhu No. 2 People's Hospital, Wuhu, Anhui 241001
| | - Hongjie Fan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Yuting Zhu
- Department of Ultrasound, Wuhu No. 2 People's Hospital, Wuhu, Anhui 241001
| | - Chunyun Shen
- Department of Ultrasound, Wuhu No. 2 People's Hospital, Wuhu, Anhui 241001
| | - Banghong Qiang
- Department of Ultrasound, Wuhu No. 2 People's Hospital, Wuhu, Anhui 241001
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Singh M, Nair A, Aglyamov SR, Larin KV. Compressional Optical Coherence Elastography of the Cornea. PHOTONICS 2021; 8:111. [PMID: 37727230 PMCID: PMC10508915 DOI: 10.3390/photonics8040111] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Assessing the biomechanical properties of the cornea is crucial for detecting the onset and progression of eye diseases. In this work, we demonstrate the application of compression-based optical coherence elastography (OCE) to measure the biomechanical properties of the cornea under various conditions, including validation in an in situ rabbit model and a demonstration of feasibility for in vivo measurements. Our results show a stark increase in the stiffness of the corneas as IOP was increased. Moreover, UV-A/riboflavin corneal collagen crosslinking (CXL) also dramatically increased the stiffness of the corneas. The results were consistent across 4 different scenarios (whole CXL in situ, partial CXL in situ, whole CXL in vivo, and partial CXL in vivo), emphasizing the reliability of compression OCE to measure corneal biomechanical properties and its potential for clinical applications.
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Affiliation(s)
- Manmohan Singh
- Department of Biomedical Engineering, University of Houston, 3517 Cullen Blvd., Room 2027, Houston, TX 77204, USA
| | - Achuth Nair
- Department of Biomedical Engineering, University of Houston, 3517 Cullen Blvd., Room 2027, Houston, TX 77204, USA
| | - Salavat R. Aglyamov
- Department of Mechanical Engineering, University of Houston, 4726 Calhoun Rd., Room N207, Houston, TX 77204, USA
| | - Kirill V. Larin
- Department of Biomedical Engineering, University of Houston, 3517 Cullen Blvd., Room 2027, Houston, TX 77204, USA
- Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, BCM335, Houston, TX 77030, USA
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15
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Sinha D, Kundaragi NG, Sharma S, Kale SK. Can strain elastography be used in reclassification of indeterminate breast lesions in BIRADS lexicon?: A prospective study. Indian J Radiol Imaging 2021; 30:493-499. [PMID: 33737779 PMCID: PMC7954173 DOI: 10.4103/ijri.ijri_425_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/16/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the role of strain elastography (SE) in reclassification of indeterminate breast lesions placed under BIRADS 3 and 4 categories by conventional ultrasound (US) parameters so as to recourse biopsy only for suspicious stiffer lesions. Methods 113 breast lesions in 100 women assigned as BIRADS category 3 and 4 on US parameters were prospectively evaluated by SE followed by histo-pathological examination. Strain ratio (SR) and Elastography Score (ES) were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality and diagnostic performance were compared. The best cut-off point was calculated for each of the elastography parameter using the receiver operator curve analysis (ROC). Results Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). A statistically significant difference was observed in the AUC for ES and conventional US: 0.98 vs 0.90 (Difference = 0.08, P = 0.02). Elastography parameters were more specific as compared to US (ES-94.5 & SR-93.2% vs 63%, P < 0.05) with high NPV. SE performed better in BIRADS 4 category lesions. On the basis of elastography parameters, 85% of BIRADS 4 category lesions were correctly predicted as benign with overall sensitivity, specificity and diagnostic accuracy of elastography being 97%, 84.6% and 91.9%. Among BIRADS 3 category lesions, 97% were correctly predicted as benign and 50% lesions were correctly predicted as malignant with a sensitivity of 50%, specificity of 97.8% and diagnostic accuracy of 94%. Conclusion Strain elastography is a useful adjunct to conventional ultrasonography for the assessment of indeterminate breast lesions and may help in avoiding unnecessary follow ups and biopsies. Elastography score is a better parameter as compared to strain ratio.
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Affiliation(s)
- Dimpi Sinha
- Department of Radiology, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Nischal G Kundaragi
- Department of Interventional Radiology, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Sukrity Sharma
- Department of Radiology, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Sudhir K Kale
- Department of Radiology, Aster CMI Hospital, Bangalore, Karnataka, India
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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Lian KM, Lin T. The value of color-map virtual touch tissue imaging (CMV) in the differential diagnosis of benign and malignant breast lesions. Clin Hemorheol Microcirc 2021; 78:49-56. [PMID: 33523047 DOI: 10.3233/ch-201088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Researchers have evaluated the virtual touch tissue imaging (VTI) value in the diagnosis of breast lesions, mostly based on gray-scale. PURPOSE This study aimed to evaluate the value of color-map virtual touch tissue imaging (CMV) in the diagnosis of breast lesions. METHODS We retrospectively analyzed the VTI images of 55 breast lesions in 49 female patients who underwent an examination of breast lesions in our hospital from January 2019 to December 2019. The pathological results were taken as the gold standard. The receiver operating characteristic (ROC) curve of CMV was analyzed, and its diagnostic performance was evaluated. Weighted Kappa (k) statistics were used to assess the inter-observer agreement for CMV. RESULTS A total of 55 breast lesions were included, including 19 malignant lesions and 36 benign lesions. Multivariate analysis showed that patients with higher CMV scores (P = 0.014, odds ratio [OR] = 13.667, 95% confidence interval = 1.702-109.773) were independent predictors of breast cancer. The sensitivity, specificity, and the area under curve (AUC) of CMV were 94.47%, 72.22%, and 0.912. The CMV's inter-observer agreement was almost perfect among radiologists with different work experience (k = 0.854, standard error = 0.049, 95% CI = 0.758-0.950). CONCLUSIOS CMV has high accuracy and repeatability in the diagnosis of malignant breast lesions.
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Affiliation(s)
- Kai-Mei Lian
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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18
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Lai HW, Lyv GR, Wei YT, Zhou T. The diagnostic value of two-dimensional shear wave elastography in gestational diabetes mellitus. Placenta 2020; 101:147-153. [PMID: 32980791 DOI: 10.1016/j.placenta.2020.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of our study is to establish the reference range of Young's modulus values of placenta in normal pregnancies and to evaluate the diagnostic value of two-dimensional shear wave elastography (2D-SWE) in gestational diabetes mellitus (GDM). METHODS A total of 223 normal pregnant women, 22 pregnancies complicated by A1GDM (controlled by diet), and 14 pregnancies complicated by A2GDM (controlled by medication) were recruited for this study. The elasticity values of the central parts of the placentas were determined by 2D-SWE imaging. The mean value (Emean), min value (Emin), and max value (Emax) of the placentas were recorded. Twenty placentas were randomly selected for reliability analysis. RESULTS (1) All values (Emean, Emin, Emax) showed great repeatability and consistency. (2) The reference range of Young's modulus values of placentas in normal pregnancies were Emean (4.12 ± 0.83), Emin (2.15 ± 0.83) and Emax (6.72 ± 1.43). No significant correlations were observed between elasticity values and gestational age (r < 0.3, p > 0.05) or between elasticity values and placental maturity (r < 0.3, p > 0.05). (3) The Young's modulus values in the A1 GDM and A2 GDM women were Emean (6.39 ± 1.74), Emin (2.95 ± 1.05), Emax (10.78 ± 2.94) and Emean (11.96 ± 7.29), Emin (6.79 ± 4.70a), Emax (18.94 ± 11.61) respectively. All values were significantly higher in GDM pregnancies than in normal pregnancies (p < 0.05). A2GDM pregnancies had higher values than A1GDM pregnancies (p < 0.05). CONCLUSION Placental elasticity is independent of gestational age and placental maturity. 2D-SWE can play an important role in diagnosing GDM by assessing placental hardness.
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Affiliation(s)
- Hong-Wei Lai
- The Second Affiliated Hospital of Fujian Medical University, China
| | - Guo-Rong Lyv
- The Second Affiliated Hospital of Fujian Medical University, China; Quanzhou Medical College, China.
| | - Yu-Ting Wei
- Fujian Medical University Affiliated First Quanzhou Hospital, China
| | - Ting Zhou
- The Second Affiliated Hospital of Fujian Medical University, China
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Patel BK, Samreen N, Zhou Y, Chen J, Brandt K, Ehman R, Pepin K. MR Elastography of the Breast: Evolution of Technique, Case Examples, and Future Directions. Clin Breast Cancer 2020; 21:e102-e111. [PMID: 32900617 DOI: 10.1016/j.clbc.2020.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
Recognizing that breast cancers present as firm, stiff lesions, the foundation of breast magnetic resonance elastography (MRE) is to combine tissue stiffness parameters with sensitive breast MR contrast-enhanced imaging. Breast MRE is a non-ionizing, cross-sectional MR imaging technique that provides for quantitative viscoelastic properties, including tissue stiffness, elasticity, and viscosity, of breast tissues. Currently, the technique continues to evolve as research surrounding the use of MRE in breast tissue is still developing. In the setting of a newly diagnosed cancer, associated desmoplasia, stiffening of the surrounding stroma, and necrosis are known to be prognostic factors that can add diagnostic information to patient treatment algorithms. In fact, mechanical properties of the tissue might also influence breast cancer risk. For these reasons, exploration of breast MRE has great clinical value. In this review, we will: (1) address the evolution of the various MRE techniques; (2) provide a brief overview of the current clinical studies in breast MRE with interspersed case examples; and (3) suggest directions for future research.
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Affiliation(s)
| | | | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic, Phoenix, AZ
| | - Jun Chen
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Kathy Brandt
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Kay Pepin
- Department of Radiology, Mayo Clinic, Rochester, MN
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Sinha D, Sharma S, Kundaragi NG, Kale SK. Added value of strain elastography in the characterisation of breast lesions: A prospective study. ULTRASOUND (LEEDS, ENGLAND) 2020; 28:164-173. [PMID: 32831889 PMCID: PMC7412947 DOI: 10.1177/1742271x20912762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/21/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion. PURPOSE To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US). METHODS In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis. RESULTS Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%. CONCLUSION Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.
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Affiliation(s)
- Dimpi Sinha
- Department of Radio Diagnosis, Aster CMI Hospital, Bengaluru, India
| | - Sukrity Sharma
- Department of Radio Diagnosis, Aster CMI Hospital, Bengaluru, India
| | - Nischal G Kundaragi
- Department of Interventional Radiology, Aster CMI Hospital, Bengaluru, India
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21
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Li Y, Polyak D, Johnson E, Yecies D, Shevidi S, de la Zerda A, Gephart MH, Chu S. Difference-Frequency Ultrasound Imaging With Non-Linear Contrast. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1759-1766. [PMID: 31804930 PMCID: PMC8189081 DOI: 10.1109/tmi.2019.2957280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Conventional ultrasound imaging is based on the scattering of sound from inhomogeneities in the density and the speed of sound and is often used in medicine to resolve pathologic compared to normal tissue. Here we demonstrate a difference-frequency ultrasound (dfUS) imaging method that is based on the interaction of two sound pulses that propagate non-collinearly and intersect in space and time. The dfUS signal arises primarily from the second-order non-linear coefficient, a contrast mechanism that differs from linear and harmonic US imaging. The distinct contrast mechanism allows dfUS to image anatomic features that are not identifiable in conventional US images of salmon and pig kidney tissue. Further, dfUS produces enhanced contrast of glioblastoma tumor implanted in the mouse brain, revealing its potential for improving medical diagnosis. Progress towards a real-time system is discussed.
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Zhang S, Wan J, Liu H, Yao M, Xiang L, Fang Y, Jia L, Wu R. Value of conventional ultrasound, ultrasound elasticity imaging, and acoustic radiation force impulse elastography for prediction of malignancy in breast lesions. Clin Hemorheol Microcirc 2020; 74:241-253. [PMID: 31683464 DOI: 10.3233/ch-180527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Shupin Zhang
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Department of Medical Ultrasound, Shanghai First People’s Hospital Baoshan Branch, Shanghai, China
| | - Jing Wan
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Minghua Yao
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Lihua Xiang
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Yan Fang
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Liqiong Jia
- Department of Medical Ultrasound, Shanghai First People’s Hospital Baoshan Branch, Shanghai, China
| | - Rong Wu
- Department of Ultrasound in Medical, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ultrasound in Medical, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Zhang L, Dong YJ, Zhou JQ, Jia XH, Li S, Zhan WW. Similar Reproducibility for Strain and Shear Wave Elastography in Breast Mass Evaluation: A Prospective Study Using the Same Ultrasound System. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:981-991. [PMID: 31980291 DOI: 10.1016/j.ultrasmedbio.2019.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to evaluate the inter-operator reproducibility of strain elastography (SE) and shear wave elastography (SWE) in three groups: all lesions, benign lesions and malignant lesions. Ninety-one lesions from ninety-one women were examined by SE and SWE from January 2017 to December 2017 by two radiologists. The reproducibility of elastic score, SE strain ratio and SWE Young's modulus between operators was prospectively evaluated. There was good agreement on elasticity score, with κ values of 0.711, 0.640 and 0.766. The intra-class correlation coefficients of the strain ratio, mean elastic modulus (Emean), maximum elastic modulus (Emax) and elastic modulus standard deviation (Esd) ranged from 0.723-0.876, which indicated good and excellent agreement. We concluded that both SE and SWE had good reproducibility among different operators using the same probe in the same ultrasound instrument. Strain elasticity score was more consistent among operators in malignant breast tumors. There was better agreement on strain elastic ratio and shear wave elasticity among operators in benign breast lesions.
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Affiliation(s)
- Lu Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Jie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiao-Hong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ShuangShuang Li
- Ultrasound Imaging System Development Department, Shenzhen Mindray Bio-Medical Electronics Co. Ltd, Nanshan, Shenzhen, China
| | - Wei-Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Jin Y, Walker E, Krokhin A, Heo H, Choi TY, Neogi A. Enhanced Instantaneous Elastography in Tissues and Hard Materials Using Bulk Modulus and Density Determined Without Externally Applied Material Deformation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:624-634. [PMID: 31675326 DOI: 10.1109/tuffc.2019.2950343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ultrasound is a continually developing technology that is broadly used for fast, non-destructive mechanical property detection of hard and soft materials in applications ranging from manufacturing to biomedical. In this study, a novel monostatic longitudinal ultrasonic pulsing elastography imaging method is introduced. The existing elastography methods require an acoustic radiational or dynamic compressive externally applied force to determine the effective bulk modulus or density. This new, passive M-mode imaging technique does not require an external stress and can be effectively used for both soft and hard materials. Strain map imaging and shear wave elastography are two current categories of M-mode imaging that show both relative and absolute elasticity information. The new technique is applied to hard materials and soft material tissue phantoms for demonstrating effective bulk modulus and effective density mapping. When compared with standard techniques, the effective parameters fall within 10% of standard characterization methods for both hard and soft materials. As neither the standard A-mode imaging technique nor the presented technique require an external applied force, the techniques are applied to composite heterostructures and the findings presented for comparison. The presented passive M-mode technique is found to have enhanced resolution over standard A-mode modalities.
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Farooq F, Mubarak S, Shaukat S, Khan N, Jafar K, Mahmood T, Saeed MA. Value of Elastography in Differentiating Benign from Malignant Breast Lesions Keeping Histopathology as Gold Standard. Cureus 2019; 11:e5861. [PMID: 31763084 PMCID: PMC6834091 DOI: 10.7759/cureus.5861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions. Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard. Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical Centre, Karachi. All consecutive patients undergoing breast biopsy and elastography of breast lesions were enlisted; 2 x 2 tables were used to measure the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of breast ultrasound elastography for differentiation of benign from malignant breast masses. Results: A total of 155 female patients were included with a mean age of 45.41 ± 14.24 years (range 20-70 years). On histological evaluation, 115 (74.2%) lesions were malignant and 40 (25.8%) were benign. The overall average mean elastography value was 108.45 kPa ± 52.75. The mean elastography (EMean) value for benign breast lesions was 48.96 kPa ± 42.32 and 132.78 kPa ± 42.32 for malignant lesions. The difference in mean elastography values of benign and malignant breast lesions was statistically significant (48.96 kPa ± 42.32 vs 32.78 kPa ± 42.32, P <0.001). The area under the curve (AUC) was 0.952, optimal cutoff EMean value of 72 kPa and higher likelihood ratio was 9.41. A cutoff mean elastography (EMean) value of ≤ 72 kilopascal (kPa) for benign lesions had sensitivity 92.17%, specificity 90.4%, PPV 96.36%, NPV 80.0% and diagnostic accuracy 91.61%. Conclusion: Ultrasound elastography was found to have high sensitivity and specificity and diagnostic accuracy for differentiating benign from malignant breast lesions. Use of shear-wave elastography may increase malignancy detection rate by reducing the need for biopsy in benign breast lesions.
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Affiliation(s)
- Faryal Farooq
- Diagnostic Radiology, Jinnah Post Graduate Medical Centre, Karachi, PAK
| | - Syed Mubarak
- Diagnostic Radiology, Karachi Medical and Dental College, Karachi, PAK
| | - Shaista Shaukat
- Radiology, Jinnah Post Graduate Medical Centre, Karachi, PAK
| | - Noman Khan
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Tariq Mahmood
- Radiology, Jinnah Post Graduate Medical Centre, Karachi, PAK
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Fernandes J, Sannachi L, Tran WT, Koven A, Watkins E, Hadizad F, Gandhi S, Wright F, Curpen B, El Kaffas A, Faltyn J, Sadeghi-Naini A, Czarnota G. Monitoring Breast Cancer Response to Neoadjuvant Chemotherapy Using Ultrasound Strain Elastography. Transl Oncol 2019; 12:1177-1184. [PMID: 31226518 PMCID: PMC6586920 DOI: 10.1016/j.tranon.2019.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023] Open
Abstract
Strain elastography was used to monitor response to neoadjuvant chemotherapy (NAC) in 92 patients with biopsy-proven, locally advanced breast cancer. Strain elastography data were collected before, during, and after NAC. Relative changes in tumor strain ratio (SR) were calculated over time, and responder status was classified according to tumor size changes. Statistical analyses determined the significance of changes in SR over time and between response groups. Machine learning techniques, such as a naïve Bayes classifier, were used to evaluate the performance of the SR as a marker for Miller-Payne pathological endpoints. With pathological complete response (pCR) as an endpoint, a significant difference (P < .01) in the SR was observed between response groups as early as 2 weeks into NAC. Naïve Bayes classifiers predicted pCR with a sensitivity of 84%, specificity of 85%, and area under the curve of 81% at the preoperative scan. This study demonstrates that strain elastography may be predictive of NAC response in locally advanced breast cancer as early as 2 weeks into treatment, with high sensitivity and specificity, granting it the potential to be used for active monitoring of tumor response to chemotherapy.
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Affiliation(s)
- Jason Fernandes
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Lakshmanan Sannachi
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA; Physical Sciences, Sunnybrook Research Institute, Toronto, CA
| | - William T Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA; Department of Radiation Oncology, University of Toronto, Toronto, CA; Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK; Institute of Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, CA
| | - Alexander Koven
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Elyse Watkins
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Farnoosh Hadizad
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Sonal Gandhi
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Frances Wright
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, CA
| | - Ahmed El Kaffas
- Physical Sciences, Sunnybrook Research Institute, Toronto, CA
| | - Joanna Faltyn
- Physical Sciences, Sunnybrook Research Institute, Toronto, CA
| | - Ali Sadeghi-Naini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA; Department of Radiation Oncology, University of Toronto, Toronto, CA; Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, CA; Physical Sciences, Sunnybrook Research Institute, Toronto, CA
| | - Gregory Czarnota
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CA; Department of Radiation Oncology, University of Toronto, Toronto, CA; Department of Medical Biophysics, University of Toronto, Toronto, CA; Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, CA; Physical Sciences, Sunnybrook Research Institute, Toronto, CA.
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Histopathology and elastography discordance in evaluation of breast lesions with acoustic radiation force impulse elastography. Pol J Radiol 2019; 84:e224-e233. [PMID: 31481994 PMCID: PMC6717941 DOI: 10.5114/pjr.2019.86852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose It is known that, besides its benefits, ultrasound (US) elastography may show discordance findings, leading to biopsy, so this technique has some limitations. The purpose of the present study was to compare histopathological results and shear wave velocity (SWV) values in patients, to reveal discordance findings, and to investigate its statistical significance in making the decision for biopsy with SWV values. Material and methods A total of 190 patients presenting with breast lesions were included in the study. The mean age of the patients was 39.87 ± 13.56 years. All morphological features of lesions were evaluated by B-mode US. The mean SWV values were measured using the region of interest (ROI) through all lesions with ARFI elastography. An ultrasound-guided Tru-Cut needle biopsy was performed, and histopathologic data were obtained. Results The SWV values of false positive benign lesions, such as: granulomatous mastitis, sclerosing adenosis, chronic inflammation, fat necrosis, fibrotic breast tissue, and scar tissue, were as high as the SWV values of malignant lesions. Sensitivity was found as 91.6% and specificity as 40.9% for SWV values in ARFI US. Conclusions Our results showed that breast lesions showed false positivity (59.1%) and false negativity (8.3%) in ARFI US. Elastography is useful and sensitive in the evaluation of breast lesions, but some benign lesions may mimic malignant lesions; thus, this information should not be underestimated in biopsy decision-making for elastography users.
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Dória MT, Jales RM, Conz L, Derchain SFM, Sarian LOZ. Diagnostic accuracy of shear wave elastography – Virtual touch™ imaging quantification in the evaluation of breast masses: Impact on ultrasonography’s specificity and its ultimate clinical benefit. Eur J Radiol 2019; 113:74-80. [DOI: 10.1016/j.ejrad.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 12/18/2022]
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Hari S, Paul SB, Vidyasagar R, Dhamija E, Adarsh AD, Thulkar S, Mathur S, Sreenivas V, Sharma S, Srivastava A, Seenu V, Prashad R. Breast mass characterization using shear wave elastography and ultrasound. Diagn Interv Imaging 2018; 99:699-707. [PMID: 30006125 DOI: 10.1016/j.diii.2018.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the role of SWE in characterizing breast masses and ascertain whether additional use of SWE to ultrasound for evaluating BI-RADS 3 and 4a masses could help reduce long-term follow-up and unnecessary biopsies of these suspicious breast masses. MATERIALS AND METHODS This prospective, cross-sectional study was performed between June 2013 and November 2014. All enrolled patients underwent clinical breast examination, ultrasound, SWE and ultrasound-guided core biopsy of the breast mass. Breast Imaging Reporting and Data System (BI-RAD) categories were assigned to breast masses. For qualitative and quantitative variables of SWE, cut-off values for differentiation between benign and malignant breast masses were estimated. Modified BIRADS' (up/downgrading of BIRADS category) was done for BI-RADS 3/4a masses by combining individual SWE parameters and ultrasound findings. Sensitivity, specificity, positive and negative predictive value of modified BI-RADS' and ultrasound BI-RADS were compared. RESULTS A total of 119 women (mean age, 42.3±13.6 [SD] years; range: 13-87 years) with a single breast mass each were enrolled. Histopathologically, 57/119 (48%) breast masses were benign and 62 (52%) were malignant. On ultrasound, 42 breast masses were BI-RADS3 and 77 were BI-RADS 4 (4a, n=10; 4b, n=24; 4c, n=43) leading to 96.8% sensitivity and 70.2% specificity. On SWE, benign breast masses were oval/round, homogenous/reasonably homogenous, blue/green with lower elasticity values and malignant breast masses were irregular, inhomogeneous, red/orange with high elasticity values. On modified BI-RADS' using E-color and E-mean/E-max, specificity improved to 78.9% and 75.4% respectively. CONCLUSION Addition of SWE to ultrasound improves characterization of BI-RADS 3 and 4a masses. E-max, E-mean and E-color are the most useful SWE parameters to differentiate between malignant and benign breast masses.
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Affiliation(s)
- S Hari
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S B Paul
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India.
| | - R Vidyasagar
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - E Dhamija
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - A D Adarsh
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S Thulkar
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S Mathur
- Departments of Pathology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - V Sreenivas
- Departments of Biostatistics, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S Sharma
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - A Srivastava
- Departments of Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - V Seenu
- Departments of Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - R Prashad
- Departments of Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
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Zou H, Xue Y, Ou Y, Li S, Zhao Y, Shao L, Li Y. Factors Affecting the Quality of Breast Quasistatic Ultrasound Elastograms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1701-1712. [PMID: 29288591 DOI: 10.1002/jum.14518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/01/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore factors affecting the quality of quasistatic ultrasound elastograms of the breast and to evaluate their accuracy in distinguishing benign and malignant breast lesions. METHODS A total of 663 patients with 702 breast lesions were recruited. All patients received both conventional ultrasonography and quasistatic elastography. Patients' breast lesions were divided into A and B groups according to satisfactory and unsatisfactory elastographic examinations. Group A included 590 satisfactory elastograms, whereas Group B included 112 unsatisfactory elastograms. Various factors-maximum depth of the lesion, maximum transverse diameter of the lesion, thickness of the adipose layer, thickness of the glandular layer, thickness of the breast, distance between the nipple and lesion, age, body mass index, and menopausal status-were analyzed and compared between the groups to gauge their effects on the quality of the elastograms. RESULTS Significantly deeper lesions, higher maximum transverse lesion diameters, thicker adipose layers, thicker glandular layers, and thicker breasts were identified in group B patients compared to group A patients (P < .05). Multivariate logistic regression analyses showed that the maximum depth of the lesion, thickness of the adipose layer, and thickness of the breast were independent factors in the quality of elastograms. The area under the curve for the maximum depth of the lesion was 0.986 with the optimal cutoff threshold of 2.5 cm. CONCLUSIONS Quasistatic elastography can be a supplementary approach to conventional ultrasonography in helping improve the diagnostic accuracy of breast lesions. The depth and size of breast lesions are correlated with the quality of elastograms.
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Affiliation(s)
- Hongsheng Zou
- Department of Surgical Intensive Care Unit, People's Hospital of Rongcheng, Rongcheng, China
| | - Yan Xue
- Department of Statistics, Jinan Child Hospital, Jinan, China
| | - Yang Ou
- Department of Graduate School, School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Zhangqiu, China
- Departments of Hepatobiliary Surgery, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Sheng Li
- Departments of Hepatobiliary Surgery, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yuehuan Zhao
- Department of Special Diagnosis, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Limei Shao
- Department of Special Diagnosis, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yunling Li
- Department of Special Diagnosis, Shandong Cancer Hospital, affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China
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Bae SJ, Park JT, Park AY, Youk JH, Lim JW, Lee HW, Lee HM, Ahn SG, Son EJ, Jeong J. Ex Vivo Shear-Wave Elastography of Axillary Lymph Nodes to Predict Nodal Metastasis in Patients with Primary Breast Cancer. J Breast Cancer 2018; 21:190-196. [PMID: 29963115 PMCID: PMC6015987 DOI: 10.4048/jbc.2018.21.2.190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/20/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose There is still a clinical need to easily evaluate the metastatic status of lymph nodes during breast cancer surgery. We hypothesized that ex vivo shear-wave elastography (SWE) would predict precisely the presence of metastasis in the excised lymph nodes. Methods A total of 63 patients who underwent breast cancer surgery were prospectively enrolled in this study from May 2014 to April 2015. The excised axillary lymph nodes were examined using ex vivo SWE. Metastatic status was confirmed based on the final histopathological diagnosis of the permanent section. Lymph node characteristics and elasticity values measured by ex vivo SWE were assessed for possible association with nodal metastasis. Results A total of 274 lymph nodes, harvested from 63 patients, were examined using ex vivo SWE. The data obtained from 228 of these nodes from 55 patients were included in the analysis. Results showed that 187 lymph nodes (82.0%) were nonmetastatic and 41 lymph nodes (18.0%) were metastatic. There was significant difference between metastatic and nonmetastatic nodes with respect to the mean (45.4 kPa and 17.7 kPa, p<0.001) and maximum (55.3 kPa and 23.2 kPa, p<0.001) stiffness. The elasticity ratio was higher in the metastatic nodes (4.36 and 1.57, p<0.001). Metastatic nodes were significantly larger than nonmetastatic nodes (mean size, 10.5 mm and 7.5 mm, p<0.001). The size of metastatic nodes and nodal stiffness were correlated (correlation coefficient of mean stiffness, r=0.553). The area under curve of mean stiffness, maximum stiffness, and elasticity ratio were 0.794, 0.802, and 0.831, respectively. Conclusion Ex vivo SWE may be a feasible method to predict axillary lymph node metastasis intraoperatively in patients undergoing breast cancer surgery.
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Affiliation(s)
- Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Tae Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Park
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Lim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Woo Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Min Lee
- Department of Surgery, International St. Mary' Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Wang JW, Guo ZX, Lin QG, Zheng W, Zhuang SL, Lin SY, Li AH, Pei XQ. Ultrasound elastography as an imaging biomarker for detection of early tumor response to chemotherapy in a murine breast cancer model: a feasibility study. Br J Radiol 2018; 91:20170698. [PMID: 29400545 DOI: 10.1259/bjr.20170698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study investigated the feasibility of using strain elastography (SE) and real time shear wave elastography (RT-SWE) to evaluate early tumor response to cytotoxic chemotherapy in a murine xenograft breast cancer tumor model. METHODS MCF-7 breast cancer-bearing nude mice were treated with either cisplatin 2 mg kg-1 plus paclitaxel 10 mg kg-1 (treatment group) or sterile saline (control group) once daily for 5 days. The tumor elasticity was measured by SE or RT-SWE before and after therapy. Tumor cell density was assessed by hematoxylin and eosin staining, and the ratio of collagen fibers in the tumor was evaluated by Van Gieson staining. The correlation between tumor elasticity, as determined by SE and SWE, as well as the pathological tumor responses were analyzed. RESULTS Chemotherapy significantly attenuated tumor growth compared to the control treatment (p < 0.05). Chemotherapy also significantly increased tumor stiffness (p < 0.05) and significantly decreased (p < 0.05) tumor cell density compared with the control. Moreover, chemotherapy significantly increased the ratio of collagen fibers (p < 0.05). Tumor stiffness was positively correlated with the ratio of collagen fibers but negatively correlated with tumor cell density. CONCLUSION The study suggests that ultrasound elastography by SE and SWE is a feasible tool for assessing early responses of breast cancer to chemotherapy in our murine xenograft model. Advances in knowledge: This study showed that the tumor elasticity determined by ultrasound elastography could be a feasible imaging biomarker for assessing very early therapeutic responses to chemotherapy.
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Affiliation(s)
- Jian-Wei Wang
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
| | - Zhi-Xing Guo
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
| | - Qing-Guang Lin
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
| | - Wei Zheng
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
| | - Shu-Lian Zhuang
- 2 Department of Ultrasound, Guangdong Provincial Traditional Chinese Medicine Hospital, the second affiliated hospital of Guangzhou University of traditional Chinese medicine , Guangzhou , PR China
| | - Shi-Yang Lin
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
| | - An-Hua Li
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
| | - Xiao-Qing Pei
- 1 Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou , PR China
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Zhou C, Chase JG, Ismail H, Signal MK, Haggers M, Rodgers GW, Pretty C. Silicone phantom validation of breast cancer tumor detection using nominal stiffness identification in digital imaging elasto-tomography (DIET). Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Differential diagnostic performance of acoustic radiation force impulse imaging in small (≤20 mm) breast cancers: Is it valuable? Sci Rep 2017; 7:8650. [PMID: 28819203 PMCID: PMC5561200 DOI: 10.1038/s41598-017-08004-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/07/2017] [Indexed: 01/22/2023] Open
Abstract
To evaluate acoustic radiation force impulse (ARFI) inthe differential diagnosis of small (≤20 mm) solid breast lesions and identify the most efficient ARFI parameters. Conventional ultrasonography and ARFIwere performed in 120 patients with 121 small solid breast lesions. The area ratios (ARs) of the lesion on virtual touch tissue compared to B-mode were calculated. The shear wave velocity of the inner (SWVi) and boundary (SWVb) of the lesions and surrounding fatty tissue (SWVf) was measured. The ratio of SWVi to SWVf (SWVrat) was calculated. AR, SWVi, SWVb, and SWVrat were significantly larger in malignant lesions (all P < 0.001). A cutoff AR of 1.17 yielded the highest area under the receiver operating characteristic curveamong the various parameters (91.2% sensitivity, 85.9% specificity, 88.4% accuracy) for the differential diagnosis of small breast lesions, but this value did not significantly differ from SWVi (P = 0.1144). This AR cutoff indowngradingcategory 4a to category 3 would avoid 83.3% unnecessary biopsies, and improved diagnostic specificity up to 73.4% without decreasing sensitivity. AR and SWVi are efficient parameters for the differential diagnosis of small breast lesions, whichwill improve diagnostic specificity and reduce unnecessary biopsies.
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Hawley JR, Kalra P, Mo X, Raterman B, Yee LD, Kolipaka A. Quantification of breast stiffness using MR elastography at 3 Tesla with a soft sternal driver: A reproducibility study. J Magn Reson Imaging 2017; 45:1379-1384. [PMID: 27779802 PMCID: PMC5395339 DOI: 10.1002/jmri.25511] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Previous studies of breast MR elastography (MRE) evaluated the technique at magnetic field strengths of 1.5 Tesla (T) with the breast in contact with the driver. The aim of this study is to evaluate breast stiffness measurements and their reproducibility using a soft sternal driver at 3T and compare the results with qualitative measures of breast density. MATERIALS AND METHODS Twenty-two healthy volunteers each underwent two separate breast MRE scans in a 3T MRI. MRE vibrations were introduced into the breasts at 60 Hz using a soft sternal driver and axial slices were collected using a gradient echo MRE sequence. Mean stiffness measurements were calculated for each volunteer as well as a measure of reproducibility using concordance correlation between scans. Mean stiffness values for each volunteer were assessed and related to amounts of fibroglandular tissue (i.e., breast lobules, ducts, and fibrous connective tissue). RESULTS The stiffness values were reproducible with a significant P-value < 0.0001 between two scans with concordance correlation of 0.87 and 0.91 for center slice and grouping all slices, respectively. Volunteers with dense breasts (i.e., higher grades of fibroglandular tissue) had mean stiffness values of 0.96 kPa (center slice) and 0.92 kPa (all slices) while those without dense breasts had mean stiffness values of 0.85 kPa (center slice) and 0.83 kPa (all slices) (P ≤ 0.05). CONCLUSION Breast MRE is a reproducible technique at 3T using a soft sternal driver. Dense breasts had significantly higher stiffness measurements compared with nondense breasts. LEVEL OF EVIDENCE 2 J. MAGN. RESON. IMAGING 2017;45:1379-1384.
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Affiliation(s)
- Jeffrey R. Hawley
- Department of Radiology, The Ohio State University Wexner Medical Center Columbus, Ohio
| | - Prateek Kalra
- Department of Radiology, The Ohio State University Wexner Medical Center Columbus, Ohio
| | - Xiaokui Mo
- Department of Radiology, The Ohio State University Wexner Medical Center Columbus, Ohio
| | - Brian Raterman
- Department of Radiology, The Ohio State University Wexner Medical Center Columbus, Ohio
| | - Lisa D. Yee
- Department of Surgical Oncology, The Ohio State University Wexner Medical Center Columbus, Ohio
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center Columbus, Ohio
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Bojanic K, Katavic N, Smolic M, Peric M, Kralik K, Sikora M, Vidačić K, Pacovski M, Stimac D, Ivanac G. Implementation of Elastography Score and Strain Ratio in Combination with B-Mode Ultrasound Avoids Unnecessary Biopsies of Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:804-816. [PMID: 28094066 DOI: 10.1016/j.ultrasmedbio.2016.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/15/2016] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to evaluate whether the combination of B-mode ultrasound, elastography score (ES) and strain ratio (SR) improves diagnostic performance with respect to breast lesions. One hundred thirty lesions were prospectively evaluated by B-mode ultrasound and strain elastography, followed by fine-needle aspiration cytology/biopsy in 117 woman who were scheduled for regular breast BUS. The median ES (4.5 vs. 2.9, p < 0.001) and SR (4.9 vs. 2.3, p < 0.001) were significantly higher for malignant than for benign lesions. A sensitivity of 90.5% and specificity of 93.2% for the ES (cutoff point = 3.8) and a sensitivity of 87.5% and specificity of 87.6% for the SR (cutoff point = 3.5) were obtained. Elastography combined with B-mode ultrasound improved the specificity, accuracy and positive predictive value. Receiver operating characteristic curves yielded a higher value for the combined technique for diagnosis of breast lesions. Routine use of such a diagnostic algorithm could reduce the number of unnecessary biopsies.
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Affiliation(s)
- Kristina Bojanic
- Department of Radiology, Health Center Osijek, Osijek, Croatia; Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.
| | - Natasa Katavic
- Department of Radiology, Health Center Osijek, Osijek, Croatia
| | - Martina Smolic
- Department of Mineral Metabolism, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia; Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Marija Peric
- Department of Cytology, University Hospital Center Osijek, Osijek, Croatia
| | - Kristina Kralik
- Department of Statistics, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Miroslav Sikora
- Department of Oral Pathology, Health Center Osijek, Osijek, Croatia; Department of Dental Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | | | - Mirta Pacovski
- Department of Radiology, Health Center Osijek, Osijek, Croatia
| | - Damir Stimac
- Department of Biophysics and Radiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Gordana Ivanac
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
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Sigrist RM, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017; 7:1303-1329. [PMID: 28435467 PMCID: PMC5399595 DOI: 10.7150/thno.18650] [Citation(s) in RCA: 915] [Impact Index Per Article: 130.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 12/15/2022] Open
Abstract
Elastography-based imaging techniques have received substantial attention in recent years for non-invasive assessment of tissue mechanical properties. These techniques take advantage of changed soft tissue elasticity in various pathologies to yield qualitative and quantitative information that can be used for diagnostic purposes. Measurements are acquired in specialized imaging modes that can detect tissue stiffness in response to an applied mechanical force (compression or shear wave). Ultrasound-based methods are of particular interest due to its many inherent advantages, such as wide availability including at the bedside and relatively low cost. Several ultrasound elastography techniques using different excitation methods have been developed. In general, these can be classified into strain imaging methods that use internal or external compression stimuli, and shear wave imaging that use ultrasound-generated traveling shear wave stimuli. While ultrasound elastography has shown promising results for non-invasive assessment of liver fibrosis, new applications in breast, thyroid, prostate, kidney and lymph node imaging are emerging. Here, we review the basic principles, foundation physics, and limitations of ultrasound elastography and summarize its current clinical use and ongoing developments in various clinical applications.
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Affiliation(s)
- Rosa M.S. Sigrist
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Joy Liau
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Maria Cristina Chammas
- Department of Ultrasound, Institute of Radiology, Hospital das Clínicas, Medical School of University of São Paulo
| | - Juergen K. Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
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Diagnostic Value of ARFI (Acoustic Radiation Force Impulse) in Differentiating Benign From Malignant Breast Lesions. Acad Radiol 2017; 24:45-52. [PMID: 27765598 DOI: 10.1016/j.acra.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 01/06/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to correlate acoustic radiation force impulse (ARFI) imaging velocities with the pathology results and to evaluate the ability of ARFI in distinguishing benign from malignant breast lesions. MATERIALS AND METHODS B-mode ultrasonography (US) and ARFI were performed in patients with previously diagnosed and selected breast lesions for biopsy. Shear wave velocity (SWV) was measured inside lesions and in the surrounding parenchyma (m/s). SWV measurements as well as lesion-to-parenchyma ratio (LPR) were compared between benign and malignant lesions, and receiver operating characteristic (ROC) curves were plotted. Two blinded readers independently classified the lesions as benign or malignant in two separate reading sessions, one using B-mode US alone and the other using a combined set of B-mode US and ARFI. RESULTS Eighty-one patients with a total of 92 breast lesions were included (57 benign and 35 malignant nodules). SWV inside lesions were significantly higher for malignant neoplasms compared to benign (medians of 9.1 m/s vs 3.5 m/s; P < 0.001). LPR was also significantly higher for malignant lesions (3.0 vs 1.4; P < 0.001). Parenchyma SWV had no differences between groups (P = 0.071). ROC curves showed a significant discriminative power for lesion SWV (area under the curve [AUC] = 0.980; P < 0.001) and LPR (AUC = 0.954; P < 0.001). For lesion measures, a cutoff of 6.593 m/s was obtained, with sensitivity and specificity of 88.6% and 96.5%, respectively. CONCLUSIONS ARFI provides quantitative elasticity measurements, adding valuable complementary information to B-mode ultrasound, that can potentially help in breast lesion characterization and assisting the decision for biopsy recommendations.
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Yuan S, Magarik M, Lex AM, Fleischer AC. Clinical applications of sonoelastography. Expert Rev Med Devices 2016; 13:1107-1117. [DOI: 10.1080/17434440.2016.1257938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Han Z, Li J, Singh M, Wu C, Liu CH, Raghunathan R, Aglyamov SR, Vantipalli S, Twa MD, Larin KV. Optical coherence elastography assessment of corneal viscoelasticity with a modified Rayleigh-Lamb wave model. J Mech Behav Biomed Mater 2016; 66:87-94. [PMID: 27838594 DOI: 10.1016/j.jmbbm.2016.11.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 01/22/2023]
Abstract
The biomechanical properties of the cornea play a critical role in forming vision. Diseases such as keratoconus can structurally degenerate the cornea causing a pathological loss in visual acuity. UV-A/riboflavin corneal collagen crosslinking (CXL) is a clinically available treatment to stiffen the cornea and restore its healthy shape and function. However, current CXL techniques do not account for pre-existing biomechanical properties of the cornea nor the effects of the CXL treatment itself. In addition to the inherent corneal structure, the intraocular pressure (IOP) can also dramatically affect the measured biomechanical properties of the cornea. In this work, we present the details and development of a modified Rayleigh-Lamb frequency equation model for quantifying corneal biomechanical properties. After comparison with finite element modeling, the model was utilized to quantify the viscoelasticity of in situ porcine corneas in the whole eye-globe configuration before and after CXL based on noncontact optical coherence elastography measurements. Moreover, the viscoelasticity of the untreated and CXL-treated eyes was quantified at various IOPs. The results showed that the stiffness of the cornea increased after CXL and that corneal stiffness is close to linear as a function of IOP. These results show that the modified Rayleigh-Lamb wave model can provide an accurate assessment of corneal viscoelasticity, which could be used for customized CXL therapies.
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Affiliation(s)
- Zhaolong Han
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - Jiasong Li
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - Manmohan Singh
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - Chen Wu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - Chih-Hao Liu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - Raksha Raghunathan
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - Salavat R Aglyamov
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712, United States
| | - Srilatha Vantipalli
- College of Optometry, University of Houston, Houston, TX 77204, United States
| | - Michael D Twa
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Kirill V Larin
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States; Interdisciplinary Laboratory of Biophotonics, Tomsk State University, Tomsk, Russia; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, United States.
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Ma Y, Zhang S, Zang L, Li J, Li J, Kang Y, Ren W. Combination of shear wave elastography and Ki-67 index as a novel predictive modality for the pathological response to neoadjuvant chemotherapy in patients with invasive breast cancer. Eur J Cancer 2016; 69:86-101. [PMID: 27821323 DOI: 10.1016/j.ejca.2016.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/03/2016] [Accepted: 09/26/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE This study evaluated shear wave elastography (SWE) and SWE combined with the Ki-67 index as novel predictive modalities for the pathological response of invasive breast cancer to neoadjuvant chemotherapy (NAC). METHODS The prospective study recruited 66 eligible patients from July 2014 to November 2015. Tumour stiffness, which corresponds with tumour progression and invasiveness, was assessed by quantitative SWE 1 d before biopsy (time point t0, elasticity E0), 1 d before next NAC cycle (t1-t5, E1-E5), and 1 d before surgery (t6, E6). The relative changes in SWE parameters after the first and second NAC cycles were considered as the variables [ΔE (t1), ΔE (t2)]. The pathological response was classified according to the residual cancer burden (RCB) protocol. Correlations between RCB scores and variables were evaluated. The predictive diagnostic performances of SWE parameters, Ki-67 index, and the predictive RCB (predRCB) score determined by a linear regression model were compared. RESULTS Some immunohistochemical and molecular factors and SWE parameters were significantly different among the three RCB groups. The ΔEmean (t2) and Ki-67 had significantly better diagnostic performance than other parameters regarding predicting the pathological response (the RCB-I response and RCB-III resistance). However, the correlation between ΔEmean (t2) and Ki-67 index was significantly weaker as a diagnostic predictor (r = 0.29). We generated a new predictive modality, predRCB, which is a multivariable linear regression model that combines ΔEmean (t2) and the Ki-67 index. The predRCB modality showed better diagnostic performance than SWE parameters and Ki-67 index alone. CONCLUSION Our findings highlight the potential utility for adding the Ki-67 index to the SWE results, which may improve the predictive power of SWE and facilitate personalising the treatment regimens of patients with breast cancer. These results should be validated in the future by performing a multicentre prospective study with a larger cohort.
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Affiliation(s)
- Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Li Zang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jing Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jianyi Li
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
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Han Z, Singh M, Aglyamov SR, Liu CH, Nair A, Raghunathan R, Wu C, Li J, Larin KV. Quantifying tissue viscoelasticity using optical coherence elastography and the Rayleigh wave model. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:90504. [PMID: 27653931 PMCID: PMC5028422 DOI: 10.1117/1.jbo.21.9.090504] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/30/2016] [Indexed: 05/02/2023]
Abstract
This study demonstrates the feasibility of using the Rayleigh wave model (RWM) in combination with optical coherence elastography (OCE) technique to assess the viscoelasticity of soft tissues. Dispersion curves calculated from the spectral decomposition of OCE-measured air-pulse induced elastic waves were used to quantify the viscoelasticity of samples using the RWM. Validation studies were first conducted on 10% gelatin phantoms with different concentrations of oil. The results showed that the oil increased the viscosity of the gelatin phantom samples. This method was then used to quantify the viscoelasticity of chicken liver. The Young’s modulus of the chicken liver tissues was estimated as E=2.04±0.88??kPa with a shear viscosity ?=1.20±0.13??Pa?s. The analytical solution of the RWM correlated very well with the OCE-measured phased velocities (R2=0.96±0.04). The results show that the combination of the RWM and OCE is a promising method for noninvasively quantifying the biomechanical properties of soft tissues and may be a useful tool for detecting disease.
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Affiliation(s)
- Zhaolong Han
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Manmohan Singh
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Salavat R. Aglyamov
- University of Texas at Austin, Department of Biomedical Engineering, 107 West Dean Keeton Street, Stop C0800, Austin, Texas 78712, United States
| | - Chih-Hao Liu
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Achuth Nair
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Raksha Raghunathan
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Chen Wu
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Jiasong Li
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
| | - Kirill V. Larin
- University of Houston, Department of Biomedical Engineering, 3605 Cullen Boulevard, Houston, Texas 77204, United States
- Tomsk State University, Interdisciplinary Laboratory of Biophotonics, 36 Lenin Avenue, Tomsk 634050, Russia
- Baylor College of Medicine, Molecular Physiology and Biophysics, One Baylor Plaza, Houston, Texas 77030, United States
- Address correspondence to: Kirill V. Larin, E-mail:
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Trottmann M, Marcon J, D’Anastasi M, Bruce M, Stief C, Reiser M, Buchner A, Clevert D. Shear-wave elastography of the testis in the healthy man – determination of standard values. Clin Hemorheol Microcirc 2016; 62:273-81. [DOI: 10.3233/ch-162046] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M. Trottmann
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - J. Marcon
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - M. D’Anastasi
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - M.F. Bruce
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - C.G. Stief
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - M.F. Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - A. Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - D.A. Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
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Wada H, Yasufuku K. Reply to Uramoto et al. Eur J Cardiothorac Surg 2015; 49:1539. [PMID: 26419773 DOI: 10.1093/ejcts/ezv343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/03/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hironobu Wada
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Canada
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