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Lin M, Xu X, Dai H, Huang Q, Liu L. A case of primary breast angiosarcoma diagnosed by multimodal ultrasound imaging with literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38708797 DOI: 10.1002/jcu.23682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024]
Abstract
Primary Breast Angiosarcoma (PBA) is an exceptionally rare form of breast cancer, accounting for less than 0.05% of all breast cancers. It is characterized by a high level of malignancy, invasiveness, and has a prognosis that is typically poor. The lack of distinctive clinical features makes it prone to underdiagnosis and misdiagnosis. This study retrospectively examines a case utilizing multimodal ultrasound imaging techniques (including 2D ultrasound, contrast-enhanced ultrasound, and ultrasound elastography) for diagnosing PBA. Furthermore, the study reviews relevant literature to summarize the ultrasound characteristics of PBA, with the aim of improving understanding of this elusive condition.
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Affiliation(s)
- Minhao Lin
- Department of Ultrasound Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaohong Xu
- Department of Ultrasound Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haixia Dai
- Department of Ultrasound Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qiuxia Huang
- Department of Ultrasound Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lijuan Liu
- Department of Ultrasound Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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2
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Shamir SB, Sasson AL, Margolies LR, Mendelson DS. New Frontiers in Breast Cancer Imaging: The Rise of AI. Bioengineering (Basel) 2024; 11:451. [PMID: 38790318 PMCID: PMC11117903 DOI: 10.3390/bioengineering11050451] [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: 03/21/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Artificial intelligence (AI) has been implemented in multiple fields of medicine to assist in the diagnosis and treatment of patients. AI implementation in radiology, more specifically for breast imaging, has advanced considerably. Breast cancer is one of the most important causes of cancer mortality among women, and there has been increased attention towards creating more efficacious methods for breast cancer detection utilizing AI to improve radiologist accuracy and efficiency to meet the increasing demand of our patients. AI can be applied to imaging studies to improve image quality, increase interpretation accuracy, and improve time efficiency and cost efficiency. AI applied to mammography, ultrasound, and MRI allows for improved cancer detection and diagnosis while decreasing intra- and interobserver variability. The synergistic effect between a radiologist and AI has the potential to improve patient care in underserved populations with the intention of providing quality and equitable care for all. Additionally, AI has allowed for improved risk stratification. Further, AI application can have treatment implications as well by identifying upstage risk of ductal carcinoma in situ (DCIS) to invasive carcinoma and by better predicting individualized patient response to neoadjuvant chemotherapy. AI has potential for advancement in pre-operative 3-dimensional models of the breast as well as improved viability of reconstructive grafts.
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Affiliation(s)
- Stephanie B. Shamir
- Department of Diagnostic, Molecular and Interventional Radiology, The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
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3
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Kim GS, Moon HH, Lee HS, Jeong JS. Compound Acoustic Radiation Force Impulse Imaging of Bovine Eye by Using Phase-Inverted Ultrasound Transducer. SENSORS (BASEL, SWITZERLAND) 2024; 24:2700. [PMID: 38732804 PMCID: PMC11085659 DOI: 10.3390/s24092700] [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: 01/15/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
In general, it is difficult to visualize internal ocular structure and detect a lesion such as a cataract or glaucoma using the current ultrasound brightness-mode (B-mode) imaging. This is because the internal structure of the eye is rich in moisture, resulting in a lack of contrast between tissues in the B-mode image, and the penetration depth is low due to the attenuation of the ultrasound wave. In this study, the entire internal ocular structure of a bovine eye was visualized in an ex vivo environment using the compound acoustic radiation force impulse (CARFI) imaging scheme based on the phase-inverted ultrasound transducer (PIUT). In the proposed method, the aperture of the PIUT is divided into four sections, and the PIUT is driven by the out-of-phase input signal capable of generating split-focusing at the same time. Subsequently, the compound imaging technique was employed to increase signal-to-noise ratio (SNR) and to reduce displacement error. The experimental results demonstrated that the proposed technique could provide an acoustic radiation force impulse (ARFI) image of the bovine eye with a broader depth-of-field (DOF) and about 80% increased SNR compared to the conventional ARFI image obtained using the in-phase input signal. Therefore, the proposed technique can be one of the useful techniques capable of providing the image of the entire ocular structure to diagnose various eye diseases.
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Affiliation(s)
| | | | | | - Jong Seob Jeong
- Department of Biomedical Engineering, Dongguk University, Seoul 04620, Republic of Korea; (G.S.K.); (H.H.M.); (H.S.L.)
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4
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Carriero A, Groenhoff L, Vologina E, Basile P, Albera M. Deep Learning in Breast Cancer Imaging: State of the Art and Recent Advancements in Early 2024. Diagnostics (Basel) 2024; 14:848. [PMID: 38667493 PMCID: PMC11048882 DOI: 10.3390/diagnostics14080848] [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: 02/29/2024] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The rapid advancement of artificial intelligence (AI) has significantly impacted various aspects of healthcare, particularly in the medical imaging field. This review focuses on recent developments in the application of deep learning (DL) techniques to breast cancer imaging. DL models, a subset of AI algorithms inspired by human brain architecture, have demonstrated remarkable success in analyzing complex medical images, enhancing diagnostic precision, and streamlining workflows. DL models have been applied to breast cancer diagnosis via mammography, ultrasonography, and magnetic resonance imaging. Furthermore, DL-based radiomic approaches may play a role in breast cancer risk assessment, prognosis prediction, and therapeutic response monitoring. Nevertheless, several challenges have limited the widespread adoption of AI techniques in clinical practice, emphasizing the importance of rigorous validation, interpretability, and technical considerations when implementing DL solutions. By examining fundamental concepts in DL techniques applied to medical imaging and synthesizing the latest advancements and trends, this narrative review aims to provide valuable and up-to-date insights for radiologists seeking to harness the power of AI in breast cancer care.
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Affiliation(s)
| | - Léon Groenhoff
- Radiology Department, Maggiore della Carità Hospital, 28100 Novara, Italy; (A.C.); (E.V.); (P.B.); (M.A.)
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5
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Mesurolle B, El-Khoury M. Artificial Intelligence and Breast US: Radiologists Won't Regret Opening Pandora's Box. Acad Radiol 2024:S1076-6332(24)00204-6. [PMID: 38584016 DOI: 10.1016/j.acra.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, Centre République, Elsan, 99, avenue de la république, 63023 Clermont-Ferrand, France (B.M.).
| | - Mona El-Khoury
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Québec, Canada (M.E.K.)
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6
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Cruz-Ramos JA, Trapero-Corona MI, Valencia-Hernández IA, Gómez-Vargas LA, Toranzo-Delgado MT, Cano-Magaña KR, De la Mora-Jiménez E, del Carmen López-Armas G. Strain Elastography Fat-to-Lesion Index Is Associated with Mammography BI-RADS Grading, Biopsy, and Molecular Phenotype in Breast Cancer. BIOSENSORS 2024; 14:94. [PMID: 38392013 PMCID: PMC10886583 DOI: 10.3390/bios14020094] [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: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
Breast cancer (BC) affects millions of women worldwide, causing over 500,000 deaths annually. It is the leading cause of cancer mortality in women, with 70% of deaths occurring in developing countries. Elastography, which evaluates tissue stiffness, is a promising real-time minimally invasive technique for BC diagnosis. This study assessed strain elastography (SE) and the fat-to-lesion (F/L) index for BC diagnosis. This prospective study included 216 women who underwent SE, ultrasound, mammography, and breast biopsy (108 malignant, 108 benign). Three expert radiologists performed imaging and biopsies. Mean F/L index was 3.70 ± 2.57 for benign biopsies and 18.10 ± 17.01 for malignant. We developed two predictive models: a logistic regression model with AUC 0.893, 79.63% sensitivity, 87.62% specificity, 86.9% positive predictive value (+PV), and 80.7% negative predictive value (-PV); and a neural network with AUC 0.902, 80.56% sensitivity, 88.57% specificity, 87.9% +PV, and 81.6% -PV. The optimal Youden F/L index cutoff was >5.76, with 84.26% sensitivity and specificity. The F/L index positively correlated with BI-RADS (Spearman's r = 0.073, p < 0.001) and differed among molecular subtypes (Kruskal-Wallis, p = 0.002). SE complements mammography for BC diagnosis. With adequate predictive capacity, SE is fast, minimally invasive, and useful when mammography is contraindicated.
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Affiliation(s)
- José Alfonso Cruz-Ramos
- Departamento de Clínicas Médicas, Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Guadalajara 44340, Mexico
- Subdirección de Desarrollo Institucional, Instituto Jalisciense de Cancerología, Guadalajara 44280, Mexico
| | - Mijaíl Irak Trapero-Corona
- Subdirección de Desarrollo Institucional, Instituto Jalisciense de Cancerología, Guadalajara 44280, Mexico
| | - Ingrid Aurora Valencia-Hernández
- Departamento de Ciencias Computacionales, Instituto Nacional de Astrofísica Óptica y Electrónica, San Andrés Cholula 72840, Mexico
| | - Luz Amparo Gómez-Vargas
- Subdirección de Desarrollo Institucional, Instituto Jalisciense de Cancerología, Guadalajara 44280, Mexico
| | | | - Karla Raquel Cano-Magaña
- Subdirección de Desarrollo Institucional, Instituto Jalisciense de Cancerología, Guadalajara 44280, Mexico
| | | | - Gabriela del Carmen López-Armas
- Laboratorio de Biomédica-Mecatrónica, Subdirección de Investigación y Extensión, Centro de Enseñanza Técnica Industrial Plantel Colomos, Guadalajara 44638, Mexico
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7
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Zandi A, Shojaeian F, Abbasvandi F, Faranoush M, Anbiaee R, Hoseinpour P, Gilani A, Saghafi M, Zandi A, Hoseinyazdi M, Davari Z, Miraghaie SH, Tayebi M, Taheri MS, Ardestani SMS, Sheikhi Mobarakeh Z, Nikshoar MR, Enjavi MH, Kordehlachin Y, Mousavi-kiasary SMS, Mamdouh A, Akbari ME, Yunesian M, Abdolahad M. A human pilot study on positive electrostatic charge effects in solid tumors of the late-stage metastatic patients. Front Med (Lausanne) 2023; 10:1195026. [PMID: 37915327 PMCID: PMC10616960 DOI: 10.3389/fmed.2023.1195026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Background Correlative interactions between electrical charges and cancer cells involve important unknown factors in cancer diagnosis and treatment. We previously reported the intrinsic suppressive effects of pure positive electrostatic charges (PEC) on the proliferation and metabolism of invasive cancer cells without any effect on normal cells in cell lines and animal models. The proposed mechanism was the suppression of pro-caspases 3 and 9 with an increase in Bax/Bcl2 ratio in exposed malignant cells and perturbation induced in the KRAS pathway of malignant cells by electrostatic charges due to the phosphate molecule electrostatic charge as the trigger of the pathway. This study aimed to examine PECs as a complementary treatment for patients with different types of solid metastatic tumors, who showed resistance to chemotherapy and radiotherapy. Methods In this study, solid metastatic tumors of the end-stage patients (n = 41) with various types of cancers were locally exposed to PEC for at least one course of 12 days. The patient's signs and symptoms, the changes in their tumor size, and serum markers were followed up from 30 days before positive electrostatic charge treating (PECT) until 6 months after the study. Results Entirely, 36 patients completed the related follow-ups. Significant reduction in tumor sizes and cancer-associated enzymes as well as improvement in cancer-related signs and symptoms and patients' lifestyles, without any side effects on other tissues or metabolisms of the body, were observed in more than 80% of the candidates. Conclusion PECT induced significant cancer remission in combination with other therapies. Therefore, this non-ionizing radiation would be a beneficial complementary therapy, with no observable side effects of ionizing radiotherapy, such as post-radiation inflammation.
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Affiliation(s)
- Ashkan Zandi
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Nano Electronic Centre of Excellence, Nanoelectronics and Thin Film Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Fatemeh Shojaeian
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Abbasvandi
- Department of ATMP, Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
- Cancer Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Centre, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
- Cardio-Oncology Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Robab Anbiaee
- Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Hoseinpour
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- SEPAS Pathology Laboratory, Tehran, Iran
| | - Ali Gilani
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Saghafi
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Afsoon Zandi
- Department of Otolaryngology, Head and Neck Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Hoseinyazdi
- Medical Imaging Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Davari
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Seyyed Hossein Miraghaie
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Mahtab Tayebi
- Department of ATMP, Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S. Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioural Sciences Research Centre, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sheikhi Mobarakeh
- Department of Quality of Life, Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Mohammad Reza Nikshoar
- Department of Gastroenterology Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Enjavi
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Nano Electronic Centre of Excellence, Nanoelectronics and Thin Film Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Yasin Kordehlachin
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - S. M. Sadegh Mousavi-kiasary
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Amir Mamdouh
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | | | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdolahad
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Nano Electronic Centre of Excellence, Nanoelectronics and Thin Film Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Imam-Khomeini Hospital, Tehran University of Medical Sciences, Cancer Institute, Tehran, Iran
- UT&TUMS Cancer Electrotechnique Research Centre, YAS Hospital, Tehran, Iran
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Demirci BÖ, Buğdaycı O, Ertaş G, Şanlı DET, Kaya H, Arıbal E. Linear Regression Modeling Based Scoring System to Reduce Benign Breast Biopsies Using Multi-parametric US with Color Doppler and SWE. Acad Radiol 2023; 30 Suppl 2:S143-S153. [PMID: 36804295 DOI: 10.1016/j.acra.2023.01.024] [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: 11/07/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a simple ultrasound (US) based scoring system to reduce benign breast biopsies. MATERIALS AND METHODS Women with BI-RADS 4 or 5 breast lesions underwent shear-wave elastography (SWE) imaging before biopsy. Standard US and color Doppler US (CDUS) parameters were recorded, and the size ratio (SzR=longest/shortest diameter) was calculated. Measured/calculated SWE parameters were minimum (SWVMin) and maximum (SWVMax) shear velocity, velocity heterogeneity (SWVH=SWVMax-SWVMin), velocity ratio (SWVR=SWVMin/SWVMax), and normalized SWVR (SWVRn=(SWVMax-SWVMin)/SWVMin). Linear regression analysis was performed by converting continuous parameters into categorical corresponding equivalents using decision tree analyses. Linear regression models were fitted using stepwise regression analysis and optimal coefficients for the predictors in the models were determined. A scoring model was devised from the results and validated using a different data set from another center consisting of 187 cases with BI-RADS 3, 4, and 5 lesions. RESULTS A total of 418 lesions (238 benign, 180 malignant) were analyzed. US and CDUS parameters exhibited poor (AUC=0.592-0.696), SWE parameters exhibited poor-good (AUC=0.607-0.816) diagnostic performance in benign/malignant discrimination. Linear regression models of US+CDUS and US+SWE parameters revealed an AUC of 0.819 and 0.882, respectively. The developed scoring system could have avoided biopsy in 37.8% of benign lesions while missing 1.1% of malignant lesions. The scoring system was validated with a 100% NPV rate with a specificity of 74.6%. CONCLUSION The linear regression model using US+SWE parameters performed better than any single parameter alone. The developed scoring method could lead to a significant decrease in benign biopsies.
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Affiliation(s)
| | - Onur Buğdaycı
- Department of Radiology, Marmara University, Istanbul, Türkiye.
| | - Gökhan Ertaş
- Department of Biomedical Engineering, Yeditepe University, Istanbul, Türkiye
| | - Deniz E T Şanlı
- Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Türkiye; Department of Radiology, Gaziantep University, Gaziantep, Türkiye
| | - Handan Kaya
- Department of Pathology, Marmara University, Istanbul, Türkiye
| | - Erkin Arıbal
- Department of Radiology, Marmara University, Istanbul, Türkiye; Department of Radiology, Acıbadem University Medical School, Istanbul, Türkiye
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9
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Ong EMW. Translating new breast ultrasound techniques into clinical practice: evaluating their intended uses and describing other unexpected uses for them. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2023; 4:23. [PMID: 38751486 PMCID: PMC11093072 DOI: 10.21037/tbcr-23-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 05/18/2024]
Abstract
Several new ultrasound tools have been developed to further evaluate breast lesions detected on B-mode ultrasound. Strain elastography (SRE) was developed to assess the likelihood of malignancy of lesions based on their stiffness. This has been incorporated into the latest edition of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) lexicon and atlas. However, no agreed cut-off stiffness values have been established to distinguish benign from malignant lesions making the translation into routine clinical practice difficult. Superb microvascular imaging (SMI) was developed to better evaluate the vascularity within sonographic lesions and assess their likelihood of malignancy. However, there is also no agreed cut-off value for vascular index (VI) to distinguish between benign and malignant lesions. MicroPure was developed to better visualize and evaluate calcifications seen on ultrasound. Its effective use in breast screening and evaluating the calcifications detected for likelihood of malignancy have not been established. This article describes the original intended uses of these applications and reviews the studies evaluating them, showing the varying success of the translation of these tools into routine clinical practice. Also described are some other uses of these tools for which they were not originally intended. This illustrates the importance of being perceptive to alternative uses of imaging tools in their translation from bench to bedside.
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10
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Kim HJ, Kim HH, Choi WJ, Chae EY, Shin HJ, Cha JH. Correlation of shear-wave elastography parameters with the molecular subtype and axillary lymph node status in breast cancer. Clin Imaging 2023; 101:190-199. [PMID: 37418896 DOI: 10.1016/j.clinimag.2023.06.006] [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: 03/09/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE To examine correlations between shear-wave elastography (SWE) parameters with molecular subtype and axillary lymph node (LN) status of breast cancer. METHODS We retrospectively analyzed 545 consecutive women (mean age, 52.7 ± 10.7 years; range, 26-83) with breast cancer who underwent preoperative breast ultrasound with SWE between December 2019 and January 2021. SWE parameters (Emax, Emean, and Eratio) and the histopathologic information from surgical specimens including histologic type, histologic grade, size of invasive cancer, hormone receptor and HER2 status, Ki-67 proliferation index, and axillary LN status were analyzed. The relationships between SWE parameters and histopathologic findings were analyzed using an independent sample t-test, one-way ANOVA test with Tukey's post hoc test, and logistic regression analyses. RESULTS Higher stiffness values of SWE were associated with larger lesion size (>20 mm) on ultrasound, high histologic grade, larger invasive cancer size (>20 mm), high Ki-67, and axillary LN metastasis. Emax and Emean were the lowest in the luminal A-like subtype, and all three parameters were the highest in the triple-negative subtype. Lower value of Emax was independently associated with the luminal A-like subtype (P = 0.04). Higher value of Emean was independently associated with axillary LN metastasis for tumors ≤ 20 mm (P = 0.03). CONCLUSION Increases in the tumor stiffness values on SWE were significantly associated with aggressive histopathologic features of breast cancer. Lower stiffness values were associated with the luminal A-like subtype, and tumors with higher stiffness values were associated with axillary LN metastasis in small breast cancers.
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Affiliation(s)
- Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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Catalano O, Fusco R, De Muzio F, Simonetti I, Palumbo P, Bruno F, Borgheresi A, Agostini A, Gabelloni M, Varelli C, Barile A, Giovagnoni A, Gandolfo N, Miele V, Granata V. Recent Advances in Ultrasound Breast Imaging: From Industry to Clinical Practice. Diagnostics (Basel) 2023; 13:diagnostics13050980. [PMID: 36900124 PMCID: PMC10000574 DOI: 10.3390/diagnostics13050980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Breast ultrasound (US) has undergone dramatic technological improvement through recent decades, moving from a low spatial resolution, grayscale-limited technique to a highly performing, multiparametric modality. In this review, we first focus on the spectrum of technical tools that have become commercially available, including new microvasculature imaging modalities, high-frequency transducers, extended field-of-view scanning, elastography, contrast-enhanced US, MicroPure, 3D US, automated US, S-Detect, nomograms, images fusion, and virtual navigation. In the subsequent section, we discuss the broadened current application of US in breast clinical scenarios, distinguishing among primary US, complementary US, and second-look US. Finally, we mention the still ongoing limitations and the challenging aspects of breast US.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Igino Simonetti
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, 80131 Naples, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Michela Gabelloni
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
| | - Carlo Varelli
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, 80131 Naples, Italy
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12
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Li J, Liu Y, Li Y, Li S, Wang J, Zhu Y, Lu H. Comparison of diagnostic potential of shear wave elastography between breast mass lesions and non-mass-like lesions. Eur J Radiol 2023; 158:110609. [PMID: 36423364 DOI: 10.1016/j.ejrad.2022.110609] [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: 08/29/2022] [Revised: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) can improve the specificity of B-mode ultrasound (US) without reducing the sensitivity for breast cancer diagnosis. Existing research on SWE includes both mass lesions and non‑mass‑like (NML) lesions or only NML lesions; however, there are no studies comparing the diagnostic potential of SWE in the detection of mass and NML lesions in the same trial. OBJECTIVE This study aimed to compare the diagnostic performance of SWE in detecting mass lesions and NML lesions and determine the different individualised thresholds of the SWE parameters according to the lesion type. METHODS This Study included 623 breast lesions of 562 consecutive women, who were scheduled for conventional US and SWE between January 2021 and December 2021. The diagnostic performances of conventional US and each quantitative SWE parameter (maximum elastic modulus [Emax], mean elastic modulus [Emean], and elastic modulus standard deviation [Esd]) were assessed. Histological diagnosis for all Breast Imaging Reporting and Database System (BI-RADS) category 4/5 patients and some BI-RADS category 3 patients and the follow-up results of other BI-RADS category 3 patients were used as the reference standard. RESULTS In this study, 281 benign lesions and 342 malignant lesions were identified. The diagnostic performance of conventional US and SWE was better in the mass lesion group than in the NML lesion group. Every SWE parameter had a different threshold in each group, and the thresholds of the SWE parameters were higher in the mass lesion group than in the NML lesion group. In the mass lesion group, Esd had the highest Az value, whereas in the NML lesion group, Emax had the highest Az value. In both the mass and NML lesion groups, the diagnostic specificity of the combination of conventional US and SWE was significantly higher than that of conventional US alone (P < 0.05), without a significantly decrease in the diagnosticsensitivity. CONCLUSIONS SWE could increase the confidence of breast ultrasound diagnosis, especially for NML lesions. NML lesions had lower thresholds of SWE parameters than did the mass lesions.
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Affiliation(s)
- Junnan Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Yacong Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Yanbo Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Shuang Li
- Department of Bone and Tissue Oncology, Tianjin Hospital, Tianjin University, Tianjin, PR China
| | - Jiahui Wang
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Ying Zhu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China.
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13
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Baek J, O’Connell AM, Parker KJ. Improving breast cancer diagnosis by incorporating raw ultrasound parameters into machine learning. MACHINE LEARNING: SCIENCE AND TECHNOLOGY 2022; 3:045013. [PMID: 36698865 PMCID: PMC9855672 DOI: 10.1088/2632-2153/ac9bcc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 01/28/2023] Open
Abstract
The improved diagnostic accuracy of ultrasound breast examinations remains an important goal. In this study, we propose a biophysical feature-based machine learning method for breast cancer detection to improve the performance beyond a benchmark deep learning algorithm and to furthermore provide a color overlay visual map of the probability of malignancy within a lesion. This overall framework is termed disease-specific imaging. Previously, 150 breast lesions were segmented and classified utilizing a modified fully convolutional network and a modified GoogLeNet, respectively. In this study multiparametric analysis was performed within the contoured lesions. Features were extracted from ultrasound radiofrequency, envelope, and log-compressed data based on biophysical and morphological models. The support vector machine with a Gaussian kernel constructed a nonlinear hyperplane, and we calculated the distance between the hyperplane and each feature's data point in multiparametric space. The distance can quantitatively assess a lesion and suggest the probability of malignancy that is color-coded and overlaid onto B-mode images. Training and evaluation were performed on in vivo patient data. The overall accuracy for the most common types and sizes of breast lesions in our study exceeded 98.0% for classification and 0.98 for an area under the receiver operating characteristic curve, which is more precise than the performance of radiologists and a deep learning system. Further, the correlation between the probability and Breast Imaging Reporting and Data System enables a quantitative guideline to predict breast cancer. Therefore, we anticipate that the proposed framework can help radiologists achieve more accurate and convenient breast cancer classification and detection.
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Affiliation(s)
- Jihye Baek
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States of America
| | - Avice M O’Connell
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Kevin J Parker
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States of America,Author to whom any correspondence should be addressed
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14
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Chen Y, Lu J, Li J, Liao J, Huang X, Zhang B. Evaluation of diagnostic efficacy of multimode ultrasound in BI-RADS 4 breast neoplasms and establishment of a predictive model. Front Oncol 2022; 12:1053280. [PMID: 36505867 PMCID: PMC9730703 DOI: 10.3389/fonc.2022.1053280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore the diagnostic efficacy of ultrasound (US), two-dimensional and three-dimensional shear-wave elastography (2D-SWE and 3D-SWE), and contrast-enhanced ultrasound (CEUS) in breast neoplasms in category 4 based on the Breast Imaging Reporting and Data System (BI-RADS) from the American College of Radiology (ACR) and to develop a risk-prediction nomogram based on the optimal combination to provide a reference for the clinical management of BI-RADS 4 breast neoplasms. Methods From September 2021 to April 2022, a total of 104 breast neoplasms categorized as BI-RADS 4 by US were included in this prospective study. There were 78 breast neoplasms randomly assigned to the training cohort; the area under the receiver-operating characteristic curve (AUC), 95% confidence interval (95% CI), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2D-SWE, 3D-SWE, CEUS, and their combination were analyzed and compared. The optimal combination was selected to develop a risk-prediction nomogram. The performance of the nomogram was assessed by a validation cohort of 26 neoplasms. Results Of the 78 neoplasms in the training cohort, 16 were malignant and 62 were benign. Among the 26 neoplasms in the validation cohort, 6 were malignant and 20 were benign. The AUC values of 2D-SWE, 3D-SWE, and CEUS were not significantly different. After a comparison of the different combinations, 2D-SWE+CEUS showed the optimal performance. Least absolute shrinkage and selection operator (LASSO) regression was used to filter the variables in this combination, and the variables included Emax, Eratio, enhancement mode, perfusion defect, and area ratio. Then, a risk-prediction nomogram with BI-RADS was built. The performance of the nomogram was better than that of the radiologists in the training cohort (AUC: 0.974 vs. 0.863). In the validation cohort, there was no significant difference in diagnostic accuracy between the nomogram and the experienced radiologists (AUC: 0.946 vs. 0.842). Conclusions US, 2D-SWE, 3D-SWE, CEUS, and their combination could improve the diagnostic efficiency of BI-RADS 4 breast neoplasms. The diagnostic efficacy of US+3D-SWE was not better than US+2D-SWE. US+2D-SWE+CEUS showed the optimal diagnostic performance. The nomogram based on US+2D-SWE+CEUS performs well.
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15
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Kim H, Kim H, Han BK, Choi JS, Ko ES, Ko EY. Accuracy and reproducibility of shear wave elastography according to the size and elasticity of lesions: A phantom study. Medicine (Baltimore) 2022; 101:e31095. [PMID: 36253983 PMCID: PMC9575830 DOI: 10.1097/md.0000000000031095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
While the extrinsic factors affecting reproducibility of shear wave elastography (SWE) have been well documented, there are few resources assessing intrinsic characteristics of the lesion affecting the reproducibility and accuracy of SWE. In this regard, this study aimed to evaluate the accuracy of measured elasticity and the reproducibility of SWE according to the lesion size and stiffness. Two breast radiologists examined 20 targets of 4 different levels of stiffness and 5 different sizes (2.5, 4, 7, 11, and 18 mm) in a customized elasticity phantom. The B-mode image, color elastography image, and kPa measurement were obtained twice by each examiner with a 1-week interval. Inter- and intra-observer reproducibility and the accuracy of measured kPa were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Subgroup analysis was run to evaluate the effect of lesion size and stiffness on the reproducibility and accuracy of measured kPa. Inter- and intraobserver reproducibility for measuring kPa showed excellent agreement (ICC: 0.9742 and 0.9582; ICC: 0.9932 and 0.9294). The size and stiffness of the targets did not affect reproducibility. The overall accuracy of measured kPa was very high (ICC: 0.8049). In the subgroup analysis, targets that were ≤4 mm in size showed lower accuracy (ICC: 0.542), whereas targets that were 7 and 11 mm in size showed higher accuracy (ICC: 0.9832 and 0.9656, respectively). SWE shows excellent reproducibility regardless of lesion size or stiffness in phantom targets. The accuracy of measured kPa is high in lesions that are 7 and 11 mm in size but is low in lesions that are ≤4 mm in size.
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Affiliation(s)
- Harim Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Haejung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
- *Correspondence: Eun Young Ko, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (e-mail: )
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16
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Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters. Sci Rep 2022; 12:16205. [PMID: 36171328 PMCID: PMC9519555 DOI: 10.1038/s41598-022-19971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
To investigate the diagnostic value of combined SWE, SMI, and B-mode US scores for distinguishing between benign and malignant masses. A total of 450 breast masses that underwent US-guided core needle biopsies were prospectively enrolled. The breast masses were assessed based on the BI-RADS and quantitative SWE and SMI parameters. The SWEmax, SWEratio, and SMIVI cutoff value were determined using Youden’s index by comparison to the pathological results. The BI-RADS categories were scored on a scale from 1 to 5, and SWEmax, SWEratio, and SMIVI were dichotomized based on each cutoff values (0 or 1). The combined scores (1 to 8) were calculated as the sum of the BI-RADS score and the quantitative scores and compared to the pathologic results using AUROC analysis. The cutoff values were 52.25 kPa for SWEmax, 5.03 for SWEratio, and 2.15% for SMIVI. In AUROC, the combined scores showed significantly better diagnostic performance compared to BI-RADS alone (p < 0.001). The combined score showed significantly increased than BI-RADS alone in specificity (p < 0.001) and accuracy (p < 0.001), but a sensitivity decreased without significance (p = 0.082). When a combined score cutoff value of 4 was used, the false negative rate was 2.7%. Using the combined score, 76.4% of the C4a lesions were considered benign also pathologically diagnosed as benign. The combined scores showed improved diagnostic performance in differentiating between benign and malignant breast masses, which could be helpful for determining a breast biopsy eligibility.
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17
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Bartolotta TV, Orlando AAM, Dimarco M, Zarcaro C, Ferraro F, Cirino A, Matranga D, Vieni S, Cabibi D. Diagnostic performance of 2D-shear wave elastography in the diagnosis of breast cancer: a clinical appraisal of cutoff values. Radiol Med 2022; 127:1209-1220. [DOI: 10.1007/s11547-022-01546-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
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18
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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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19
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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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20
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Li H, Bhatt M, Qu Z, Zhang S, Hartel MC, Khademhosseini A, Cloutier G. Deep learning in ultrasound elastography imaging: A review. Med Phys 2022; 49:5993-6018. [PMID: 35842833 DOI: 10.1002/mp.15856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022] Open
Abstract
It is known that changes in the mechanical properties of tissues are associated with the onset and progression of certain diseases. Ultrasound elastography is a technique to characterize tissue stiffness using ultrasound imaging either by measuring tissue strain using quasi-static elastography or natural organ pulsation elastography, or by tracing a propagated shear wave induced by a source or a natural vibration using dynamic elastography. In recent years, deep learning has begun to emerge in ultrasound elastography research. In this review, several common deep learning frameworks in the computer vision community, such as multilayer perceptron, convolutional neural network, and recurrent neural network are described. Then, recent advances in ultrasound elastography using such deep learning techniques are revisited in terms of algorithm development and clinical diagnosis. Finally, the current challenges and future developments of deep learning in ultrasound elastography are prospected. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hongliang Li
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Manish Bhatt
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Zhen Qu
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Shiming Zhang
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Martin C Hartel
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Ali Khademhosseini
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
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21
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Iacob R, Manolescu DL, Stoicescu ER, Fabian A, Malita D, Oancea C. Breast Cancer—How Can Imaging Help? Healthcare (Basel) 2022; 10:healthcare10071159. [PMID: 35885686 PMCID: PMC9323053 DOI: 10.3390/healthcare10071159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common malignant disease among women, causing death and suffering worldwide. It is known that, for the improvement of the survival rate and the psychological impact it has on patients, early detection is crucial. For this to happen, the imaging techniques should be used at their full potential. We selected and examined 44 articles that had as subject the use of a specific imaging method in breast cancer management (mammography, ultrasound, MRI, ultrasound-guided biopsy, PET-CT). After analyzing their data, we summarized and concluded which are the best ways to use each one of the mentioned techniques for a good outcome. We created a simplified algorithm with easy steps that can be followed by radiologists when facing this type of neoplasia.
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Affiliation(s)
- Roxana Iacob
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania; (R.I.); (E.R.S.); (A.F.); (D.M.)
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania; (R.I.); (E.R.S.); (A.F.); (D.M.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Correspondence:
| | - Emil Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania; (R.I.); (E.R.S.); (A.F.); (D.M.)
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania
| | - Antonio Fabian
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania; (R.I.); (E.R.S.); (A.F.); (D.M.)
| | - Daniel Malita
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania; (R.I.); (E.R.S.); (A.F.); (D.M.)
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Department of Pulmonology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
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22
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Luo H, Li J, Shi Y, Xiao X, Wang Y, Wei Z, Xu J. Stiffness in breast masses with posterior acoustic shadowing: significance of ultrasound real time shear wave elastography. BMC Med Imaging 2022; 22:71. [PMID: 35430798 PMCID: PMC9013446 DOI: 10.1186/s12880-022-00797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background To assess the stiffness of benign breast masses in ultrasound images with posterior acoustic shadowing (PAS) and malignant lesions, and explore the significance of differential diagnosis using ultrasound real time shear wave elastography. Material and methods All 117 mammary masses (98 patients) with PAS were assessed by using routine ultrasound examination, and elastic modulus values were obtained with the real time shear wave elastography mode. All breast lesions were confirmed by surgery or biopsy. The significance of differences in ultrasound elastography values between breast benign and malignant masses with posterior acoustic shadowing was assessed, and the ROC curves of elasticity modulus values were analyzed. Results Among the 117 masses, 72 were benign and 45 were malignant. The two types of breast masses showed significant differences in size, margin, internal echo, calcification, and blood flow characteristics (P < 0.05), although the difference in orientation was not significant (P > 0.05). Emean, Emax and Esd obtained with real time shear wave elastography showed statistically significant differences between benign masses with posterior acoustic shadowing and breast cancer (P < 0.05), while Emin showed no significant difference between them (P = 0.633). Ultrasound real time shear wave elastography showed higher sensitivity and specificity than conventional ultrasound. Conclusions Benign and malignant breast masses with PAS show different ultrasound manifestations. Real time shear wave elastography can facilitate the differential diagnosis and treatment planning for these breast masses.
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23
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Benech N, Camargo A, Negreira C. Simplified Green's function for surface waves in quasi-incompressible elastic plates with application to elastography. JOURNAL OF PHYSICS. CONDENSED MATTER : AN INSTITUTE OF PHYSICS JOURNAL 2022; 34:214004. [PMID: 35234669 DOI: 10.1088/1361-648x/ac5993] [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: 11/29/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
Surface wave elastography is a growing method to estimate the elasticity in soft solids. It is particularly useful in the case of agrifoods like meat, cheese, or fruits because it does not require major infrastructure or large equipment and could be developed in portable devices. However, estimating the shear elastic properties from surface wave measurements is not straightforward. The shear wavelength in those materials is cm sized for the excitation frequencies usually employed in elastography (∼102 Hz), and the size of samples is comparable to it. Thus, the surface wave speed is frequency dependent with no direct relation to the shear wave speed. In this work we propose a simplified Green's function for soft solid elastic plates which allows to retrieve the shear elasticity from near field measurements. The model is compared with experimental results obtained in agar-gelatin phantoms and food samples (cheese and bovine liver). The results show a good overall agreement although improvements can be achieved by incorporating diffraction and viscosity to the model.
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Affiliation(s)
- Nicolás Benech
- Laboratorio de Acústica Ultrasonora, Facultad de Ciencias, Universidad de la República, Igua 4225, 11400, Montevideo, Uruguay
| | - Andrés Camargo
- Laboratorio de Acústica Ultrasonora, Facultad de Ciencias, Universidad de la República, Igua 4225, 11400, Montevideo, Uruguay
| | - Carlos Negreira
- Laboratorio de Acústica Ultrasonora, Facultad de Ciencias, Universidad de la República, Igua 4225, 11400, Montevideo, Uruguay
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A Surgeon's Empirical Perspectives on Use of High-resolution Ultrasound in Preoperatively Detecting a Rupture in the Context of Breast Implant Crisis in Korea. Aesthetic Plast Surg 2022; 46:1668-1678. [PMID: 35296929 DOI: 10.1007/s00266-022-02844-4] [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: 11/19/2021] [Accepted: 02/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND We previously proposed a novel method for detecting a rupture of a breast implant using high-resolution ultrasound (HRUS). We therefore conducted this retrospective, observational study to describe its feasibility in making a preoperative diagnosis of rupture of the device in patients receiving an implant-based augmentation mammaplasty. METHODS We initially evaluated the medical records of the patients who had received primary or secondary augmentation mammaplasty using a breast implant at other hospitals for aesthetic or reconstructive purposes between August 31, 2017, and August 31, 2020. The patients underwent breast US using the Aplio i600 (Canon Medical System, Otawara, Tochigi, Japan) system with a 7-18 MHz linear transducer. Through a retrospective review of the patients' medical records, we analyzed their baseline and clinical characteristics. Then, we compared an agreement between preoperative diagnosis of rupture on HRUS and findings at reoperation. RESULTS A total of 29 patients with rupture (55 breasts) were evaluated for the performance of ultrasound in making a diagnosis of rupture. This showed that they were unaware of rupture but they were diagnosed with it on ultrasound. Preoperatively, there were no cases of rupture in 110 left breasts (80.9%) and 107 right breasts (78.7%), which exactly matched to the number of breasts without rupture on HRUS. Moreover, preoperatively, there were 26 (19.1%) and 29 cases (21.3%) of rupture in the left and right breast, respectively, which exactly matched to the number of breasts with rupture on HRUS. CONCLUSIONS In conclusion, patients who are suspected of having rupture of a breast implant should be stringently evaluated for presence of rupture and, if any, its scope using HRUS. Moreover, we propose that surgeons consider using HRUS in making a preoperative diagnosis of rupture of a breast implant. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Kirby MA, Tang P, Liou HC, Kuriakose M, Pitre JJ, Pham TN, Ettinger RE, Wang RK, O'Donnell M, Pelivanov I. Probing elastic anisotropy of human skin in vivo with light using non-contact acoustic micro-tapping OCE and polarization sensitive OCT. Sci Rep 2022; 12:3963. [PMID: 35273250 PMCID: PMC8913799 DOI: 10.1038/s41598-022-07775-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/24/2022] [Indexed: 12/19/2022] Open
Abstract
Skin broadly protects the human body from undesired factors such as ultraviolet radiation and abrasion and helps conserve body temperature and hydration. Skin's elasticity and its level of anisotropy are key to its aesthetics and function. Currently, however, treatment success is often speculative and subjective, and is rarely based on skin's elastic properties because there is no fast and accurate non-contact method for imaging of skin's elasticity. Here we report on a non-contact and non-invasive method to image and characterize skin's elastic anisotropy. It combines acoustic micro-tapping optical coherence elastography (AμT-OCE) with a nearly incompressible transversely isotropic (NITI) model to quantify skin's elastic moduli. In addition, skin sites were imaged with polarization sensitive optical coherence tomography (PS-OCT) to help define fiber orientation. Forearm skin areas were investigated in five volunteers. Results clearly demonstrate elastic anisotropy of skin in all subjects. AμT-OCE has distinct advantages over competitive techniques because it provides objective, quantitative characterization of skin's elasticity without contact, which opens the door for broad translation into clinical use. Finally, we demonstrate that a combination of multiple OCT modalities (structural OCT, OCT angiography, PS-OCT and AμT-OCE) may provide rich information about skin and can be used to characterize scar.
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Affiliation(s)
- Mitchell A Kirby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Peijun Tang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hong-Cin Liou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Maju Kuriakose
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - John J Pitre
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Tam N Pham
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | | | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Matthew O'Donnell
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ivan Pelivanov
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
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26
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Covington MF. Ultrasound Elastography May Better Characterize BI-RADS 3 and BI-RADS 4A Lesions to Decrease False-Positive Breast Biopsy Rates and Enable Earlier Detection of Breast Cancer. J Am Coll Radiol 2022; 19:635-636. [DOI: 10.1016/j.jacr.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
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27
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Mutala TM, Mwango GN, Aywak A, Cioni D, Neri E. Determining the elastography strain ratio cut off value for differentiating benign from malignant breast lesions: systematic review and meta-analysis. Cancer Imaging 2022; 22:12. [PMID: 35151365 PMCID: PMC8841096 DOI: 10.1186/s40644-022-00447-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background Elastography is an addition to grey-scale ultrasonic examination that has gained substantial traction within the last decade. Strain ratio (SR) has been incorporated as a semiquantitative measure within strain elastography, thus a potential imaging biomarker. The World Federation for Ultrasound in Medicine and Biology (WFUMB) published guidelines in 2015 for breast elastography. These guidelines acknowledge the marked variance in SR cut-off values used in differentiating benign from malignant lesions. The objective of this review was to include more recent evidence and seek to determine the optimal strain ratio cut off value for differentiating between benign and malignant breast lesions. Methods Comprehensive search of MEDLINE and Web of Science electronic databases with additional searches via Google Scholar and handsearching set from January 2000 to May 2020 was carried out. For retrieved studies, screening for eligibility, data extraction and analysis was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) Statement guidelines of 2018. Quality and risk of bias assessment of the studies were performed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results A total of 424 articles, 412 from electronic database and 12 additional searches were retrieved and 65 studies were included in the narrative synthesis and subgroup analysis. The overall threshold effect indicated significant heterogeneity among the studies with Spearman correlation coefficient of Logit (TPR) vs Logit (FPR) at − 0.301, p-value = 0.015. A subgroup under machine model consisting seven studies with 783 patients and 844 lesions showed a favourable threshold, Spearman’s correlation coefficient,0.786 (p = 0.036). Conclusion From our review, currently the optimal breast SR cut-off point or value remains unresolved despite the WFUMB guidelines of 2015. Machine model as a possible contributor to cut-off value determination was suggested from this review which can be subjected to more industry and multi-center research determination. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00447-5.
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Ha SM, Kim HK, Kim Y, Noh DY, Han W, Chang JM. Diagnostic performance improvement with combined use of proteomics biomarker assay and breast ultrasound. Breast Cancer Res Treat 2022; 192:541-552. [PMID: 35084623 DOI: 10.1007/s10549-022-06527-1] [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: 10/28/2021] [Accepted: 01/16/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the combined use of blood-based 3-protein signature and breast ultrasound (US) for validating US-detected lesions. METHODS From July 2011 to April 2020, women who underwent whole-breast US within at least 6 months from sampling period were retrospectively included. Blood-based 3-protein signature (Mastocheck®) value and US findings were evaluated. Following outcome measures were compared between US alone and the combination of Mastocheck® value with US: sensitivity, specificity, positive predictive value (PPV), negative predictive value, area under the receiver operating characteristic curve (AUC), and biopsy rate. RESULTS Among the 237 women included, 59 (24.9%) were healthy individuals and 178 (75.1%) cancer patients. Mean size of cancers was 1.2 ± 0.8 cm. Median value of Mastocheck® was significantly different between nonmalignant (- 0.24, interquartile range [IQR] - 0.48, - 0.03) and malignant lesions (0.55, IQR - 0.03, 1.42) (P < .001). Utilizing Mastocheck® value with US increased the AUC from 0.67 (95% confidence interval [CI] 0.61, 0.73) to 0.81 (95% CI 0.75, 0.88; P < .001), and specificity from 35.6 (95% CI 23.4, 47.8) to 64.4% (95% CI 52.2, 76.6; P < .001) without loss in sensitivity. PPV was increased from 82.2 (95% CI 77.1, 87.3) to 89.3% (95% CI 85.0, 93.6; P < .001), and biopsy rate was significantly decreased from 79.3 (188/237) to 72.1% (171/237) (P < .001). Consistent improvements in specificity, PPV, and AUC were observed in asymptomatic women, in women with dense breast, and in those with normal/benign mammographic findings. CONCLUSION Mastocheck® is an effective tool that can be used with US to improve diagnostic specificity and reduce false-positive findings and unnecessary biopsies.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Yumi Kim
- Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Department of Surgery, CHA University Gangnam Medical Center, Seoul, Republic of Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Department of Surgery, CHA University Gangnam Medical Center, Seoul, Republic of Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
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Association of Tumor Strain Ratio with Prognostic Factors in Invasive Breast Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Misra S, Jeon S, Managuli R, Lee S, Kim G, Yoon C, Lee S, Barr RG, Kim C. Bi-Modal Transfer Learning for Classifying Breast Cancers via Combined B-Mode and Ultrasound Strain Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:222-232. [PMID: 34633928 DOI: 10.1109/tuffc.2021.3119251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although accurate detection of breast cancer still poses significant challenges, deep learning (DL) can support more accurate image interpretation. In this study, we develop a highly robust DL model based on combined B-mode ultrasound (B-mode) and strain elastography ultrasound (SE) images for classifying benign and malignant breast tumors. This study retrospectively included 85 patients, including 42 with benign lesions and 43 with malignancies, all confirmed by biopsy. Two deep neural network models, AlexNet and ResNet, were separately trained on combined 205 B-mode and 205 SE images (80% for training and 20% for validation) from 67 patients with benign and malignant lesions. These two models were then configured to work as an ensemble using both image-wise and layer-wise and tested on a dataset of 56 images from the remaining 18 patients. The ensemble model captures the diverse features present in the B-mode and SE images and also combines semantic features from AlexNet and ResNet models to classify the benign from the malignant tumors. The experimental results demonstrate that the accuracy of the proposed ensemble model is 90%, which is better than the individual models and the model trained using B-mode or SE images alone. Moreover, some patients that were misclassified by the traditional methods were correctly classified by the proposed ensemble method. The proposed ensemble DL model will enable radiologists to achieve superior detection efficiency owing to enhance classification accuracy for breast cancers in ultrasound (US) images.
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Bitencourt A, Daimiel Naranjo I, Lo Gullo R, Rossi Saccarelli C, Pinker K. AI-enhanced breast imaging: Where are we and where are we heading? Eur J Radiol 2021; 142:109882. [PMID: 34392105 PMCID: PMC8387447 DOI: 10.1016/j.ejrad.2021.109882] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022]
Abstract
Significant advances in imaging analysis and the development of high-throughput methods that can extract and correlate multiple imaging parameters with different clinical outcomes have led to a new direction in medical research. Radiomics and artificial intelligence (AI) studies are rapidly evolving and have many potential applications in breast imaging, such as breast cancer risk prediction, lesion detection and classification, radiogenomics, and prediction of treatment response and clinical outcomes. AI has been applied to different breast imaging modalities, including mammography, ultrasound, and magnetic resonance imaging, in different clinical scenarios. The application of AI tools in breast imaging has an unprecedented opportunity to better derive clinical value from imaging data and reshape the way we care for our patients. The aim of this study is to review the current knowledge and future applications of AI-enhanced breast imaging in clinical practice.
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Affiliation(s)
- Almir Bitencourt
- Department of Imaging, A.C.Camargo Cancer Center, Sao Paulo, SP, Brazil; Dasa, Sao Paulo, SP, Brazil
| | - Isaac Daimiel Naranjo
- Department of Radiology, Breast Imaging Service, Guy's and St. Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Roberto Lo Gullo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Outcomes of Return to Routine Screening for BI-RADS 3 Lesions Detected at Supplemental Automated Whole-Breast Ultrasound in Women with Dense Breasts: A Prospective Study. AJR Am J Roentgenol 2021; 217:1313-1321. [PMID: 34259039 DOI: 10.2214/ajr.21.26180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Supplemental screening breast ultrasound (US) detects additional cancers in women with dense breasts but identifies many BI-RADS 3 lesions that result in short-term follow-ups and biopsies. Objective: To evaluate outcomes in patients recommended for return to routine screening for lesions assessed as BI-RADS 3 on supplemental automated whole-breast US (ABUS). Methods: This prospective study invited patients with BI-RADS 1 or 2 on screening mammography and breast density C or D to undergo supplemental ABUS. ABUS was interpreted as BI-RADS 1, 2, 3, or 0. Return to routine screening was recommended for ABUS BI-RADS 1, 2, or 3. ABUS BI-RADS 0 lesions underwent targeted hand-held US. Remaining patients were followed for 2 years. Malignancy rates were compared using Fisher's exact tests. Results: A total of 2257 women (mean age, 58.0±11.2 years) were included. Supplemental ABUS was scored as BI-RADS 1 in 1186 (52.5%), BI-RADS 2 in 591 (26.2%), BI-RADS 3 in 395 (17.5%), and BI-RADS 0 in 85 (3.8%). A total of 394 patients with ABUS BI-RADS 3 had 2-year follow-up, during which no cancer (0%, 95% CI 0.0%-0.9%) was diagnosed in the quadrant of the lesion. Among patients with 2-year follow-up, breast cancer was diagnosed in 4/1117 (0.4%) with ABUS BI-RADS 1, 2/556 (0.4%) with ABUS BI-RADS 2, and 2/394 (0.5%) with ABUS BI-RADS 3 (cancer in other quadrant than the lesion). Malignancy rates were not different between ABUS BI-RADS 1, 2, and 3 (p=.28). ABUS recall rate was 3.8% (85/2257; 95% CI 3.6%-4.0%). If short-term follow-up had been recommended for ABUS BI-RADS 3, ABUS recall rate would have been 21.3% (480/2257, 95% CI 19.6%-23.0%). Biopsy rate was 0.4% (12/2257; 95% CI 0.3%-0.9%); positive biopsy rate was 58.3% (7/12). One of 7 patients diagnosed with cancer by initial supplemental ABUS, and none of 8 patients diagnosed with cancer during subsequent follow-up, had node-positive cancer. Conclusions: Return to routine screening for ABUS BI-RADS 3 lesions results in a substantial decrease in recall rate, while being unlikely to result in adverse outcome. Clinical Impact: This prospective study supports a recommendation for routine annual follow-up for BI-RADS 3 lesions at supplemental ABUS.
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Athamnah SI, Oglat AA, Fohely F. Diagnostice breast elastography estimation from doppler imaging using central difference (CD) and least-squares (LS) algorithms. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gomez A, Hurtado M, Callejas A, Torres J, Saffari N, Rus G. Experimental Evidence of Generation and Reception by a Transluminal Axisymmetric Shear Wave Elastography Prototype. Diagnostics (Basel) 2021; 11:diagnostics11040645. [PMID: 33918357 PMCID: PMC8067333 DOI: 10.3390/diagnostics11040645] [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: 12/11/2020] [Revised: 03/20/2021] [Accepted: 03/30/2021] [Indexed: 01/30/2023] Open
Abstract
Experimental evidence on testing a non-ultrasonic-based probe for a new approach in transluminal elastography was presented. The proposed modality generated shear waves by inducing oscillatory rotation on the lumen wall. Detection of the propagated waves was achieved at a set of receivers in mechanical contact with the lumen wall. The excitation element of the probe was an electromagnetic rotational actuator whilst the sensing element was comprised by a uniform anglewise arrangement of four piezoelectric receivers. The prototype was tested in two soft-tissue-mimicking phantoms that contained lumenlike conduits and stiffer inclusions. The shear wave speed of the different components of the phantoms was characterized using shear wave elastography. These values were used to estimate the time-of-flight of the expected reflections. Ultrafast ultrasound imaging, based on Loupas’ algorithm, was used to estimate the displacement field in transversal planes to the lumenlike conduit and to compare against the readouts from the transluminal transmission–reception tests. Experimental observations between ultrafast imaging and the transluminal probe were in good agreement, and reflections due to the stiffer inclusions were detected by the transluminal probe. The obtained experimental evidence provided proof-of-concept for the transluminal elastography probe and encouraged further exploration of clinical applications.
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Affiliation(s)
- Antonio Gomez
- Department of Mechanical Engineering, University College London, London WC1E 6BT, UK; (A.G.); (N.S.)
| | - Manuel Hurtado
- Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (M.H.); (J.T.); (G.R.)
| | - Antonio Callejas
- Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (M.H.); (J.T.); (G.R.)
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
- Correspondence:
| | - Jorge Torres
- Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (M.H.); (J.T.); (G.R.)
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
| | - Nader Saffari
- Department of Mechanical Engineering, University College London, London WC1E 6BT, UK; (A.G.); (N.S.)
| | - Guillermo Rus
- Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (M.H.); (J.T.); (G.R.)
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
- Excellence Research Unit “ModelingNature” (MNat), Universidad de Granada, 18071 Granada, Spain
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Kim SY, Choi Y, Kim EK, Han BK, Yoon JH, Choi JS, Chang JM. Deep learning-based computer-aided diagnosis in screening breast ultrasound to reduce false-positive diagnoses. Sci Rep 2021; 11:395. [PMID: 33432076 PMCID: PMC7801712 DOI: 10.1038/s41598-020-79880-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/09/2020] [Indexed: 01/31/2023] Open
Abstract
A major limitation of screening breast ultrasound (US) is a substantial number of false-positive biopsy. This study aimed to develop a deep learning-based computer-aided diagnosis (DL-CAD)-based diagnostic model to improve the differential diagnosis of screening US-detected breast masses and reduce false-positive diagnoses. In this multicenter retrospective study, a diagnostic model was developed based on US images combined with information obtained from the DL-CAD software for patients with breast masses detected using screening US; the data were obtained from two hospitals (development set: 299 imaging studies in 2015). Quantitative morphologic features were obtained from the DL-CAD software, and the clinical findings were collected. Multivariable logistic regression analysis was performed to establish a DL-CAD-based nomogram, and the model was externally validated using data collected from 164 imaging studies conducted between 2018 and 2019 at another hospital. Among the quantitative morphologic features extracted from DL-CAD, a higher irregular shape score (P = .018) and lower parallel orientation score (P = .007) were associated with malignancy. The nomogram incorporating the DL-CAD-based quantitative features, radiologists' Breast Imaging Reporting and Data Systems (BI-RADS) final assessment (P = .014), and patient age (P < .001) exhibited good discrimination in both the development and validation cohorts (area under the receiver operating characteristic curve, 0.89 and 0.87). Compared with the radiologists' BI-RADS final assessment, the DL-CAD-based nomogram lowered the false-positive rate (68% vs. 31%, P < .001 in the development cohort; 97% vs. 45% P < .001 in the validation cohort) without affecting the sensitivity (98% vs. 93%, P = .317 in the development cohort; each 100% in the validation cohort). In conclusion, the proposed model showed good performance for differentiating screening US-detected breast masses, thus demonstrating a potential to reduce unnecessary biopsies.
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Affiliation(s)
- Soo -Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun -Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Jia W, Luo T, Dong Y, Zhang X, Zhan W, Zhou J. Breast Elasticity Imaging Techniques: Comparison of Strain Elastography and Shear-Wave Elastography in the Same Population. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:104-113. [PMID: 33109379 DOI: 10.1016/j.ultrasmedbio.2020.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
Our purpose was to compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating breast lesions by combining with conventional ultrasound (US). A total of 198 patients with 203 breast lesions underwent conventional US, SE and SWE examination using MyLab 90 and Aixplorer US systems. The SE parameters were SEscore, fat-to-lesion ratio, gland-to-lesion ratio, muscle-to-lesion ratio and SEmean, and the SWE parameters were Emax, Emean, Emin and Esd. Conventional US had the best diagnostic performance, with an area under the curve (AUC) of 0.896. Among all SE parameters, the AUCs of SEscore, fat-to-lesion ratio and SEmean were 0.802, 0.810 and 0.833. For SWE parameters, they were 0.845, 0.746 and 0.845, respectively, for Emax, Emean and Esd. When combined with US, the sensitivity and AUC of SWE seemed to be better than those of SE (96.55% vs. 93.10%, 0.958 vs. 0.947), but no statistically significant difference existed between them.
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Affiliation(s)
- WanRu Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YiJie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - XiaoXiao Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 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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Potential role of shear wave elastography features in medullary breast cancer differentiation. Med Hypotheses 2020; 144:110021. [DOI: 10.1016/j.mehy.2020.110021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/09/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
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Sezgin G, Coskun M, Apaydin M, Akder Sari A. The role of rare breast cancers in the false negative strain elastography results. Radiol Med 2020; 126:349-355. [PMID: 32894448 DOI: 10.1007/s11547-020-01270-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Elastography was primarily used as an adjunctive method along with ultrasonography in differentiation between benign from malignant lesions. Occasionally, overlaps can occur which are caused by some rare invasive breast cancers. Our aim is to analyze the role of rare breast cancers in false negative strain elastography results and to assess the relation among false negative results and tumor size, lesion distance to skin, and tumor grade. METHODS Patients with BI-RADS 5 category underwent strain elastography and core biopsy. All those with confirmed invasive breast cancer were included. For each rare breast cancer, four usual invasive breast cancer cases were taken as a control group. The cut-off value of strain ratio was considered as 2.3. The true positive and the false negative groups were compared in terms of histological type (rare carcinomas and the others) and the other parameters. Pearson Chi-square and Fisher's exact test were used for statistical analyses. P values < 0.05 were considered statistically significant. RESULTS One hundred-thirteen patients were defined as true positive (70.6%), and 47 patients were defined as false negative (29.4%). Strain ratio values of the rare breast cancers were significantly lower than those of the other breast cancers (p = 0.012). There was no statistically significant difference between the groups with respect to tumor size, distance to skin, and tumor grade (p > 0.05). CONCLUSION The rare breast cancers are an important cause of false negativity in elastographic evaluation of invasive breast cancers. The results should be interpreted in combination with grayscale US findings.
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Affiliation(s)
- Gulten Sezgin
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey.
| | - Mehmet Coskun
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey
| | - Melda Apaydin
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey
| | - Aysegul Akder Sari
- Department of Pathology, Izmir Katip Celebi University Faculty of Medicine, 35150, Izmir, Turkey
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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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Rus G, Faris IH, Torres J, Callejas A, Melchor J. Why Are Viscosity and Nonlinearity Bound to Make an Impact in Clinical Elastographic Diagnosis? SENSORS (BASEL, SWITZERLAND) 2020; 20:E2379. [PMID: 32331295 PMCID: PMC7219338 DOI: 10.3390/s20082379] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
The adoption of multiscale approaches by the biomechanical community has caused a major improvement in quality in the mechanical characterization of soft tissues. The recent developments in elastography techniques are enabling in vivo and non-invasive quantification of tissues' mechanical properties. Elastic changes in a tissue are associated with a broad spectrum of pathologies, which stems from the tissue microstructure, histology and biochemistry. This knowledge is combined with research evidence to provide a powerful diagnostic range of highly prevalent pathologies, from birth and labor disorders (prematurity, induction failures, etc.), to solid tumors (e.g., prostate, cervix, breast, melanoma) and liver fibrosis, just to name a few. This review aims to elucidate the potential of viscous and nonlinear elastic parameters as conceivable diagnostic mechanical biomarkers. First, by providing an insight into the classic role of soft tissue microstructure in linear elasticity; secondly, by understanding how viscosity and nonlinearity could enhance the current diagnosis in elastography; and finally, by compounding preliminary investigations of those elastography parameters within different technologies. In conclusion, evidence of the diagnostic capability of elastic parameters beyond linear stiffness is gaining momentum as a result of the technological and imaging developments in the field of biomechanics.
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Affiliation(s)
- Guillermo Rus
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
- Excellence Research Unit “ModelingNature” MNat UCE.PP2017.03, University of Granada, 18071 Granada, Spain
| | - Inas H. Faris
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Jorge Torres
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Antonio Callejas
- Ultrasonics Group (TEP-959), Department of Structural Mechanics, University of Granada, 18071 Granada, Spain; (G.R.); (I.H.F.); (A.C.)
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
| | - Juan Melchor
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain;
- Excellence Research Unit “ModelingNature” MNat UCE.PP2017.03, University of Granada, 18071 Granada, Spain
- Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain
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