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Niu Q, Zhao L, Wang R, Du L, Shi Q, Jia C, Li G, Jin L, Li F. Predictive value of contrast-enhanced ultrasonography and ultrasound elastography for management of BI-RADS category 4 nonpalpable breast masses. Eur J Radiol 2024; 173:111391. [PMID: 38422608 DOI: 10.1016/j.ejrad.2024.111391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The objective of this study was to investigate the independent risk factors and associated predictive values of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and strain elastography (SE) for high-risk lesions (HRL) and malignant tumors (MT) among nonpalpable breast masses classified as BI-RADS category 4 on conventional ultrasound. METHODS This prospective study involved consecutively admitted patients with breast tumors from January 2018, aiming to explore the management of BI-RADS category 4 breast tumors using CEUS and elastography. We conducted a retrospective review of patient data, focusing on those with a history of a nonpalpable mass as the primary complaint. Pathologic findings after surgical resection served as the gold standard. The CEUS arterial-phase indices were analyzed using contrast agent arrival-time parametric imaging processing mode, while quantitative and qualitative indices were examined on ES images. Independent risk factors were identified through binary logistic regression multifactorial analysis. The predictive efficacy of different modalities was compared using a receiver operating characteristics curve. Subsequently, a nomogram for predicting the risk of HRL/MT was established based on a multifactorial logistic regression model. RESULTS A total of 146 breast masses from 146 patients were included, comprising 80 benign tumors, 12 HRLs, and 54 MTs based on the final pathology. There was no significant difference in pathologic size between the benign and HRL/MT groups [8.00(6.25,10.00) vs. 9.00(6.00,10.00), P = 0.506]. The diagnostic efficacy of US plus CEUS exceeded that of US plus SWE/SE for BI-RADS 4 nonpalpable masses, with an AUC of 0.954 compared to 0.798/0.741 (P < 0.001). Further stratified analysis revealed a more pronounced improvement for reclassification of BI-RADS 4a masses (AUC: 0.943 vs. 0.762/0.675, P < 0.001) than BI-RADS 4b (AUC:0.950 vs. 0.885/0.796, P>0.05) with the assistance of CEUS than SWE/SE. Employing downgrade CEUS strategies resulted in negative predictive values ranging from 95.2 % to 100.0 % for BI-RADS 4a and 4b masses. Conversely, using upgrade nomogram strategies, which included the independent predictive risk factors of irregular enhanced shape, poor defined enhanced margin, earlier enhanced time, increased surrounding vessels, and presence of contrast agent retention, the diagnostic performance achieved an AUC of 0.947 with good calibration. CONCLUSION After investigating the potential of CEUS and ES in improving risk assessment and diagnostic accuracy for nonpalpable BI-RADS category 4 breast masses, it is evident that CEUS has a more significant impact on enhancing classification compared to ES, particularly for BI-RADS 4a subgroup masses. This finding suggests that CEUS may offer greater benefits in improving risk assessment and diagnostic accuracy for this specific subgroup of breast masses.
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Affiliation(s)
- Qinghua Niu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruitao Wang
- Department of Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Niu Q, Li H, Du L, Wang R, Lin J, Chen A, Jia C, Jin L, Li F. Development of a Multi-Parametric ultrasonography nomogram for prediction of invasiveness in ductal carcinoma in situ. Eur J Radiol 2024; 175:111415. [PMID: 38471320 DOI: 10.1016/j.ejrad.2024.111415] [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: 12/03/2023] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the independent risk variables associated with the potential invasiveness of ductal carcinoma in situ (DCIS) on multi-parametric ultrasonography, and further construct a nomogram for risk assessment. METHODS Consecutive patients from January 2017 to December 2022 who were suspected of having ductal carcinoma in situ (DCIS) based on magnetic resonance imaging or mammography were prospectively enrolled. Histopathological findings after surgical resection served as the gold standard. Grayscale ultrasound, Doppler ultrasound, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) examinations were preoperative performed. Binary logistic regression was used for multifactorial analysis to identify independent risk factors from multi-parametric ultrasonography. The correlation between independent risk factors and pathological prognostic markers was analyzed. The predictive efficacy of DCIS associated with invasiveness was assessed by logistic analysis, and a nomogram was established. RESULTS A total of 250 DCIS lesions were enrolled from 249 patients, comprising 85 pure DCIS and 165 DCIS with invasion (DCIS-IDC), of which 41 exhibited micro-invasion. The multivariate analysis identified independent risk factors for DCIS with invasion on multi-parametric ultrasonography, including image size (>2cm), Doppler ultrasound RI (≥0.72), SWE's Emax (≥66.4 kPa), hyper-enhancement, centripetal enhancement, increased surrounding vessel, and no contrast agent retention on CEUS. These factors correlated with histological grade, Ki-67, and human epidermal growth factor receptor 2 (HER2) (P < 0.1). The multi-parametric ultrasound approach demonstrated good predictive performance (sensitivity 89.7 %, specificity 73.8 %, AUC 0.903), surpassing single US modality or combinations with SWE or CEUS modalities. Utilizing these factors, a predictive nomogram achieved a respectable performance (AUC of 0.889) for predicting DCIS with invasion. Additionally, a separate nomogram for predicting DCIS with micro-invasion, incorporating independent risk factors such as RI (≥0.72), SWE's Emax (≥65.2 kPa), and centripetal enhancement, demonstrated an AUC of 0.867. CONCLUSION Multi-parametric ultrasonography demonstrates good discriminatory ability in predicting both DCIS with invasion and micro-invasion through the analysis of lesion morphology, stiffness, neovascular architecture, and perfusion. The use of a nomogram based on ultrasonographic images offers an intuitive and effective method for assessing the risk of invasion in DCIS. Although the nomogram is not currently considered a clinically applicable diagnostic tool due to its AUC being below the threshold of 0.9, further research and development are anticipated to yield positive outcomes and enhance its viability for clinical utilization.
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Affiliation(s)
- Qinghua Niu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruitao Wang
- Department of Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Lin
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - An Chen
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Yao J, Zhou W, Zhu Y, Zhou J, Chen X, Zhan W. Predictive nomogram using multimodal ultrasonographic features for axillary lymph node metastasis in early‑stage invasive breast cancer. Oncol Lett 2024; 27:95. [PMID: 38288042 PMCID: PMC10823315 DOI: 10.3892/ol.2024.14228] [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: 08/10/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
Axillary lymph node (ALN) status is a key prognostic factor in patients with early-stage invasive breast cancer (IBC). The present study aimed to develop and validate a nomogram based on multimodal ultrasonographic (MMUS) features for early prediction of axillary lymph node metastasis (ALNM). A total of 342 patients with early-stage IBC (240 in the training cohort and 102 in the validation cohort) who underwent preoperative conventional ultrasound (US), strain elastography, shear wave elastography and contrast-enhanced US examination were included between August 2021 and March 2022. Pathological ALN status was used as the reference standard. The clinicopathological factors and MMUS features were analyzed with uni- and multivariate logistic regression to construct a clinicopathological and conventional US model and a MMUS-based nomogram. The MMUS nomogram was validated with respect to discrimination, calibration, reclassification and clinical usefulness. US features of tumor size, echogenicity, stiff rim sign, perfusion defect, radial vessel and US Breast Imaging Reporting and Data System category 5 were independent risk predictors for ALNM. MMUS nomogram based on these factors demonstrated an improved calibration and favorable performance [area under the receiver operator characteristic curve (AUC), 0.927 and 0.922 in the training and validation cohorts, respectively] compared with the clinicopathological model (AUC, 0.681 and 0.670, respectively), US-depicted ALN status (AUC, 0.710 and 0.716, respectively) and the conventional US model (AUC, 0.867 and 0.894, respectively). MMUS nomogram improved the reclassification ability of the conventional US model for ALNM prediction (net reclassification improvement, 0.296 and 0.288 in the training and validation cohorts, respectively; both P<0.001). Taken together, the findings of the present study suggested that the MMUS nomogram may be a promising, non-invasive and reliable approach for predicting ALNM.
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Affiliation(s)
- Jiejie Yao
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Ying Zhu
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
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Togawa R, Pfob A, Büsch C, Fastner S, Gomez C, Goncalo M, Hennigs A, Killinger K, Nees J, Riedel F, Schäfgen B, Stieber A, Tozaki M, Heil J, Barr R, Golatta M. Intra- and Interobserver Reliability of Shear Wave Elastography in Breast Cancer Diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:109-114. [PMID: 37772458 DOI: 10.1002/jum.16344] [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: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Shear wave elastography (SWE) is increasingly used in breast cancer diagnostics. However, large, prospective, multicenter data evaluating the reliability of SWE is missing. We evaluated the intra- and interobserver reliability of SWE in patients with breast lesions categorized as BIRADS 3 or 4. METHODS We used data of 1288 women at 12 institutions in 7 countries with breast lesions categorized as BIRADS 3 to 4 who underwent conventional B-mode ultrasound and SWE. 1243 (96.5%) women had three repetitive conventional B-mode ultrasounds as well as SWE measurements performed by a board-certified senior physician. 375 of 1288 (29.1%) women received an additional ultrasound examination with B-mode and SWE by a second physician. Intraclass correlation coefficients (ICC) were calculated to examine intra- and interobserver reliability. RESULTS ICC for intraobserver reliability showed an excellent correlation with ICC >0.9, while interobserver reliability was moderate with ICC of 0.7. There were no clinically significant differences in intraobserver reliability when SWE was performed in lesions categorized as BI-RADS 3 or 4 as well as in histopathologically benign or malignant lesions. CONCLUSION Reliability of additional SWE was evaluated on a study cohort consisting of 1288 breast lesions categorized as BI-RADS 3 and 4. SWE shows an excellent intraobserver reliability and a moderate interobserver reliability in the evaluation of solid breast masses.
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Affiliation(s)
- Riku Togawa
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | | | - Manuela Goncalo
- Department of Radiology, University of Coimbra, Coimbra, Portugal
| | - André Hennigs
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Kristina Killinger
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Nees
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Schäfgen
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Jörg Heil
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Richard Barr
- Department of Radiology, Northeast Ohio Medical University, Ravenna, USA
| | - Michael Golatta
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
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Huang X, Chen X, Chen X, Chi P, Wang P, Zhan X, Zou C, Wang L, Dong Y. Sound touch elastography of Achilles tendons in patients with type 2 diabetes mellitus versus healthy adults. Diabetol Metab Syndr 2023; 15:174. [PMID: 37599363 PMCID: PMC10440868 DOI: 10.1186/s13098-023-01148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND The studies of the effect of diabetes on the stiffness of Achilles tendon (AT) tissue remain inconclusive, we believe it is necessary to find a reliable method which can be used to detect the stiffness changes of the AT in the diabetic state. The objective of the present study was to investigate the effectiveness of sound touch elastography (STE) as a tool for detecting diabetic Achilles tendinopathy. METHODS We conducted a retrospective review of 180 participants, consisting of 82 patients with type 2 diabetes mellitus (T2DM) and 98 healthy adults, who had undergone AT ultrasonography. Young 's modulus (E) values of the distal, middle, and proximal segments of bilateral ATs of all participants were measured using STE technique. The E values of each AT segment between the case and control group were compared. RESULTS The E values of the three segments of ATs in T2DM patients were lower than the healthy controls (P < 0.05). In both groups, the E values of the distal segments were lower than those of the middle segments, and the latter were lower than those of the proximal segments (P < 0.05). The E value of each segment of AT was inversely related to FPG, HbA1c, and diabetes duration (P < 0.05). The best cut-off points for the E values of the three segments of the AT for detecting diabetic tendinopathy were 347.44 kPa (AUC, 0.779), 441.57 kPa (AUC, 0.692), and 484.35 kPa (AUC, 0.676), respectively. CONCLUSION STE can be used as a complementary diagnostic tool for the diagnosis of diabetic Achilles tendinopathy.
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Affiliation(s)
- Xinxin Huang
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Xingyu Chen
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Xiu Chen
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Ping Chi
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Pengfei Wang
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Xiaomei Zhan
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Chunpeng Zou
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China.
| | - Liang Wang
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China.
| | - Yanyan Dong
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China.
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Zhong X, Chen L, Long H, Zheng R, Su L, Duan Y, Xie X, Lin M. The "stiff rim" sign of hepatocellular carcinoma on shear wave elastography: correlation with pathological features and potential prognostic value. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4115-4125. [PMID: 35962810 DOI: 10.1007/s00261-022-03628-9] [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: 07/01/2022] [Revised: 07/01/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To explore the pathologic basis, the influencing factors and potential prognostic value of the stiff rim sign in two-dimensional shear wave elastography (2D-SWE) of hepatocellular carcinoma (HCC). METHODS HCC patients who underwent tumor 2D-SWE examination before resection were prospectively enrolled. The stiff rim sign was defined as increased stiffness in the peritumoral region. Interobserver and intraobserver variability of the stiff rim sign was assessed. The correlation between the stiff rim sign and pathological characteristics was analyzed. Multivariate analysis was performed to examine clinical and radiological factors influencing the appearance of stiff rim sign. The Kaplan-Meier method was used to analyze the relationship between recurrence-free survival (RFS) and the stiff rim sign. RESULTS The stiff rim sign on 2D-SWE was present in 44.7% of HCC lesions. Interobserver agreement and intraobserver agreement for the stiff rim sign were substantial (κ = 0.772) and almost perfect (κ = 0.895), respectively. Pathologically, the stiff rim sign was associated with capsule status, capsule integrity, capsule thickness, proportion of peritumoral fibrous tissue, and peritumoral fibrous arrangement. Multivariate analysis showed that tumor size was an independent clinical predictor for the appearance of stiff rim sign (OR 1.201, p = 0.008). Kaplan-Meier analysis showed RFS was significantly poorer in the stiff rim sign (+) group than the stiff rim sign (-) group in solitary tumors smaller than 5 cm (p = 0.007) and solitary tumors with intratumoral stiffness less than 33.7 kPa (p = 0.007). CONCLUSION The stiff rim sign on 2D-SWE was mainly correlated with peritumoral fibrous tissue status and was a poor prognostic indicator for HCC.
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Affiliation(s)
- Xian Zhong
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Haiyi Long
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Ruiying Zheng
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Liya Su
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yu Duan
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Manxia Lin
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China.
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Xie X, Ma Y, Xing X, Zhou H, Liu S, Zhang Y, Xu M. The values of elastic quantitative and semi-quantitative indexes measured from different frequencies in the establishment of prediction models for breast tumor diagnosis. BMC Med Imaging 2022; 22:196. [DOI: 10.1186/s12880-022-00915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Objective
To obtain the elastic quantitative and semi-quantitative indexes of solid breast masses using ultrasound linear array probes with two different frequencies, and to construct prediction models and evaluate their diagnostic values.
Methods
A total of 92 patients who were scheduled for surgical treatment on solid breast masses were enrolled in this study. Linear array probes with two frequencies, 9-3 MHz (L9 group) and 14-5 MHz (L14 group), were used for sound touch elastography and strain elastography before surgery, and the maximum elasticity value (Emax), average elasticity value (Emean), minimum elasticity value (Emin), standard deviation (SD)(in kPa), elasticity ratio (E), and strain ratio to fat (SRf) were recorded and calculated for the breast mass (A) and surrounding tissues (Shell). The elastic characteristic indexes of the L9 group and L14 group were compared, and the prediction models of these two groups were constructed using Logistic regression method.
Results
The diagnostic performance of the prediction model based on L9 group was better than the model based on L14 group (AUC: 0.904 vs. 0.810, P = 0.0343, z = 2.116) and the best single index EMax-shell-L9 (P = 0.0398, z = 2.056). The sensitivity of L9 based model was 85.19% and the specificity was 84.21%.
Conclusion
The prediction model based on quantitative and semi-quantitative elastic ultrasound indexes from L9-3 probe exhibited better performance, which could improve the diagnostic accuracy for malignant breast tumors.
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Ventura C, Baldassarre S, Cerimele F, Pepi L, Marconi E, Ercolani P, Floridi C, Argalia G, Goteri G, Giovagnoni A. 2D shear wave elastography in evaluation of prognostic factors in breast cancer. Radiol Med 2022; 127:1221-1227. [DOI: 10.1007/s11547-022-01559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
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Value of shear wave elastography during second-look breast ultrasonography for suspicious lesions on magnetic resonance imaging. J Med Ultrason (2001) 2022; 49:719-730. [DOI: 10.1007/s10396-022-01253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
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Value of shear wave elasticity in predicting the efficacy of neoadjuvant chemotherapy in different molecular types. Clin Imaging 2022; 89:97-103. [DOI: 10.1016/j.clinimag.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
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Cui YY, He NA, Ye XJ, Hu L, Xie L, Zhong W, Zhang CX. Evaluation of Tissue Stiffness Around Lesions by Sound Touch Shear Wave Elastography in Breast Malignancy Diagnosis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1672-1680. [PMID: 35672199 DOI: 10.1016/j.ultrasmedbio.2022.04.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee-approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, Emax and Emean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding Emax-shell and Emean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of Emax-shell-2.0 was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, Emax-shell-2.0 and age were independent predictors of malignancy. Emax-shell-2.0 was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and Emax-shell-2.0 performs best.
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Affiliation(s)
- Ya-Yun Cui
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Nian-An He
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xian-Jun Ye
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lei Hu
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Li Xie
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wen Zhong
- Department of Pathology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chao-Xue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Zhang T, Jia Y, Yu Y, Zhang B, Xu F, Guo H. Targeting the tumor biophysical microenvironment to reduce resistance to immunotherapy. Adv Drug Deliv Rev 2022; 186:114319. [PMID: 35545136 DOI: 10.1016/j.addr.2022.114319] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023]
Abstract
Immunotherapy based on immune checkpoint inhibitors has evolved into a new pillar of cancer treatment in clinics, but dealing with treatment resistance (either primary or acquired) is a major challenge. The tumor microenvironment (TME) has a substantial impact on the pathological behaviors and treatment response of many cancers. The biophysical clues in TME have recently been considered as important characteristics of cancer. Furthermore, there is mounting evidence that biophysical cues in TME play important roles in each step of the cascade of cancer immunotherapy that synergistically contribute to immunotherapy resistance. In this review, we summarize five main biophysical cues in TME that affect resistance to immunotherapy: extracellular matrix (ECM) structure, ECM stiffness, tumor interstitial fluid pressure (IFP), solid stress, and vascular shear stress. First, the biophysical factors involved in anti-tumor immunity and therapeutic antibody delivery processes are reviewed. Then, the causes of these five biophysical cues and how they contribute to immunotherapy resistance are discussed. Finally, the latest treatment strategies that aim to improve immunotherapy efficacy by targeting these biophysical cues are shared. This review highlights the biophysical cues that lead to immunotherapy resistance, also supplements their importance in related technologies for studying TME biophysical cues in vitro and therapeutic strategies targeting biophysical cues to improve the effects of immunotherapy.
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Affiliation(s)
- Tian Zhang
- Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an 710061, PR China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, PR China
| | - Yuanbo Jia
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, PR China; MOE Key Laboratory of Biomedical Information Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, PR China
| | - Yang Yu
- Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an 710061, PR China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, PR China
| | - Baojun Zhang
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710049, PR China
| | - Feng Xu
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, PR China; MOE Key Laboratory of Biomedical Information Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, PR China.
| | - Hui Guo
- Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an 710061, PR China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, PR China.
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Luo C, Lu L, Zhang W, Li X, Zhou P, Ran Z. The Value of Shear Wave Elastography in the Diagnosis of Breast Cancer Axillary Lymph Node Metastasis and Its Correlation With Molecular Classification of Breast Masses. Front Oncol 2022; 12:846568. [PMID: 35372023 PMCID: PMC8968036 DOI: 10.3389/fonc.2022.846568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the diagnostic value of shear wave elastography examination (SWE) on axillary node metastasis (ANM) in breast cancer, this study aimed to evaluate the correlation between the SWE features and different molecular types of breast cancer, and to check the elastic modulus differences among the molecular types. Methods Breast cancer patients from November 2020 to December 2021 were subjected to both conventional ultrasonic examination (CUE) and SWE before ultrasound-guided percutaneous biopsy or axillary lymph node dissection (ALND). We used the pathological results as the gold standard to draw the receiver operating characteristic (ROC) curve. Results SWE outperforms CUE, but their conjunctive use is the best option. No significant correlation was found between the elastic modulus values and the molecular types of breast cancer. Conclusion SWE can be used as an routine auxiliary method of CUE for ANM.
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Affiliation(s)
- Changyun Luo
- Regular Physical Examination Centre, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Li Lu
- Ultrasonography Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Weifu Zhang
- Public Health Section, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Xiangqi Li
- Breast Surgery, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Ping Zhou
- Liyang People’s Hospital, Liyang, China
| | - Zhangshen Ran
- Regular Physical Examination Centre, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
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Huang S, Ye X, Yang K, Tian H, Ding Z, Chen J, Xu J, Dong F. The significance of dual-mode elastography in the diagnosis of breast lesions by physicians with different levels of experience. Quant Imaging Med Surg 2022; 12:1438-1449. [PMID: 35111637 DOI: 10.21037/qims-21-636] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to assess the diagnostic value of dual-mode elastography for benign and malignant breast lesions and determine whether this technique can improve the diagnostic ability of physicians with different levels of experience. METHODS One hundred and eighty-three breast lesions were analyzed retrospectively, and the following values were calculated for the lesions with various shells: shear modulus (G), Young's modulus (E), shear wave velocity (Cs), and strain ratio (SR). A random forest algorithm was used to select the optimal modes for elastography. A receiver operating characteristic curve was used to assess the diagnostic efficacy for benign and malignant breast lesions. Sensitivity and specificity values were calculated to evaluate any improvements in the diagnostic efficacy of physicians with different levels of experience (junior, intermediate-level, and senior) in the evaluation of malignant breast lesions using dual-mode elastography. RESULTS The best-performing mode of shear wave elastography (SWE) in the diagnosis of breast lesions was the A'min 1.0 (Cs) mode (minimum shear wave velocity of the area of interest and 1.0 mm around the area of interest), and the best-performing mode of strain elastography (SE) was the B/A' 0.5 (ratio of fat to the elasticity of the area of interest and 0.5 mm around the area of interest). When the two methods were used in series, results showed high specificity (98%), positive likelihood ratio (PLR) (21.2), and positive predictive value (PPV) (95%). Series means that if SE and SWE were malignant, the result in series was malignant, and that if either SE or SWE was benign, the result in series was benign. When the methods were used in parallel, the results showed high sensitivity (91%), negative likelihood ratio (NLR) (0.15), and negative predictive value (NPV) (89%). Parallel means that if SE and SWE were benign, the result in parallel was benign, and that if either SE or SWE was malignant, the result in parallel was malignant. When conventional ultrasound was combined with dual-mode elastography, the intermediate-level and junior physicians' diagnoses of breast lesions showed a higher sensitivity, specificity, and area under the curve than conventional ultrasound diagnosis alone. CONCLUSIONS Dual-mode elastography is effective in the diagnosis of breast lesions. The sensitivity and specificity values in this study show that diagnoses made by junior and intermediate-level physicians improve when dual-mode elastography is used, although diagnoses made by senior physicians do not improve significantly.
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Affiliation(s)
- Sijing Huang
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xiuqin Ye
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Keen Yang
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Hongtian Tian
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jing Chen
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Zhang YX, Xue JP, Li HZ, Miao JW, Kang CS. Clinical Value of Shear Wave Elastography Color Scores in Classifying Thyroid Nodules. Int J Gen Med 2021; 14:8007-8018. [PMID: 34785943 PMCID: PMC8590981 DOI: 10.2147/ijgm.s331406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the clinical value of qualitative shear wave elastography (SWE) color in the differential diagnosis of benign and malignant thyroid nodules. Methods From January 2017 to July 2018, 241 patients with 261 thyroid nodules, who underwent conventional ultrasonography and SWE examination before surgical resection, were enrolled. The nodules were also evaluated by histopathologic analyses. The SWE color characteristics that could differentiate malignant and benign thyroid nodules were selected and scored based on the malignancy rate. The diagnostic performances were evaluated by receiver operating characteristic (ROC) curves analysis. Results Among the 261 thyroid nodules, 58 were benign, and 203 were malignant. Malignancy was associated with orange or red as the color of maximum hardness inside a nodule, green as the primary color, with a “stiff rim,” inhomogeneous internal color, and inhomogeneous color between the nodules and its surrounding areas. The SWE color scores for benign thyroid nodules were mainly 0 and 1, while 4 and 5 were for malignant thyroid nodules. The area under the ROC curve (AUC) of the SWE color score ≥3 for the diagnosis of malignant thyroid nodules was 0.828 (95% CI: 0.764, 0.891) with a sensitivity of 82.8%, a specificity of 82.8%, and an accuracy of 83.1%. Additionally, conventional ultrasound combined with SWE color scores had a higher diagnostic performance than conventional ultrasound (AUC 0.820 vs AUC 0.796, P = 0.04). Conclusion The SWE color scores might be a convenient and effective method to assist in differentiating thyroid nodules.
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Affiliation(s)
- Yan-Xia Zhang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Ji-Ping Xue
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Hui-Zhan Li
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Jun-Wang Miao
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Chun-Song Kang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
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Xue SS, Zhao QL, Ruan LT, Wang FQ, Zhou C, Sheng W. Comparative analysis of the quantitative parameter method and elasticity color mode method for real-time shear wave elastography in the diagnosis of benign and malignant solid breast lesions. TUMORI JOURNAL 2021; 108:578-585. [PMID: 34651522 DOI: 10.1177/03008916211048239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the performance of real-time shear wave elastography (RT-SWE) in routine clinical practice. METHODS This was a prospective study of 500 patients. The elasticity color mode method was judged by a four-mode system. The quantitative parameter method was used to measure the modulus of elasticity of the lesions. Pathologic reports were used as a gold standard to comparatively analyze the diagnostic performance of the two methods. RESULTS A total of 553 tumors were detected. The average mode value and the modulus of elasticity (Emax) of the benign breast masses was lower than that of malignant masses (p < 0.05). With Emax = 67.4 as the diagnostic threshold value, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of the two methods were not statistically significant different (p > 0.05). CONCLUSIONS The shear wave quantitative parameter method and the elasticity color mode method showed similar performances in the diagnosis of benign and malignant breast masses. The elasticity color mode method is convenient and intuitive, whereas the quantitative parameter method can be used to objectively assess the lesions when it is difficult to score the elasticity of an image, but could not be relied on alone.
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Affiliation(s)
- Shan-Shan Xue
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Qiao-Ling Zhao
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Li-Tao Ruan
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Fei-Qian Wang
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Can Zhou
- Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Wei Sheng
- Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
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Cheng C, Hu C, Zhou S, Zhao H, Yu M. Qualitative Diagnosis of Solid Breast Mass by Blood Flow in Solid Breast Mass. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Breast cancer is one of the most common malignant tumors that seriously endangers women’s physical and mental health and even life-threatening. With the increasing incidence of breast malignant tumors year by year, people are increasingly concerned about the health of female breasts.
However, due to the lack of primary prevention methods for breast cancer, the key to improving the cure rate of breast cancer and reducing mortality is early detection, early diagnosis, and early treatment. Hemodynamics embodies the characteristics and laws of the movement of blood and its
components in the body. Clinically, monitoring of hemodynamic indicators is usually used to reveal the physiological or pathological changes of the body and understand the development process of the disease. The blood flow in the tumor tissue is high-speed and high-impedance. CDFI can show
the distribution of blood flow in the mass. The highest peak velocity (PSV), resistance index (RI) and pulsatility index (PI) of systolic phase can be measured by sampling. This study use contrast-enhanced ultrasound (CEUS) combined with color energy Doppler flow imaging (CDFI) to explore
the hemodynamic information of the main blood supply arteries and masses of the breast, analyze the abnormal hemodynamic information of tumors and surrounding tissues, and explore the blood in the breast, the clinical value of hydrodynamics in the qualitative diagnosis of breast masses.
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Affiliation(s)
- Chen Cheng
- First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, China
| | - Chunhong Hu
- First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, China
| | - Shengli Zhou
- The First People's Hospital of Lianyungang, Lianyungang Jiangsu, 222002, China
| | - Hongyan Zhao
- Lianyungang Traditional Chinese Medicine Hospital, Lianyungang Jiangsu, 222004, China
| | - Ming Yu
- The First People's Hospital of Lianyungang, Lianyungang Jiangsu, 222002, China
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Woo JH, Ko EY, Han BK. Comparison of 2 shear wave elastography systems in reproducibility and accuracy using an elasticity phantom. Medicine (Baltimore) 2021; 100:e24921. [PMID: 33847610 PMCID: PMC8052081 DOI: 10.1097/md.0000000000024921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to compare the accuracy and inter- and intra-observer reproducibility of the measured elasticity between 2 shear wave elastography systems. Three breast radiologists examined 8 targets of 4 different levels of stiffness (size: 11 mm, 4 mm) in an elasticity phantom (Customized 049A Elasticity QA Phantom, CIRS, Norfolk, VA, USA) using 2 different shear wave ultrasound elastography systems: SuperSonic Imagine (SSI) (SSI, Aix en Provence, France) and ShearScan (RS-80A, Samsung Medison, Seoul, Korea). Three radiologists performed ultrasound (US) elastography examinations for the phantom lesions using 2 equipment over a 1-week interval. Intra- and inter-observer reproducibility and the accuracy of the measured elasticity were analyzed and compared between the 2 systems. The accuracy of shape was also analyzed by shape-matching between B-mode and elastography color image. Intra-class correlation coefficients (ICC) were used in statistical analysis. For measured elasticity, the intra-observer and inter-observer reproducibility were excellent in both SSI and ShearScan (0.994 and 0.998). The overall accuracy was excellent in both systems, but the accuracy in small lesions (4 mm target) was lower in SSI than ShearScan (0.780 vs 0.967). The accuracy of shape-matching on the elastography image was 59.0% and 81.4% in the SSI and ShearScan, respectively. In conclusion, the SSI and ShearScan showed excellent intra- and inter-observer reproducibility. The accuracy of the Young's modulus was high in both the SSI and ShearScan, but the SSI showed decreased accuracy in measurement of elasticity in small targets and poor shape-matching between the B-mode image and color-coded elastography image.
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Dai WB, Xu J, Yu B, Chen L, Chen Y, Zhan J. Correlation of Stiffness of Prostate Cancer Measured by Shear Wave Elastography with Grade Group: A Preliminary Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:288-295. [PMID: 33234327 DOI: 10.1016/j.ultrasmedbio.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/15/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
The aim of study was to explore the correlation between shear wave elastography (SWE) and grade group (GG) of prostate cancer (PCa). This retrospective study involved prostate-specific antigen elevated patients with elevated prostate-specific antigen levels who underwent SWE before transrectal ultrasound-guided needle biopsy. A total of 49 PCa lesions were reviewed after radical prostatectomy; 3-7 regions of interest were placed within the cancerous area on axial view compared with the tumor foci outlined on the slides by pathologist. The maximum SWE value was measured, quantitative SWE parameters (Emax, Emean, Emin and standard deviation [SD]) were recorded and correlated with GG and then parameters were compared between indolent (≤2) and aggressive (≥3) GGs. The diagnostic value of each parameter was compared with the receiver operating characteristic curve. Forty-nine PCa foci were divided into two groups on the basis of their GGs. All SWE parameters exhibited a significant linear trend with GG. The area under the receiver operating characteristic curve (AUC) was 0.816 for Emax; with a cutoff point of 84 kPa, sensitivity and specificity were 81.3% and 82.4% to differentiate low and high GGs in PCa. The AUC was 0.776 for Emean; with a cutoff point of 71 kPa, sensitivity and specificity were 78.1% and 76.5%. For Emin, the AUC was 0.739; with a cutoff point of 60 kPa, sensitivity and specificity were 68.8% and 70.6%. For SD, the AUC was 0.681; with a cutoff point of 8.3 kPa, sensitivity and specificity were 46.9% and 94.1%. There were no significant differences between the four SWE parameters (p < 0.05 for all). SWE features were correlated with GGs, and this correlation may have excellent diagnostic performance in predicting high GG in PCa.
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Affiliation(s)
- Wen-Bin Dai
- Department of Urology Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Jun Xu
- Department of Urology Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Bo Yu
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
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Gendin DI, Nayak R, Wang Y, Bayat M, Fazzio RT, Oberai AA, Hall TJ, Barbone PE, Alizad A, Fatemi M. Repeatability of Linear and Nonlinear Elastic Modulus Maps From Repeat Scans in the Breast. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:748-757. [PMID: 33151880 PMCID: PMC11017922 DOI: 10.1109/tmi.2020.3036032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Compression elastography allows the precise measurement of large deformations of soft tissue in vivo. From an image sequence showing tissue undergoing large deformation, an inverse problem for both the linear and nonlinear elastic moduli distributions can be solved. As part of a larger clinical study to evaluate nonlinear elastic modulus maps (NEMs) in breast cancer, we evaluate the repeatability of linear and nonlinear modulus maps from repeat measurements. Within the cohort of subjects scanned to date, 20 had repeat scans. These repeated scans were processed to evaluate NEM repeatability. In vivo data were acquired by a custom-built, digitally controlled, uniaxial compression device with force feedback from the pressure-plate. RF-data were acquired using plane-wave imaging, at a frame-rate of 200 Hz, with a ramp-and-hold compressive force of 8N, applied at 8N/sec. A 2D block-matching algorithm was used to obtain sample-level displacement fields which were then tracked at subsample resolution using 2D cross correlation. Linear and nonlinear elasticity parameters in a modified Veronda-Westmann model of tissue elasticity were estimated using an iterative optimization method. For the repeated scans, B-mode images, strain images, and linear and nonlinear elastic modulus maps are measured and compared. Results indicate that when images are acquired in the same region of tissue and sufficiently high strain is used to recover nonlinearity parameters, then the reconstructed modulus maps are consistent.
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Xu YJ, Gong HL, Hu B, Hu B. Role of "Stiff Rim" sign obtained by shear wave elastography in diagnosis and guiding therapy of breast cancer. Int J Med Sci 2021; 18:3615-3623. [PMID: 34522189 PMCID: PMC8436109 DOI: 10.7150/ijms.64243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/18/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Because the halo around the tumor in shear wave elastography (SWE) is defined as the "stiff rim" sign, the diagnosis of breast lesions with the stiff rim sign is popular. However, only a few studies have described the stiff rim sign quantitatively. Objective: This study aimed to investigate the usefulness of the stiff rim sign in the diagnosis and tumor, node, metastasis stage of breast cancer. Methods: Two hundred and ten breast lesions were analyzed retrospectively. The maximum, mean, minimum Young's modulus (YM), and the YM standard deviation in the lesion, the peritumoral stiffness (shell), and the region containing lesion and shell were obtained. The suspicious SWE feature with the best diagnostic performance was chosen to downgrade or upgrade the Breast Imaging Reporting and Data System (BI-RADS) classification. The coincidence rates of SWE and B-mode ultrasound in T staging and their positive predictive value (PPV) for T staging were compared. Results: The presence of "stiff rim" sign was selected to upgrade or downgrade the BI-RADS classification because of its best performance. In pathological benign lesions, 18.9% (25 of 132) of lesions should undergo biopsy if BI-RADS combined with the stiff rim sign were referred while it was 57.6% (76 of 132) if BI-RADS alone was referred. The coincidence rate of T2 staging evaluated by SWE was significantly higher than B-mode ultrasound (about 30% increase, P < 0.001). The PPVs of SWE for T1 and T2 staging were higher than B-mode ultrasound (P < 0.05). Conclusions: BI-RADS combined with "stiff rim" sign is expected to improve the diagnostic performance of breast lesions to avoid unnecessary biopsy. The maximum diameter of the lesion measured in SWE is more accurate than B-mode ultrasound in the estimation of T staging, which is beneficial to the treatment and prognosis of breast cancer.
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Affiliation(s)
- Yan-Jun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R, China
| | - Hui-Ling Gong
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai 201199, P.R, China
| | - Bin Hu
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai 201199, P.R, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R, China
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Park SY, Kang BJ. Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis. Ultrasonography 2020; 40:318-332. [PMID: 33652513 PMCID: PMC8217803 DOI: 10.14366/usg.20058] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose This study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE. Methods A systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool. Results Twenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively. Conclusion Adding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies.
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Affiliation(s)
- Sun-Young Park
- Devision of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Luo T, Zhang JW, Zhu Y, Jia XH, Dong YJ, Zhan WW, Zhou JQ. Virtual touch imaging quantification shear-wave elastography for breast lesions: the diagnostic value of qualitative and quantitative features. Clin Radiol 2020; 76:316.e1-316.e8. [PMID: 33328105 DOI: 10.1016/j.crad.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
AIM To investigate the value of the qualitative and quantitative features of Virtual Touch imaging quantification (VTIQ) shear-wave elastography in the characterisation of breast lesions. MATERIALS AND METHODS Conventional ultrasound (US) and VTIQ were performed in 148 solid breast lesions in 148 women. During qualitative analysis, patterns of VTIQ were categorised into two patterns, 1 and 2. During quantitative analysis, the mean SWV (SWVmean) and the maximum SWV (SWVmax) of each lesion were used. The sensitivity, specificity, and the areas under the receiver operating characteristic (ROC) curve (Az value) were calculated for conventional US, VTIQ, and combined conventional US and VTIQ. RESULTS Malignant lesions were more likely to show VTIQ pattern 2 than the benign lesions (p<0.001). There was no significant difference in the Az values between SWVmean (0.907) and SWVmax (0.902; p=0.572). There was no significant difference in the Az values between the VTIQ pattern (0.884) and SWVmax (p=0.572). The combined conventional US and VTIQ pattern carried a similar Az value (0.949) as compared with the combined conventional US and SWVmax, which yielded an Az value of 0.952 (p=0.683). CONCLUSION The combination of either VTIQ pattern or SWVmax and conventional US may be helpful in the characterisation of benign and malignant breast lesions.
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Affiliation(s)
- T Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - J W Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Y Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - X H Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Y J Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
| | - W W Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - J Q Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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Hu L, He NA, Xie L, Ye X, Liu X, Pei C, Zhou HC, Zhong W. Evaluation of the Perinodular Stiffness Potentially Predicts the Malignancy of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2183-2193. [PMID: 32412124 DOI: 10.1002/jum.15329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the surrounding tissue stiffness measured by sound touch elastography for differential diagnosis of thyroid nodules (TNs). METHODS Thirty-nine benign and 90 malignant TNs were included in this study. The conventional ultrasound features, the maximum Young modulus value of the stiffness of the TNs (recorded as E), and the stiffness of the 0.5-, 1.0-, 1.5-, and 2.0-mm perinodular regions of the TNs (recorded as Eshell0.5 , Eshell1.0 , Eshell1.5 , and Eshell2.0 , respectively) were prospectively analyzed and compared to histopathologic results. The abundance of collagen fibers at various widths in the perinodular regions of the TNs was evaluated by Masson staining and ImageJ software (National Institutes of Health, Bethesda, MD). The fibrous structures in the perinodular regions of the TNs were classified. RESULTS The various Eshell values of malignant TNs were significantly higher than those of benign TNs (P < .001 for all). Eshell0.5 correlated highly with E in the malignant TNs and in all samples (r = 0.722 and 0.772; P < .001 for both). Eshell2 yielded the highest area under the receiving operating characteristic curve value (0.96) for the differential diagnosis of TNs. The abundance of collagen fibers in the 2-mm perinodular region of the TNs was closely correlated with Eshell2 in the malignant TNs and in all samples (r =0.729 and 0.867; P < .001). The Eshell2 values for different levels of disorder of the tissue surrounding TNs were significantly different (P < .01 for all). CONCLUSIONS Perinodular stiffness measured by sound touch elastography improved the diagnostic accuracy in TNs.
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Affiliation(s)
- Lei Hu
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Nian An He
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li Xie
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianjun Ye
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiao Liu
- Department of Ultrasound, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chong Pei
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Hefei City, Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hang Cheng Zhou
- Department of Pathology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wen Zhong
- Department of Pathology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Ko KH, Jung HK, Park AY, Koh JE, Jang H, Kim Y. Accuracy of tumor size measurement on shear wave elastography (SWE): Correlation with histopathologic factors of invasive breast cancer. Medicine (Baltimore) 2020; 99:e23023. [PMID: 33126387 PMCID: PMC7598781 DOI: 10.1097/md.0000000000023023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to investigate the accuracy of tumor size assessment by shear wave elastography (SWE) in invasive breast cancer and also evaluated histopathologic factors influencing the accuracy.A total of 102 lesions of 102 women with breast cancers of which the size was 3 cm or smaller were included and retrospectively analyzed. Tumor size on B-mode ultrasound (US) and SWE were recorded and compared with the pathologic tumor size. If tumor size measurements compared to pathological size were within ±3 mm, they were considered as accurate. The relationship between the accuracy and histopathologic characteristics were evaluated.The mean pathologic tumor size was 16.60 ± 6.12 mm. Tumor sizes on SWE were significantly different from pathologic sizes (18.00 ± 6.71 mm, P < 0.001). The accuracy of SWE (69.6%) was lower than that by B-mode US (74.5%). There was more size overestimation than underestimation (23.5% vs 6.9%) using SWE. Conversely, there was more size underestimation than overestimation (18.6% vs 6.9%) using B-mode US. The accuracy of SWE was associated with ER positivity (P = .004), PR positivity (P = .02), molecular subtype (P = .02), and histologic grade (P = .03). In the multivariate analysis, ER positivity (P = .002) and molecular subtype (P = .027) significantly influenced the accuracy of tumor size measurement by SWE.In conclusion, the accuracy of the tumor size measured with SWE was lower than that measured with B-mode US and SWE tends to overestimate the size. ER positivity and molecular subtype are significantly associated with the accuracy of SWE in tumor size assessment.
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Yang H, Xu Y, Zhao Y, Yin J, Chen Z, Huang P. The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography. BMC Cancer 2020; 20:930. [PMID: 32993571 PMCID: PMC7526131 DOI: 10.1186/s12885-020-07423-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 09/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background Elastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE. Methods Between September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (Emean), elasticity maximum (Emax), and elasticity minimum (Emin), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models. Results This prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of Emax-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the Emax-3shell and the Emin-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86. Conclusions SWE features, particularly the combination of Emax-3shell and Emin-3shell can improve the diagnosis of breast lesions.
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Affiliation(s)
- Hui Yang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yongyuan Xu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yanan Zhao
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jing Yin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, The Third Affiliated Hospital of Guangzhou Medical University, The Liwan Hospital of the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, Guangdong, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Xie X, Zhang Q, Liu S, Ma Y, Liu Y, Xu M, Xu B. Value of quantitative sound touch elastography of tissues around breast lesions in the evaluation of malignancy. Clin Radiol 2020; 76:79.e21-79.e28. [PMID: 32948313 DOI: 10.1016/j.crad.2020.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
AIM To assess the value of quantitative analysis of sound touch elastography of tissues around breast lesions to facilitate the evaluation of malignancy of the lesions. MATERIALS AND METHODS With the permission of the Ethics Committee, every patient signed informed consent forms before the study. One hundred and eighty-two solid breast lesions were analysed retrospectively. Postoperative histopathology proved that 63 lesions were malignant and 119 were benign. All lesions were examined by two-dimensional ultrasonography, colour Doppler ultrasonography and ultrasound elastography including sound touch elastography (STE) and strain elastography. Using pathological diagnosis as the reference, the correlation between each ultrasound marker and the malignancy of the solid breast masses was evaluated by chi-square test, and the logistic regression model was constructed to determine the best diagnostic model with multiple markers. RESULTS The areas under the receiver operating characteristic (ROC) curve (AUCs) of various elastography markers were compared and the markers with the largest AUC values, including quantitative, semi-quantitative, and distance markers were identified. Logistic regression analysis showed that the combination of accuracy of Breast Imaging Reporting and Data System (BI-RADS) classification + age + maximum elasticity value of the tissue around the lesion (EMax_shell) in predicting malignant lesions was higher than that of the other combinations. The prediction model verified that the sensitivity of diagnosis of the mammary lump was 94.12% and the specificity was 84.13%. CONCLUSIONS EMax_shell in the elasticity is the most valuable marker for the diagnosis of breast cancer, and age combined with EMax_shell can effectively improve the diagnostic efficacy of the BI-RADS classification in breast cancer.
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Affiliation(s)
- X Xie
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Q Zhang
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - S Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Y Ma
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Y Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - M Xu
- Department of Echocardiography, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China.
| | - B Xu
- Department of Tumour Biotherapy, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
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Kim H, Lee J, Kang BJ, Kim SH. What shear wave elastography parameter best differentiates breast cancer and predicts its histologic aggressiveness? Ultrasonography 2020; 40:265-273. [PMID: 32660207 PMCID: PMC7994732 DOI: 10.14366/usg.20007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/15/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose This study aimed to identify useful shear wave elastography (SWE) parameters for differentiating breast cancer and predicting associated immunohistochemical factors and subtypes. Methods From November 2018 to February 2019, a total of 211 breast lesions from 190 patients who underwent conventional breast ultrasonography and SWE were included. The Breast Imaging Reporting and Data System categories and qualitative and quantitative SWE parameters for each lesion were obtained. Pathologic results including immunohistochemical factors were evaluated. The diagnostic performance of each parameter and its correlation with histological characteristics, immunohistochemical factors, and subtypes of breast cancer were analyzed using analysis of variance, the independent t test, the Fisher exact test, logistic regression analysis, and the DeLong method. Results Among 211 breast lesions, 82 were malignant, and 129 were benign. Of the SWE parameters, Emax showed the highest area under the curve (AUC) for differentiating malignant from benign lesions (AUC, 0.891; cut-off>50.85). Poor tumor differentiation and progesterone receptor-negativity were correlated with higher SDmean and Emax (P<0.05). Ki-67-positive breast cancer showed higher SDmean and a heterogeneous color distribution (P<0.05). Ki-67 and cytokeratin 5/6-positive breast cancers showed higher Emax/Efat ratios (P<0.05). Luminal B, human epidermal growth factor receptor 2-enriched, and triple-negative (non-basal) subtypes showed somewhat higher SDmean values than the luminal A and triple-negative (basal) subtypes (P=0.028). Conclusion Emax is a reliable parameter for differentiating malignancies from benign breast lesions. In addition, high stiffness and SDmean values in tumors measured on SWE could be used to predict poorly differentiated, progesterone receptor-negative, or Ki-67-positive breast cancer.
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Affiliation(s)
- Hyunjin Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeongmin Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Diagnostic performance of shear wave elastography in discriminating malignant and benign breast lesions : Our experience with QelaXtoTM software. J Ultrasound 2020; 23:575-583. [PMID: 32529557 DOI: 10.1007/s40477-020-00481-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
STUDY AIMS We sought to evaluate the diagnostic performance of quantitative elastography (shear wave elastography) and to establish the optimal cutoff value to differentiate malignant and benign breast lesions using QelaXtoTM software. METHODS We conducted a retrospective observational study of adult women with suspicious breast lesions (BIRADS 3, 4 or 5) who underwent programmed ultrasound-guided core biopsies. Breast lesions were assessed using quantitative elastography combined with B-mode ultrasound. Histopathology was used as reference standard. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated, and a ROC curve analysis was conducted. Three elastography cutoff values were considered: 36, 50 and 80 kPa. RESULTS We included 143 women (mean age of 56 years) with a total of 145 breast lesions: 68 benign tumors (47.26%) and 77 malignancies (52.74%). Mean elasticity measurements of benign and malignant lesions were significantly different (24.6 kPa, SD 28.47, vs. 101.49 kPa, SD 47.38, [Formula: see text]). Using the 50 kPa cutoff, elastography showed a global sensitivity of 87% to discriminate malignant lesions (AUC = 0.897). Moreover, sensitivity was 90.7% when lesions were located 5-40 mm below the skin surface (optimal elastographic field of view). Our false positive rate was 17.65%, comprised mainly of fibroepithelial neoplasms, fibroadenomas and fibrosis. CONCLUSIONS Quantitative elastography can differentiate malignant and benign breast lesions with acceptable to excellent performance. In our sample, the QelaXtoTM software showed a lower optimal cutoff than other ultrasound systems.
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The Mechanical Microenvironment in Breast Cancer. Cancers (Basel) 2020; 12:cancers12061452. [PMID: 32503141 PMCID: PMC7352870 DOI: 10.3390/cancers12061452] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023] Open
Abstract
Mechanotransduction is the interpretation of physical cues by cells through mechanosensation mechanisms that elegantly translate mechanical stimuli into biochemical signaling pathways. While mechanical stress and their resulting cellular responses occur in normal physiologic contexts, there are a variety of cancer-associated physical cues present in the tumor microenvironment that are pathological in breast cancer. Mechanistic in vitro data and in vivo evidence currently support three mechanical stressors as mechanical modifiers in breast cancer that will be the focus of this review: stiffness, interstitial fluid pressure, and solid stress. Increases in stiffness, interstitial fluid pressure, and solid stress are thought to promote malignant phenotypes in normal breast epithelial cells, as well as exacerbate malignant phenotypes in breast cancer cells.
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Zhu Y, Jia XH, Zhou W, Zhan WW, Zhou JQ. Qualitative Evaluation of Virtual Touch Imaging Quantification: A Simple and Useful Method in the Diagnosis of Breast Lesions. Cancer Manag Res 2020; 12:2037-2045. [PMID: 32256111 PMCID: PMC7090171 DOI: 10.2147/cmar.s241815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/21/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To test the value of qualitative virtual touch imaging quantification (VTIQ) features in differentiating benign from malignant breast lesions. Methods From November 2016 to August 2017, 230 lesions were subjected to conventional US and virtual touch imaging quantification before biopsy. The maximum shear wave velocity (SWVmax) was measured using a standardized method. Qualitative VTIQ features, including the “stiff rim” sign and color pattern classification, were assessed according to a binary classification. The sensitivity, specificity and area under the receiver operating curve (AUC) of Breast Imaging Reporting and Data System (BI-RADS), SWVmax, qualitative VTIQ features, and combined data were compared. Results Among the 230 breast lesions, 150 were benign and 80 were malignant. Compared to the benign lesions, the malignant ones had higher SWVmax values and were more likely to show the “stiff rim” sign and VTIQ pattern 2 (P <0.001 for all). The AUC value was 0.885 for the qualitative VTIQ combination (the presence of the “stiff rim” sign and/or the display of VTIQ pattern 2), similar to that for SWVmax (P=0.472). BI-RADS combined with the qualitative VTIQ combination and with SWVmax yielded similar results, including significantly higher AUC values (P = 0.018 and 0.014, respectively), significantly higher specificities (P<0.001 for both), and nonsignificantly decreased sensitivities (P = 0.249 for both) compared to BI-RADS alone. Conclusion The dual-category classification of qualitative VTIQ features according to the presence of the “stiff rim” sign and/or the classification of VTIQ pattern 2 is a simple and useful method that may be representative of quantitative VTIQ parameters in the evaluation of breast masses.
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Affiliation(s)
- Ying Zhu
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Xiao-Hong Jia
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Wei Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Wei-Wei Zhan
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Jian-Qiao Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
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Li A, Peng XJ, Ma Q, Dong Y, Mao CL, Hu Y. Diagnostic performance of conventional ultrasound and quantitative and qualitative real-time shear wave elastography in musculoskeletal soft tissue tumors. J Orthop Surg Res 2020; 15:103. [PMID: 32160894 PMCID: PMC7066781 DOI: 10.1186/s13018-020-01620-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To explore the feasibility to identify malignant musculoskeletal soft tissue tumors using real-time shear wave elastography (rtSWE). METHODS One hundred fifteen musculoskeletal soft tissue tumors in 92 consecutive patients were examined using both conventional ultrasonography (US) and rtSWE. For each patient, the rtSWE parameters including maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), standard deviation of the elasticity (Esd), and rtSWE image pattern were obtained. Eighty-one histopathologically confirmed tumors from 73 patients were subjected to analysis. RESULTS The 81 lesions included in the study were histopathologically classified as malignant (n = 21) or benign (n = 60). The statistically significant differences between benign and malignant lesions were found in conventional US characters including size, depth, margin, echogenicity, mass texture, and power Doppler signal. Meanwhile, the significant differences were also found in quantitative rtSWE findings including Emax, Emean, Emin, and Esd values and in qualitative rtSWE parameter named rtSWE image pattern. Multivariate analysis showed that infiltrative margin (OR, 4.470), and size (OR, 1.046) were independent predictors for malignancy in US findings, while Esd value (OR, 9.047) was independent predictors for malignancy in quantitative rtSWE parameters. Areas under the ROC curve (Azs) for US features, Esd value, and rtSWE image pattern were 0.851, 0.795, and 0.792, respectively. CONCLUSIONS Conventional US and quantitative and qualitative rtSWE parameters are useful for malignancy prediction of musculoskeletal soft tissue tumors. rtSWE can be used to supplement conventional US to diagnose musculoskeletal soft tissue tumors.
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Affiliation(s)
- Ao Li
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiao-Jing Peng
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qian Ma
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ye Dong
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Cui-Lian Mao
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yu Hu
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Green CA, Goodsitt MM, Roubidoux MA, Brock KK, Davis CL, Lau JH, Carson PL. Deformable mapping using biomechanical models to relate corresponding lesions in digital breast tomosynthesis and automated breast ultrasound images. Med Image Anal 2020; 60:101599. [DOI: 10.1016/j.media.2019.101599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022]
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Huang Y, Li F, Han J, Peng C, Li Q, Cao L, Liu Y, Zhou J. Shear Wave Elastography of Breast Lesions: Quantitative Analysis of Elastic Heterogeneity Improves Diagnostic Performance. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1909-1917. [PMID: 31130413 DOI: 10.1016/j.ultrasmedbio.2019.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to evaluate whether quantitative analysis of elastic heterogeneity (EH) could improve the diagnostic performance of shear wave elastography (SWE) in breast lesions. From August 2016 to August 2017, 280 patients were enrolled in this prospective study. All lesions were evaluated with the ultrasound Breast Imaging Reporting and Data System (BI-RADS) and SWE with Virtual Touch tissue imaging quantification. The shear wave velocity (SWV) of the three areas of highest stiffness and lowest stiffness within the lesions were measured to calculate the maximum SWV (SWVmax), mean SWV (SWVmean) and EH. The EH was determined as the difference between the averaged highest SWV and lowest SWV. The diagnostic performance-including the area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity of BI-RADS, EH, SWVmax and SWVmean-were analyzed. The AUC of EH, SWVmax and SWVmean were 0.963, 0.949 and 0.937, respectively. The sensitivity of EH was 93.75%, which was significantly higher than that of SWVmax (84.37%) and SWVmean (84.37%) (p < 0.001); there was no significant difference in the specificity among EH, SWVmax and SWVmean (p > 0.05). For category 4A lesions, EH predicted all the malignant lesions, while two cancers were misdiagnosed by SWVmax and SWVmean, respectively. Quantitative analysis of EH can improve the sensitivity of SWE for the differential diagnosis of breast lesions without loss of specificity.
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Affiliation(s)
- Yini Huang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fei Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jing Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chuan Peng
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qing Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Longhui Cao
- Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Huang L, Ma M, Du Z, Liu Z, Gong X. Quantitative evaluation of tissue stiffness around lesion by sound touch elastography in the diagnosis of benign and malignant breast lesions. PLoS One 2019; 14:e0219943. [PMID: 31318932 PMCID: PMC6639001 DOI: 10.1371/journal.pone.0219943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
The purpose of our study is to assess the diagnostic performance of quantitative evaluation of tissue stiffness around lesion by Sound Touch Elastography (STE) in distinguishing between benign and malignant breast lesions. A total number of 160 breast lesions from 160 female patients were examined by STE. Resona 7 was equipped with “shell” function to measure elastic modulus values of tissue in the region of surrounding lesion quantitatively. The contours of the lesion were required to be delineated. The elastic modulus values of tissue in the region of 1mm, 2mm, and 3mm outside the boundary were acquired. The elastic modulus values included maximum elastic modulus (Emax), mean elastic modulus (Emean), minimum elastic modulus (Emin), and elastic modulus standard deviation (Esd). All lesions were confirmed by histopathology. We compared the differences of the above elastic modulus values between benign and malignant groups. Receiver operating characteristic (ROC) curve was drawn with the histological diagnostic results as the gold standard. Sensitivity and specificity were calculated to evaluate the diagnostic performance of STE. Operator consistency was also analyzed. Among the 160 lesions, 100 (62.5%) were benign and 60 (37.5%) were malignant. In the region of 1mm, 2mm, and 3mm surrounding the lesion, Emax, Emean, and Esd of malignant group were significantly higher than those of the benign group (all P<0.05). When the “shell” was 3mm, Emax had the highest AUROC value (AUROC = 0.998). Regarding the measurement of elastic modulus values, all the intra-class correlation coefficient (ICC) values of the inter-operator consistency were greater than 0.75 for Emax, Emean, and Esd. Therefore, quantitative evaluation of tissue stiffness around lesion by STE has the potential to distinguish between benign and malignant breast lesions.
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Affiliation(s)
- Leidan Huang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Mengke Ma
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Zhen Du
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
- Anhui Medical University, Hefei, Anhui, China
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
- *. E-mail: (XG); (ZL)
| | - Xuehao Gong
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
- *. E-mail: (XG); (ZL)
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Luo S, Yao G, Hong Z, Zhang S, Wang W, Zhang J, Zhang Y, Wu J, Zhang L, Cheng H, Hao Y, Li Y. Qualitative Classification of Shear Wave Elastography for Differential Diagnosis Between Benign and Metastatic Axillary Lymph Nodes in Breast Cancer. Front Oncol 2019; 9:533. [PMID: 31312611 PMCID: PMC6614346 DOI: 10.3389/fonc.2019.00533] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/03/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose: To examine diagnostic performance of qualitative shear wave elastography (SWE) for evaluation of status of axillary lymph nodes (ALN) in comparison with conventional ultrasonograghy (US) and quantitative SWE parameters. Methods: A total of 118 patients were enrolled, who were all scheduled for breast cancer surgery and core needle biopsy. Conventional US and SWE were performed before biopsy. Based on qualitative evaluation of each ALN, the SWE images were classified into four color patterns: Color Pattern 1: homogeneous; Color Pattern 2: filling defect within lymph node (LN); Color Pattern 3: homogeneous within LN with a localized colored area at the margin; and Color Pattern 4: filling defect within LN with a localized colored area at the margin. The diagnostic performances of the three methods were compared. Results: There were 60 metastatic nodes and 61 benign nodes in the 121 ALNs. Benign ALNs were presented as Color Pattern 1 while metastatic ALNs usually were presented as Color Pattern 2 to 4 (p < 0.05). The AUC of qualitative SWE classification was 0.983, higher than that of quantitative SWE parameters and conventional US (p<0.05). The highest diagnostic performance, with AUC of 0.998, could be achieved if both conventional US and qualitative SWE were applied. Conclusion: The qualitative SWE classification of ALNs proposed in our study exhibited better diagnostic performance than quantitative SWE parameters and conventional US, especially for differentiating metastatic ALNs from benign reactive ALNs. More accurate diagnosis could be reached with this new method and unnecessary biopsy might be avoided in the meantime.
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Affiliation(s)
- Shuyi Luo
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guangyu Yao
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe Hong
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shiyu Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhen Wang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingwen Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaru Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junkai Wu
- Department of Imaging Diagnostics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Cheng
- School of Biomedical Engineering, Southern Medical Uinversity, Guangzhou, China
| | - Yi Hao
- Department of Ultrasound Diagnosis, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yingjia Li
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Biswas D, Gorey A, Chen GC, Vasudevan S, Sharma N, Bhagat P, Phatak S. Empirical wavelet transform based photoacoustic spectral response technique for assessment of ex-vivo breast biopsy tissues. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Farghadani M, Tabatabaei SA, Barikbin R, Shahsanai A, Riahinezhad M, Jafarpishe S. Comparing the Sensitivity and Specificity of Two-Dimensional Shear Wave Elastography and Fine Needle Aspiration in Determining Malignant Thyroid Nodules. Adv Biomed Res 2019; 8:30. [PMID: 31114770 PMCID: PMC6507363 DOI: 10.4103/abr.abr_215_18] [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: 01/08/2023] Open
Abstract
Background Malignancy in thyroid nodules is a common clinical problem, and epidemiological studies have shown that it is increasing. Since malignancy is a very important problem in treating patients and misdiagnosis leads to many physical and financial damages, the importance of diagnostic methods becomes more important. Hence, the aim of this study was to investigate the sensitivity and specificity of the two dimensional-shear wave elastography (2D-SWE) diagnostic method in comparison with fine-needle aspiration (FNA) in determining the malignant thyroid nodules. Materials and Methods This study is cross-sectional which was performed on 57 thyroid nodules are proven by conventional ultrasound. Afterward, 2D-SWE images were taken with the help of a superSonic ultrasound machine. Then, FNA was performed from the thyroid nodules and the specimens were evaluated in a single specialized thyroid pathology center. The results of conventional sonography and 2D-SWE were compared with histopathologic results as a gold standard method. The elasticity quantity was recorded by measuring the amount of the appropriate quantities by a recording machine and analyzed using the SPSS and MedCalc software. Results From 57 nodules studied, 50 nodules were evaluated with benign diagnosis and 7 nodules with the malignant diagnosis. Among all the parameters recorded by the machine, SWE. ratio provided the highest surface area under the curve and the highest sensitivity and specificity with 0.94, 100% and 84%, respectively, and a cut-off point of 1.7. Conclusion The 2D-SWE method and the conventional ultrasound can be good references for decision making about with the thyroid nodules.
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Affiliation(s)
- Maryam Farghadani
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
| | | | - Roozbeh Barikbin
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Armindokht Shahsanai
- Department of Community and Family Medicine, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Maryam Riahinezhad
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Saleh Jafarpishe
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
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Suvannarerg V, Chitchumnong P, Apiwat W, Lertdamrongdej L, Tretipwanit N, Pisarnturakit P, Sitthinamsuwan P, Thiravit S, Muangsomboon K, Korpraphong P. Diagnostic performance of qualitative and quantitative shear wave elastography in differentiating malignant from benign breast masses, and association with the histological prognostic factors. Quant Imaging Med Surg 2019; 9:386-398. [PMID: 31032186 DOI: 10.21037/qims.2019.03.04] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background To determine the diagnostic performance of qualitative and quantitative shear wave elastography (SWE) and the optimal cutoff values of the quantitative SWE parameters in differentiating malignant from benign breast masses, and to evaluate the association between the quantitative SWE parameters and histological prognostic factors. Methods A gray scale ultrasound and SWE were prospectively performed on a total of 244 breast masses (148 benign, and 96 malignant) in 228 consecutive patients before an ultrasound-guided needle biopsy. The qualitative SWE and quantitative SWE parameters (the mean elasticity, maximum elasticity, and elasticity ratio) were measured in each mass. The diagnostic performance of SWE and the optimal cutoff values of the quantitative SWE parameters were obtained. An association analysis of the parameters and histological prognostic factors was performed. Results The malignant masses had a more heterogeneous pattern on the qualitative SWE than benign masses (P<0.001). The quantitative SWE parameters of the malignant masses were higher than those of the benign masses (P<0.001); the mean elasticity, maximum elasticity, and elasticity ratio of the benign masses were 19.73 kPa, 23.98 kPa, and 2.78, respectively; and the mean elasticity, maximum elasticity, and elasticity ratio of the malignant masses were 88.13 kPa, 98.48 kPa, and 10.64, respectively. The optimal cutoff value of the mean elasticity was 30 kPa, of the maximum elasticity was 36 kPa, and of the elasticity ratio was 4.5. The maximum elasticity had the highest AUC. Combining the three SWE parameters to differentiate between the malignant and benign masses increased the negative predictive value (NPV), which correctly downgraded 72.73% of BI-RADS category 4A masses to BI-RADS category 3. No statistically significant association was found between the quantitative SWE parameters and the tumor grading, tumor types, axillary lymph node statuses, or molecular subtypes of the breast cancers (P>0.05). Conclusions The qualitative and quantitative SWE provided good diagnostic performance in differentiating malignant and benign masses. The maximum elasticity of the quantitative SWE parameters had the best diagnostic performance. Adding the three combined quantitative SWE parameters to the BI-RADS category 4A masses potentially downgraded them to BI-RADS category 3 and avoided unnecessary biopsies. No statistically significant association was found between the quantitative SWE parameters and the histological prognostic factors.
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Affiliation(s)
- Voraparee Suvannarerg
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyanuch Chitchumnong
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wipawan Apiwat
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lassanun Lertdamrongdej
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattinee Tretipwanit
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pongthep Pisarnturakit
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panitta Sitthinamsuwan
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shanigarn Thiravit
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kobkun Muangsomboon
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpim Korpraphong
- 1Department of Radiology, Faculty of Medicine, 2Thanyarak Breast Center, 3Department of Surgery, Faculty of Medicine, 4Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Shang J, Ruan LT, Wang YY, Zhang XJ, Dang Y, Liu B, Wang WL, Song Y, Chang SJ. Utilizing size-based thresholds of stiffness gradient to reclassify BI-RADS category 3-4b lesions increases diagnostic performance. Clin Radiol 2019; 74:306-313. [PMID: 30755314 DOI: 10.1016/j.crad.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/08/2019] [Indexed: 01/16/2023]
Abstract
AIM To investigate the role of utilizing size-based thresholds of stiffness gradient in diagnosing solid breast lesions and optimizing original Breast Imaging-Reporting And Data System (BI-RADS) classifications. MATERIALS AND METHODS Two-hundred and twenty-seven consecutive women underwent shear-wave elastography (SWE) before ultrasound-guided biopsy, and 234 solid breast lesions categorized as BI-RADS 3-5 were analysed. Receiver operating characteristic curve analysis was performed based on histopathology. Diagnostic performance among SWE, BI-RADS, and their combination were compared. RESULTS The stiffness gradient correlated with the standard deviation of elasticity (SD, r=0.90), and with Tozaki's pattern classification (r=0.64). The area under the receiver operating characteristic curves (AUC) for stiffness gradient (0.939) outperformed SD (0.897) or colour pattern (0.852). Due to significant association with lesion size (r=0.394, p<0.001), stiffness gradient's size-based thresholds (lesions >15 mm: 82.5 kPa; lesions ≤15 mm: 51.1 kPa) were established to reclassify BI-RADS 3-4b lesions. Upgrading category 3 lesions (over the corresponding cut-off value, 3 to 4a) and downgrading categories 4a-4b lesions (less than or equal to the corresponding cut-off value, 4b to 4a, 4a to 3), yielded significant improvement in specificity (90.28% versus 77.78%, p<0.001) and AUC (0.948 versus 0.926, p=0.035) than BI-RADS alone. No significant loss emerged in the sensitivity (88.89% versus 91.11%, p=0.500). CONCLUSION Stiffness gradient exhibited better discriminatory ability than SD or four-colour pattern classification in determining solid breast lesions and applying its size-specific thresholds to categorize BI-RADS 3-4b lesions could improve diagnostic performance.
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Affiliation(s)
- J Shang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - L-T Ruan
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China.
| | - Y-Y Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - X-J Zhang
- Department of Pathology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - Y Dang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - B Liu
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China; Department of Ultrasound Diagnosis, Shaanxi Province People's Hospital, Xi'an 710068, China
| | - W-L Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China; Department of Ultrasound Diagnosis, Xi'an NO.3 Hospital, Xi'an 710018, China
| | - Y Song
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - S-J Chang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
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Xiang L, Ma F, Yao M, Xu G, Pu H, Liu H, Fang Y, Wu R. Benign lesion evaluation: Factors causing the "stiff rim" sign in breast tissues using shear-wave elastography. Br J Radiol 2018; 92:20180602. [PMID: 30303694 DOI: 10.1259/bjr.20180602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE: To investigate the factors causing the "stiff rim" sign in breast lesions using shear-wave elastography. METHODS: A total of 907 patients with 907 lesions were included retrospectively in this study. Traditional ultrasound and shear-wave elastography imaging were both performed. Patients age, maximum diameter, depth, distance, echogenicity, shape, boundary, margin, internal components, CDFI, calcification, echogenicity attenuation and longitudinal growth of lesions were observed and calculated by both univariate and multivariate analyses. RESULTS: Univariate analyses indicated that the age, depth, shape, margin, internal components, CDFI, calcification and pathology showed significant difference between the benign lesions with and without a "stiff rim", whereas there was no correlation of "stiff rim" with maximum diameter, distance, boundary, echogenicity, echo attenuation and longitudinal growth of the lesions. Multivariate analysis expressed that CDFI, margin, internal components, depth and age were significantly associated with the "stiff rim" sign in breast benign lesions, whereas there was no correlation with the pathology, shape or calcification of the lesions. CONCLUSIONS: The "stiff rim" sign can be helpful for differentiation between benign and malignant lesions. Older patients with a "stiff rim" sign whose benign masses are deep, poorly defined, heterogeneous and have a positive CDFI should be examined more closely to avoid unnecessary false-positives. ADVANCES IN KNOWLEDGE: The "stiff rim" sign can be helpful for differentiation between benign and malignant lesions. Positive CDFI, poorly defined margin, heterogeneous internal components, deep depth and older age were significantly associated with the "stiff rim" sign in benign breast lesions.
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Affiliation(s)
- Lihua Xiang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Fang Ma
- 3 Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People'sHospital , Shanghai , China
| | - Minghua Yao
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Guang Xu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Huan Pu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Hui Liu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Yan Fang
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,2 Ultrasound Research and Education Institute, Tongji University School of Medicine , Shanghai , China
| | - Rong Wu
- 1 Department of Medical Ultrasound, Shanghai Tenth People's Hospital, TongjiUniversity School of Medicine , Shanghai , China.,4 Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong UniversitySchool of Medicine , Shanghai , China
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Lin X, Chang C, Wu C, Chen Q, Peng Y, Luo B, Tang L, Li J, Zheng J, Zhou R, Cui G, Li A, Wang X, Qian L, Zhang J, Wen C, Gay J, Zhang H, Li A, Chen Y. Confirmed value of shear wave elastography for ultrasound characterization of breast masses using a conservative approach in Chinese women: a large-size prospective multicenter trial. Cancer Manag Res 2018; 10:4447-4458. [PMID: 30349377 PMCID: PMC6187919 DOI: 10.2147/cmar.s174690] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to investigate the value of shear wave elastography (SWE) for characterization of breast masses in a Chinese population. Patients and methods Two thousand two hundred seventy-three women consented to be prospectively enrolled for the characterization of breast masses with ultrasound and SWE. Breast masses were known from symptoms, palpability, and/or previous imaging screening with mammography and/or ultrasound. Correlation of SWE qualitative and quantitative features with malignancy risk and impact on diagnostic performance of combining SWE features were assessed, and the Breast Imaging Reporting and Data System (BI-RADS) scoring was calculated using histopathology as reference. Results Data of 2,262 masses (median size: 13 mm; range: 1.3-50) from 2,262 patients (median age: 43 years; range: 18-91) were investigated, of which 752 (33.3%) were malignant. Sensitivity and specificity of BI-RADS diagnosis were 97.5% (733/752) and 54.8% (827/1,510), respectively. By logistic regression, the combination of maximum elasticity (E max) measurements with BI-RADS assessments increased the area under the receiver operating characteristic curve from 0.908 (95% CI: 0.896-0.920) to 0.954 (95% CI: 0.944-0.962). Using E max of 30 kPa or lower to selectively downgrade BI-RADS 4a masses to follow-up, and E max of 160 kPa or higher to selectively upgrade BI-RADS 3 lesions to biopsy, specificity significantly increased from 54.8% (827/1,510) to 66.1% (998/1,510) (P<0.001) while sensitivity decreased nonsignificantly from 97.5% (733/752) to 96.9% (729/752) (P=0.2891). Positive predictive value for biopsy recommendation increased from 51.7% (733/1,417) to 58.7% (729/1,241) (P<0.001). Conclusion Adding SWE maximum stiffness to BI-RADS 3 and BI-RADS 4a breast masses in a Chinese population increased significantly the specificity of breast ultrasonography, without significant change in sensitivity.
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Affiliation(s)
- Xi Lin
- State Key Laboratory of Oncology in Southern China, Department of Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou 510060, P. R. China
| | - Cai Chang
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P. R. China,
| | - Changjun Wu
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China
| | - Qin Chen
- Department of Ultrasound, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China
| | - Yulan Peng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510235, P. R. China
| | - Lina Tang
- Department of Ultrasound, Fujian Provincial Cancer Hospital, Fuzhou 350014, P. R. China
| | - Jing Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, P. R. China
| | - Jihui Zheng
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, P. R. China
| | - Ruhai Zhou
- Department of Ultrasound, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo 315040, P. R. China
| | - Guanghe Cui
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou 256603, P. R. China
| | - Ao Li
- Department of Ultrasound, Jiangsu Province Hospital, Nanjing 210029, P. R. China
| | - Xuemei Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, P. R. China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital of Capital Medical University, Beijing 100050, P. R. China
| | - Jianxing Zhang
- Department of Ultrasound, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, P. R. China
| | - Chaoyang Wen
- Department of Ultrasound, First Affiliated Hospital of PLA General Hospital, Beijing 100037, P. R. China
| | - Joel Gay
- Supersonic Imagine, Aix-en-Provence, France
| | | | - Anhua Li
- State Key Laboratory of Oncology in Southern China, Department of Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou 510060, P. R. China
| | - Yaling Chen
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P. R. China,
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Park HS, Shin HJ, Shin KC, Cha JH, Chae EY, Choi WJ, Kim HH. Comparison of peritumoral stromal tissue stiffness obtained by shear wave elastography between benign and malignant breast lesions. Acta Radiol 2018; 59:1168-1175. [PMID: 29359949 DOI: 10.1177/0284185117753728] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Aggressive breast cancers produce abnormal peritumoral stiff areas, which can differ between benign and malignant lesions and between different subtypes of breast cancer. Purpose To compare the tissue stiffness of the inner tumor, tumor border, and peritumoral stroma (PS) between benign and malignant breast masses by shear wave elastography (SWE). Material and Methods We enrolled 133 consecutive patients who underwent preoperative SWE. Using OsiriX commercial software, we generated multiple 2-mm regions of interest (ROIs) in a linear arrangement on the inner tumor, tumor border, and PS. We obtained the mean elasticity value (Emean) of each ROI, and compared the Emean between benign and malignant tumors. Odds ratios (ORs) for prediction of malignancy were calculated. Subgroup analyses were performed among tumor subtypes. Results There were 85 malignant and 48 benign masses. The Emean of the tumor border and PS were significantly different between benign and malignant masses ( P < 0.05 for all). ORs for malignancy were 1.06, 1.08, 1.05, and 1.04 for stiffness of the tumor border, proximal PS, middle PS, and distal PS, respectively ( P < 0.05 for all). Malignant masses with a stiff rim were significantly larger than malignant masses without a stiff rim, and were more commonly associated with the luminal B and triple negative subtypes. Conclusion Stiffness of the tumor border and PS obtained by SWE were significantly different between benign and malignant masses. Malignant masses with a stiff rim were larger in size and associated with more aggressive pathologic subtypes.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki Chang Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters. Clin Imaging 2018; 50:302-307. [DOI: 10.1016/j.clinimag.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 04/13/2018] [Accepted: 05/01/2018] [Indexed: 12/30/2022]
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Moon JH, Hwang JY, Park JS, Koh SH, Park SY. Impact of region of interest (ROI) size on the diagnostic performance of shear wave elastography in differentiating solid breast lesions. Acta Radiol 2018; 59:657-663. [PMID: 28899126 DOI: 10.1177/0284185117732097] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Shear wave elastography (SWE) using a region of interest (ROI) can demonstrate the quantitative elasticity of breast lesions. Purpose To prospectively evaluate the impact of two different ROI sizes on the diagnostic performance of SWE for differentiating benign and malignant breast lesions. Material and Methods A total of 154 breast lesions were included. Two types of ROIs were investigated: one involving an approximately 2-mm diameter, small round ROIs placed over the stiffest area of the lesion, as determined by SWE (ROI-S); and another ROI drawn along the margin of the lesion using a touch pen or track ball to encompass the entire lesion (ROI-M). Maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), and standard deviation (SD) were measured for the two ROIs. The area under the receiver operating characteristic curve (AUC) as well as the sensitivity and specificity of each elasticity value were determined. Results The AUCs for ROI-S were higher than those for ROI-M when differentiating benign and malignant breast solid lesions. The Emax, Emean, Emin, and SD of the elasticity values for ROI-S were 0.865, 0.857, 0.816, and 0.849, respectively, and for ROI-M were 0.820, 0.780, 0.724, and 0.837, respectively. However, only Emax ( P = 0.0024) and Emean ( P = 0.0015) showed statistically significant differences. For ROI-S, the sensitivity and specificity of Emax were 78.8% and 84.3%, respectively, and those for Emean were 80.8% and 81.4%, respectively. Conclusion Using ROI-S with Emax and Emean has better diagnostic performance than ROI-M for differentiating between benign and malignant breast lesions.
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Affiliation(s)
- Jin Hee Moon
- Department of Radiology, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Ji-Young Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Sung Hye Koh
- Department of Radiology, Hallym Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Sun-Young Park
- Department of Radiology, Hallym Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
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Song EJ, Sohn YM, Seo M. Tumor stiffness measured by quantitative and qualitative shear wave elastography of breast cancer. Br J Radiol 2018; 91:20170830. [PMID: 29557217 DOI: 10.1259/bjr.20170830] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To correlate clinicoradiologic and pathological features of breast cancer with quantitative and qualitative shear wave elastographic parameters. METHODS 82 breast cancers in 75 patients examined by B-mode ultrasound and shear wave elastography (SWE) were included. SWE parameters including quantitative factors [maximum elasticity (Emax), mean elasticity (Emean), elasticity ratio (Eratio) and standard deviation (SD)] and qualitative factor (color pattern) were correlated with clinicoradiologic and pathological features using univariate and multivariate linear regression analyses. RESULTS Presence of symptoms and larger tumor size on ultrasound were significantly associated with higher Emax, Emean, Eratio, and SD (all p < 0.05) on univariate analysis. Older age was significantly correlated with higher Emax and Emean (p = 0.026, 0.018). Lymphovascular invasion and larger pathologic size were significantly associated with higher Emax (p = 0.036, 0.043) and SD (p < 0.001, 0.019). No immunohistochemical biomarkers were significantly correlated with SWE parameters. There was no significant correlation between color pattern and any variable. Multivariate logistic regression analysis showed that the symptom, tumor size on ultrasound and lymphovascular invasion were independent factors that influenced the SWE values. CONCLUSION Tumor stiffness as measured by SWE and B-mode ultrasound could help predict cancer prognosis. Advances in knowledge: Clinicoradiologic factors had correlation with quantitative and qualitative SWE parameters. Using SWE parameters and B-mode ultrasound, we can predict breast cancer prognosis.
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Affiliation(s)
- Eun Jee Song
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University , Seoul , South Korea
| | - Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University , Seoul , South Korea
| | - Mirinae Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University , Seoul , South Korea
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Yu Y, Xiao Y, Cheng J, Chiu B. Breast lesion classification based on supersonic shear-wave elastography and automated lesion segmentation from B-mode ultrasound images. Comput Biol Med 2017; 93:31-46. [PMID: 29275098 DOI: 10.1016/j.compbiomed.2017.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022]
Abstract
Supersonic shear-wave elastography (SWE) has emerged as a useful imaging modality for breast lesion assessment. Regions of interest (ROIs) were required to be specified for extracting features that characterize malignancy of lesions. Although analyses have been performed in small rectangular ROIs identified manually by expert observers, the results were subject to observer variability and the analysis of small ROIs would potentially miss out important features available in other parts of the lesion. Recent investigations extracted features from the entire lesion segmented by B-mode ultrasound images either manually or semi-automatically, but lesion delineation using existing techniques is time-consuming and prone to variability as intensive user interactions are required. In addition, rich diagnostic features were available along the rim surrounding the lesion. The width of the rim analyzed was subjectively and empirically determined by expert observers in previous studies after intensive visual study on the images, which is time-consuming and susceptible to observer variability. This paper describes an analysis pipeline to segment and classify lesions efficiently. The lesion boundary was first initialized and then deformed based on energy fields generated by the dyadic wavelet transform. Features of the SWE images were extracted from inside and outside of a lesion for different widths of the surrounding rim. Then, feature selection was performed followed by the Support Vector Machine (SVM) classification. This strategy obviates the empirical and time-consuming selection of the surrounding rim width before the analysis. The pipeline was evaluated on 137 lesions. Feature selection was performed 20 times using different sets of 14 lesions (7 malignant, 7 benign). Leave-one-out SVM classification was performed in each of the 20 experiments with a mean sensitivity, specificity and accuracy of 95.1%, 94.6% and 94.8% respectively. The pipeline took an average of 20 s to process a lesion. The fact that this efficient pipeline generated classification accuracy superior to that of existing algorithms suggests that improved efficiency did not compromise classification accuracy. The ability to streamline the quantitative assessment of SWE images will potentially accelerate the adoption of the combined use of ultrasound and elastography in clinical practice.
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Affiliation(s)
- Yanyan Yu
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jieyu Cheng
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China.
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Crombé A, Hurtevent-Labrot G, Asad-Syed M, Palussière J, MacGrogan G, Kind M, Ferron S. Shear-wave elastography quantitative assessment of the male breast: added value to distinguish benign and malignant palpable masses. Br J Radiol 2017; 91:20170676. [PMID: 29144159 DOI: 10.1259/bjr.20170676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the ability of shear-wave elastography (SWE) to distinguish between benign and malignant palpable masses of the adult male breast. METHODS Clinical examination, mammography, B-mode and Doppler ultrasound findings and SWE quantitative parameters were compared in 50 benign lesions (including 40 gynaecomastias) and 15 malignant lesions (invasive ductal carcinomas) from 65 patients who were consecutively addressed for specialized advice at our comprehensive cancer centre. Mean elasticity (El mean), maximum elasticity (El max), El mean of the surrounding fatty tissue and lesion to fat ratio (El ratio) were reported for each patient. RESULTS Malignant masses displayed significantly higher El mean (p < 0.0001), El max (p < 0.0001) and El ratio (p < 0.0001) compared to benign masses without overlap of values between the two groups. By adding SWE to clinical examination, mammography and ultrasound, all the lesions would have been retrospectively correctly diagnosed as benign or malignant. One false positive could have been downstaged, 14/65 undetermined masses could have been correctly reclassified as 4 malignant and 10 benign lesions, for which biopsies could have consequently been avoided. CONCLUSION Evaluation of male breast palpable masses by SWE demonstrates that malignant masses are significantly stiffer lesions and may improve diagnostic management when clinical examination, mammography and conventional ultrasound are doubtful. Advances in knowledge: Quantitative SWE is feasible in male breast and could be of great interest to help classify doubtful lesions after classical clinical and radiological evaluations, probably because of different anatomy and different tumours epidemiology compared with female breast.
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Affiliation(s)
- Amandine Crombé
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Gabrielle Hurtevent-Labrot
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Maryam Asad-Syed
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Jean Palussière
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Gaetan MacGrogan
- 2 Department of Pathology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Michèle Kind
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Stéphane Ferron
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
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Cong R, Li J, Wang X. Comparing Performance of Combinations of Shear Wave Elastography and B-Mode Ultrasound in Diagnosing Breast Masses: Is It Influenced by Mass Size? ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2133-2143. [PMID: 28673478 DOI: 10.1016/j.ultrasmedbio.2017.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/28/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
We determined the diagnostic performance of combinations of shear wave elastography (SWE) and B-mode ultrasound (US) in differentiating malignant from benign breast masses, and we investigated whether performance is affected by mass size. In this prospective study of 315 consecutive patients with 326 breast masses, US and SWE were performed before biopsy. Masses were categorized into two subgroups on the basis of mass size (≤15 mm and >15 mm), and the optimal thresholds for the SWE parameters were determined for each subgroup using receiver operating characteristic curves. The combination proposed here achieved an area under the receiver operating characteristic curve of 0.943, 95.00% sensitivity and 81.18% specificity, which approximated the diagnostic performance of US alone. The performance of the combinations using the subgroups' thresholds did not differ significantly from those based on the entire study group's thresholds, but the optimal thresholds were higher in the subgroup of larger masses. Further research is needed to determine whether mass size affects the performance of combinations of SWE and US.
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Affiliation(s)
- Rui Cong
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Xuejiao Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Jayaraman J, Indiran V, Kannan K, Maduraimuthu P. Acoustic Radiation Force Impulse Imaging in Benign and Malignant Breast Lesions. Cureus 2017; 9:e1301. [PMID: 28690935 PMCID: PMC5493461 DOI: 10.7759/cureus.1301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Elastography is a promising way to assess tissue differences regarding stiffness or elasticity, which has been historically assessed manually by palpation. Combined with conventional imaging modalities, shear wave elastography can potentially evaluate the stiffness of a breast lesion and consequently help detect malignant breast tumor from benign ones. The aim of this study was to evaluate the diagnostic role of shear wave elastography in breast lesions in the Indian population. Material and methods Fifty patients presenting with breast lesions were included in the study. All the patients were subjected to B-mode ultrasound and elastography using shear wave with Virtual Touch Imaging (VTITM) (Siemens Medical Solutions USA, Inc., PA, USA) and Virtual Touch Quantification (VTQTM) (Siemens Medical Solutions USA, Inc., PA, USA) and the obtained data was analyzed using an appropriate statistical test (independent samples t-test). Results In our study group of 50 patients, 34 were benign and 16 were malignant. VTITM showed a sensitivity of 97% and a specificity of 93% with a positive predictive value (PPV) of 97% for benign lesions. VTITM showed a sensitivity of 87.5 % and a specificity of 100% with a PPV of 100% for malignant lesions. VTQTM showed a sensitivity of 71.4% and a specificity of 100% with a PPV of 100% for benign lesions. VTQTM showed a sensitivity of 100% and a specificity of 100% with a PPV of 76.6% for malignant lesions. Conclusions VTITM was more reliable as a diagnostic tool compared to VTQTM in benign lesions and both are equally reliable in identifying malignant lesions. Acoustic radiation force impulse (ARFI) plays a significant role as an adjuvant diagnostic tool to B-mode imaging for assessing breast lesions.
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