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Li J, Wu Y, Tian Z, Shu L, Wu S, Wu Z. Application Value of Ultrasound Elastography Combined With Contrast-Enhanced Ultrasound (CEUS) Quantitative Analysis in Differentiation of Nodular Fibrocystic Changes of the Breast From Invasive Ductal Carcinoma. ULTRASONIC IMAGING 2024; 46:102-109. [PMID: 38098206 DOI: 10.1177/01617346231217087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
This study aimed to compare the value of ultrasound elastography combined with contrast-enhanced ultrasound (CEUS) quantitative analysis in the differentiation of nodular fibrocystic breast change (FBC) from breast invasive ductal carcinoma (BIDC). We selected 50 patients each with nodular FBC and BIDC, who were admitted to the Affiliated Hospital of Zunyi Medical University from January 2018 to December 2021. Their ultrasonic elastic images and CEUS videos were collected, their ultrasound elastography scores and the ratio of strain rate (SR) of the lesions were determined, and the exported DICOM format videos of CEUS were quantitatively analyzed using VueBox software to obtain quantitative perfusion parameters. The differences between the ultrasound elastography score and SR while comparing nodular FBC and BIDC cases were statistically significant (p < .05). The sensitivity, specificity, and accuracy of ultrasound elastography scores in the differential diagnoses of nodular FBC and BIDC were 74%, 88%, and 81%, respectively. Additionally, the sensitivity, specificity, and accuracy of SR in the differential diagnosis of nodular FBC and BIDC were 94%, 78%, and 86%, respectively. Statistically significant differences were observed in the CEUS quantitative perfusion parameters PE, AUC (WiAUC, WoAUC, WiWoAUC), and WiPI in both nodular FBC and BIDC according to the VueBox software (p < .05). The sensitivity, specificity, and accuracy of CEUS quantitative analysis in the differential diagnoses of nodular FBC and BIDC were 66%, 82%, and 74%, respectively. Using the pathological findings as the gold standard, ROC curves were established, and the area under the curve (AUC) of the CEUS quantitative analysis, elasticity score, SR, and ultrasound elastography combined with CEUS quantitative analysis were 0.731, 0.838, and 0.892, as well as 0.945, respectively. Ultrasound elasticity scoring, SR and CEUS quantitative analysis have certain application value for differentiating nodular FBC cases from BIDC; however, ultrasound elasticity imaging combined with CEUS quantitative analysis can help in improving the differential diagnostic efficacy of nodular FBC cases from BIDC.
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Affiliation(s)
- Jiajia Li
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yunfeng Wu
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhaoyu Tian
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Linfeng Shu
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Siru Wu
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zuohui Wu
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Yu JF, Zhang S, Yin HH, Zhou BG, Pu YY, Fang Y, Du D, Zhang Y, Xu HX. Two-dimensional shear wave elastography with two different systems for the diagnosis of breast lesions. Clin Hemorheol Microcirc 2022; 82:53-62. [DOI: 10.3233/ch-221471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Two-dimensional (2D) - shear wave elastography (SWE) has made promising advances in the diagnostic of breast lesions. However, few studies have assessed whether the diagnostic effectiveness of different platforms employing 2D-SWE is equal or different. OBJECTIVE: To compare the diagnostic effectiveness of 2D-SWE techniques from two different systems in differentiating malignant breast lesions from benign ones. METHODS: A total of 84 breast lesions were retrospectively analyzed by experienced radiologists using 2D-SWE on two ultrasound systems, i.e. system-1 (LOGIQ E9 system, GE Healthcare, Wauwatosa, WI, USA), and system-2 (Aixplorer US system, SuperSonic Imagine, Aix-en-Provence, France). Qualitative and quantitative parameters including color sign, the maximum elasticity modulus values (E-max), the mean elasticity modulus values (E-mean) and standard deviation (E-sd) of elasticity modulus values in two 2D-SWE systems were analyzed. The diagnostic performance between system-1 and system-2 were evaluated in terms of the areas under the receiver operating characteristic curves (AUROCs). RESULTS: Among the 84 lesions in this study, 66 (78.6%) were benign and 18 (21.4%) were malignant. E-max in system-1 showed the best diagnostic performance with a cut-off value of 174.5 kPa with the associated sensitivity and specificity of 100.0% and 80.3% respectively. Meanwhile, E-sd in system-2 displayed the best diagnostic performance with a cut-off value of 12.7 kPa, with the associated sensitivity and specificity of 94.4% and 80.3% respectively. The diagnostic performance of the two 2D-SWE systems was not statistically different according to ROC analysis of E-max, E-mean, and E-sd. CONCLUSION: For identifying breast lesions, system-1 and system-2 appear to be similar in diagnostic performance. However, different cut-off values for different parameters might be selected to obtain the best diagnostic performance for the two 2D-SWE systems.
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Affiliation(s)
- Ji-Feng Yu
- Department of Medical Ultrasound, Shanghai Tenth Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, P.R. China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Shen Zhang
- Department of Medical Ultrasound, Shanghai Tenth Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, P.R. China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Hao-Hao Yin
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Bang-Guo Zhou
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Yin-Ying Pu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Yan Fang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Dou Du
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Yan Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, P.R. China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
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Pillai A, Voruganti T, Barr R, Langdon J. Diagnostic Accuracy of Shear-Wave Elastography for Breast Lesion Characterization in Women: A Systematic Review and Meta-Analysis. J Am Coll Radiol 2022; 19:625-634.e0. [PMID: 35358483 DOI: 10.1016/j.jacr.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to assess the diagnostic accuracy of 2-D shear-wave elastography (SWE) for differentiating benign and malignant breast lesions in women with abnormal findings on mammography. METHODS Included in this review are studies of diagnostic accuracy published before June 2021 using 2-D SWE to evaluate female breast lesions. Included studies were required to include at least 50 lesions, report quantitative shear-wave speed (SWS) thresholds, and include a reference standard of either biopsy or 2-year stability. Included studies used the mean, maximum, minimum, or SD of SWS for classification. A systematic search of PubMed, Scopus, Embase, Ovid-MEDLINE, the Cochrane Library, and Web of Science was performed. Bias and applicability of the studies were assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A hierarchical summary receiver operating characteristic model was used to arrive at the summary statistics. RESULTS Eighty-seven prospective and retrospective studies were included, encompassing 17,810 women (mean age 42.3 ± 10.4 years) with 19,043 lesions (7,623 malignant). Summary sensitivities and specificities, respectively, were 0.86 (95% confidence interval [CI], 0.83-0.88) and 0.87 (95% CI, 0.84-0.88) for mean SWS, 0.83 (95% CI, 0.80-0.85) and 0.88 (95% CI, 0.86-0.90) for the maximum, 0.86 (95% CI, 0.74-0.93) and 0.81 (95% CI, 0.69-0.89) for the minimum, and 0.82 (95% CI, 0.77-0.86) and 0.88 (95% CI, 0.85-0.91) for the SD. Alternatively, the areas under the receiver operating characteristic curve were 0.93 (95% CI, 0.91-0.94), 0.92 (95% CI, 0.90-0.94), 0.90 (95% CI, 0.82-0.96), and 0.92 (95% CI, 0.88-0.94), respectively. CONCLUSIONS This review demonstrates the discriminative power of SWE in the diagnosis of breast cancer. Using the resulting likelihood ratios, SWE may prove beneficial in downgrading BI-RADS® 4a or upgrading BI-RADS 3 lesions. However, current society guidelines do not provide definitive recommendations regarding the use of SWE and its counterpart strain elastography (SE). Comparison with our results suggests that SE alone or a combination of SE and SWE may provide better diagnostic performance than SWE alone and serve as an adjunct to current diagnostic techniques.
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Affiliation(s)
| | | | - Richard Barr
- Northeastern Ohio Medical University, Rootstown, Ohio; President, Radiology Consultants Inc., Youngstown, Ohio
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Kayadibi Y, Ucar N, Kaya MF, Yildirim E, Bektas S. Characterization of Suspicious Microcalcifications on Mammography Using 2D Shear-Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2532-2542. [PMID: 34127332 DOI: 10.1016/j.ultrasmedbio.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
Our aim was to investigate the correlations between the findings of two-dimensional shear-wave elastography (2D-SWE) and the histopathologic results of microcalcifications (MCs) visualized using ultrasonography (USG). Fifty people with suspicious MCs without accompanying mass were evaluated. They underwent USG and 2D-SWE before USG-guided tru-cut biopsy. SWE values and histopathologic features were compared statistically. The variables between groups were analyzed using the Mann-Whitney U test. Receiver operating characteristic analysis was performed and cut-off values determined to discriminate malignancy, invasiveness and high grade. Pathology confirmed 27 malignant lesions (18 invasive ductal carcinomas, one invasive lobular and eight ductal carcinomas in situ) and 23 benign ones. There was a statistically significant difference between the SWE values of malignant and benign MCs (p < 0.001). The diagnostic performance of SWE for malignancy, invasiveness and high grade were as follows, repectively: sensitivity (93%, 83%, 88%), specificity (91%, 88%, 53%), positive predictive value (93%, 94%, 44%), negative predictive value (91%, 70%, 90%) and area under the curve (0.952, 0.885, 0.776). Cut-off values were determined as 57 kPa for malignancy, 124 kPa for invasiveness and 124.5 kPa for high grade. In conclusion, SWE is a useful method in clinical practice for characterizing MCs that can be visualized with USG.
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Affiliation(s)
- Yasemin Kayadibi
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul Universitesi-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
| | - Nese Ucar
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Mehmet Fatih Kaya
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Emine Yildirim
- Department of General Surgery, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Sibel Bektas
- Department of Pathology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
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Luo T, Zhang JW, Zhu Y, Jia XH, Dong YJ, Zhan WW, Zhou JQ. Virtual touch imaging quantification shear-wave elastography for breast lesions: the diagnostic value of qualitative and quantitative features. Clin Radiol 2020; 76:316.e1-316.e8. [PMID: 33328105 DOI: 10.1016/j.crad.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
AIM To investigate the value of the qualitative and quantitative features of Virtual Touch imaging quantification (VTIQ) shear-wave elastography in the characterisation of breast lesions. MATERIALS AND METHODS Conventional ultrasound (US) and VTIQ were performed in 148 solid breast lesions in 148 women. During qualitative analysis, patterns of VTIQ were categorised into two patterns, 1 and 2. During quantitative analysis, the mean SWV (SWVmean) and the maximum SWV (SWVmax) of each lesion were used. The sensitivity, specificity, and the areas under the receiver operating characteristic (ROC) curve (Az value) were calculated for conventional US, VTIQ, and combined conventional US and VTIQ. RESULTS Malignant lesions were more likely to show VTIQ pattern 2 than the benign lesions (p<0.001). There was no significant difference in the Az values between SWVmean (0.907) and SWVmax (0.902; p=0.572). There was no significant difference in the Az values between the VTIQ pattern (0.884) and SWVmax (p=0.572). The combined conventional US and VTIQ pattern carried a similar Az value (0.949) as compared with the combined conventional US and SWVmax, which yielded an Az value of 0.952 (p=0.683). CONCLUSION The combination of either VTIQ pattern or SWVmax and conventional US may be helpful in the characterisation of benign and malignant breast lesions.
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Affiliation(s)
- T Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - J W Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Y Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - X H Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Y J Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
| | - W W Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - J Q Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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Normative values of pancreas stiffness by shear wave elastography in healthy children and adolescents. J Med Ultrason (2001) 2020; 47:583-589. [PMID: 32676807 DOI: 10.1007/s10396-020-01039-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To define normal pancreas elasticity and velocity values with shear wave elastography (SWE) in healthy children and assess associations with gender, age, and body mass index (BMI). METHODS This prospective study included a total of 100 cases (male: 50; female: 50), aged 3-17 years. Preschool, school, and adolescent periods of 3-6 years (n = 27), 7-12 years (n = 30), and 13-17 years (n = 43), respectively, were created in addition to two groups representing prepubertal and postpubertal periods of 3-10 years (n = 50) and 11-18 years (n = 50), respectively. Demographic data regarding the gender, age, height, body weight, and BMI were recorded. Pancreatic head, corpus, and tail SWE measurements were performed with a convex transducer (3.5-5 MHz). Correlations and comparisons were made for stiffness values between groups. Statistical analyses used Mann-Whitney U, Kruskal-Wallis, and Spearman's correlation tests. RESULTS Medians (25-75th percentage) of age and BMI were 7 (4.25-10) years and 15 (13-17) years and 17.47 (14.94-19.23) kg/m2 and 21.22 (17.41-24) kg/m2 in the two age groups, respectively. The median (interquartile range) elasticity and velocity values for the head, corpus, and tail sections of the pancreas were measured as 9.35 (2.9) kPa and 1.76 (0.26) m/s; 9.3 (2.5) kPa and 1.74 (0.21) m/s; and 8.75 (2) kPa and 1.69 (0.15) m/s, respectively. No significant differences were identified for stiffness values between gender and pancreatic section. Pancreatic stiffness values were significantly different among two (p = 0.001) and three (p = 0.028) age groups, and presented mild positive correlations with age (r: 0.23, p: 0.002), height (r: 0.18, p: 0.01), body weight (r: 0.38, p: 0.003), and BMI (r: 0.37, p: 0.045). CONCLUSION Normal elasticity and velocity values were defined for the pancreas with SWE in children. Pancreatic stiffness does not significantly change among pancreas parts, but it increases with the transition from childhood to adolescence.
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Xu P, Wu M, Yang M, Xiao J, Ruan ZM, Wu LY. Evaluation of internal and shell stiffness in the differential diagnosis of breast non-mass lesions by shear wave elastography. World J Clin Cases 2020; 8:2510-2519. [PMID: 32607328 PMCID: PMC7322423 DOI: 10.12998/wjcc.v8.i12.2510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The diagnostic specificity of conventional ultrasound for breast non-mass lesions (NMLs) is low at approximately 21%-43%. Shear wave elastography (SWE) can distinguish benign from malignant lesions by evaluating the internal and peripheral stiffness. SWE has good reproducibility and high diagnostic efficacy. However, there are very few independent studies on the diagnostic value of SWE in breast NMLs.
AIM To determine the value of SWE in the differential diagnosis of breast NMLs.
METHODS This study enrolled a total of 118 patients with breast NMLs who underwent SWE examinations in the Beijing Shijitan Hospital Affiliated to Capital Medical University and The Second Hospital of Shandong University from January 2019 to January 2020. The internal elastic parameters of the lesions were recorded, including maximum (Emax), mean (Emean) and minimum elastic values and the standard deviation. The following peripheral parameters were noted: Presence of a “stiff rim” sign; Emax, and Emean elasticity values within 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm from the edge of NMLs. The receiver operating characteristic curve of each parameter was drawn, and the areas under the curve were calculated.
RESULTS Emax, Emean and elastic values, and the standard deviation of the internal elastic values in malignant NMLs were significantly higher than those in benign NMLs (P < 0.05). The percentage with the “stiff rim” sign in malignant NMLs was significantly higher than that in the benign group (P < 0.05), and Emax and Emean at the shell of 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm in the malignant group were all higher than those in the benign group (P < 0.05). Of the surrounding elasticity values, Emax of the shell at 2.5 mm in malignant NMLs had maximum areas under the curve of 0.900, and the corresponding sensitivity and specificity were 94.57% and 85.86%, respectively.
CONCLUSION The “stiff rim” sign and multiple quantitative elastic values within and around the lesion had good diagnostic performance in the differential diagnosis of breast NMLs. Emax in peripheral tissue had better diagnostic efficiency than other parameters.
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Affiliation(s)
- Ping Xu
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Mei Wu
- Department of Ultrasound, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Min Yang
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Juan Xiao
- Evidence-based Medicine Center, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Zheng-Min Ruan
- Department of Ultrasound, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Lan-Ying Wu
- Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
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The Mechanical Microenvironment in Breast Cancer. Cancers (Basel) 2020; 12:cancers12061452. [PMID: 32503141 PMCID: PMC7352870 DOI: 10.3390/cancers12061452] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023] Open
Abstract
Mechanotransduction is the interpretation of physical cues by cells through mechanosensation mechanisms that elegantly translate mechanical stimuli into biochemical signaling pathways. While mechanical stress and their resulting cellular responses occur in normal physiologic contexts, there are a variety of cancer-associated physical cues present in the tumor microenvironment that are pathological in breast cancer. Mechanistic in vitro data and in vivo evidence currently support three mechanical stressors as mechanical modifiers in breast cancer that will be the focus of this review: stiffness, interstitial fluid pressure, and solid stress. Increases in stiffness, interstitial fluid pressure, and solid stress are thought to promote malignant phenotypes in normal breast epithelial cells, as well as exacerbate malignant phenotypes in breast cancer cells.
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Arslan S, Durmaz MS, Erdogan H, Esmen SE, Turgut B, Iyisoy MS. Two-Dimensional Shear Wave Elastography in the Assessment of Salivary Gland Involvement in Primary Sjögren's Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:949-956. [PMID: 31763717 DOI: 10.1002/jum.15179] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the diagnostic performance of two-dimensional (2D) shear wave elastography (SWE) in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS). METHODS Fifty-three patients with pSS and 30 healthy volunteers were included. The echogenicity of all submandibular and parotid glands was evaluated with B-mode ultrasound, and their elasticity was assessed with 2D SWE. The mean and standard deviation of the shear wave speed and elasticity modes on 2D SWE were calculated. RESULTS The mean shear wave speed and elasticity mode values for the submandibular and parotid glands were significantly higher in the patients with pSS (P < .05). The mean elasticity of the shear wave speed mode was best able to differentiate the parotid glands of patients with pSS from those of healthy volunteers at a cutoff value of 2.48 m/s, whereas the mean elasticity of the elasticity mode was best able to differentiate the submandibular glands of patients with pSS from those of healthy volunteers at a cutoff value of 21 kPa. CONCLUSIONS Two-dimensional SWE is an effective technique for assessment of the parenchyma of the salivary glands in patients with pSS and predicts interstitial fibrosis and the severity of histologic damage.
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Affiliation(s)
- Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey (S.A.)
| | - Mehmet Sedat Durmaz
- Department of Radiology, Selcuk University School of Medicine, Konya, Turkey (M.S.D.)
| | - Hasan Erdogan
- Department of Radiology, Aksaray University Training and Research Hospital, Aksaray, Turkey (H.E.)
| | - Serpil Ergulu Esmen
- Departments of Rheumatology, University of Health Science, Konya Training and Research Hospital, Konya, Turkey (S.E.E)
| | - Bekir Turgut
- Department of Radiology, University of Health Science, Konya Training and Research Hospital, Konya, Turkey (B.T.)
| | - Mehmet Sinan Iyisoy
- and Department of Medical Education and Informatics, Necmettin Erbakan University School of Medicine, Konya, Turkey (M.S.I.)
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Relationship Between Shear Wave Elastography Findings and Histologic Prognostic Factors of Invasive Breast Cancer. Ultrasound Q 2020; 36:79-83. [DOI: 10.1097/ruq.0000000000000471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang L, Ma M, Du Z, Liu Z, Gong X. Quantitative evaluation of tissue stiffness around lesion by sound touch elastography in the diagnosis of benign and malignant breast lesions. PLoS One 2019; 14:e0219943. [PMID: 31318932 PMCID: PMC6639001 DOI: 10.1371/journal.pone.0219943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
The purpose of our study is to assess the diagnostic performance of quantitative evaluation of tissue stiffness around lesion by Sound Touch Elastography (STE) in distinguishing between benign and malignant breast lesions. A total number of 160 breast lesions from 160 female patients were examined by STE. Resona 7 was equipped with “shell” function to measure elastic modulus values of tissue in the region of surrounding lesion quantitatively. The contours of the lesion were required to be delineated. The elastic modulus values of tissue in the region of 1mm, 2mm, and 3mm outside the boundary were acquired. The elastic modulus values included maximum elastic modulus (Emax), mean elastic modulus (Emean), minimum elastic modulus (Emin), and elastic modulus standard deviation (Esd). All lesions were confirmed by histopathology. We compared the differences of the above elastic modulus values between benign and malignant groups. Receiver operating characteristic (ROC) curve was drawn with the histological diagnostic results as the gold standard. Sensitivity and specificity were calculated to evaluate the diagnostic performance of STE. Operator consistency was also analyzed. Among the 160 lesions, 100 (62.5%) were benign and 60 (37.5%) were malignant. In the region of 1mm, 2mm, and 3mm surrounding the lesion, Emax, Emean, and Esd of malignant group were significantly higher than those of the benign group (all P<0.05). When the “shell” was 3mm, Emax had the highest AUROC value (AUROC = 0.998). Regarding the measurement of elastic modulus values, all the intra-class correlation coefficient (ICC) values of the inter-operator consistency were greater than 0.75 for Emax, Emean, and Esd. Therefore, quantitative evaluation of tissue stiffness around lesion by STE has the potential to distinguish between benign and malignant breast lesions.
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Affiliation(s)
- Leidan Huang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Mengke Ma
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Zhen Du
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
- Anhui Medical University, Hefei, Anhui, China
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
- *. E-mail: (XG); (ZL)
| | - Xuehao Gong
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
- *. E-mail: (XG); (ZL)
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Pu H, Zhang XL, Xiang LH, Zhang JL, Xu G, Liu H, Tang GY, Zhao BH, Wu R. The efficacy of added shear wave elastography (SWE) in breast screening for women with inconsistent mammography and conventional ultrasounds (US). Clin Hemorheol Microcirc 2019; 71:83-94. [PMID: 29843228 DOI: 10.3233/ch-180398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xue-Li Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Jiu-Long Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang-Yu Tang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bing-Hui Zhao
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Du YR, Wu Y, Chen M, Gu XG. Application of contrast-enhanced ultrasound in the diagnosis of small breast lesions. Clin Hemorheol Microcirc 2019; 70:291-300. [PMID: 29710688 DOI: 10.3233/ch-170368] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide. The purpose of the study was to observe the features of contrast-enhanced ultrasound (CEUS) and the combination with Breast Imaging-Reporting and Data System (BI-RADS) of conventional ultrasound for assessing small breast lesions. OBJECTIVES The study was to explore the small breast lesions' features of contrast-enhanced ultrasound (CEUS) and the combination with Breast Imaging-Reporting and Data System (BI-RADS) of conventional ultrasound, in order to improve the diagnostic accuracy of early breast cancer. METHODS 105 lesions were subject to conventional US (ultrasound) and CEUS before operations or biopsies. Among 105 breast lesions, six patient diagnoses were established by thick core-needle biopsy, while the rest were all confirmed by surgery and pathology. RESULTS Significant differences were found between benign and malignant lesions in qualitative and quantitative indexes (peak) of CEUS (P < 0.05). The qualitative features of malignant small breast lesions were as follows: (1) enhanced intensity within the lesion was not uniform (61/61,100%); (2) the speed of wash-in was earlier than the surrounding tissue (58/61, 95.1%); (3) lesion interior and the surrounding tissues had contrast vessel performance (61/61,100%). Peak of malignant lesions (35.77±11.45) was higher than that of benign lesions (31.96±10.76) (P < 0.05). The diagnostic performance of BI-RADS-US plus qualitative indexes (method one) in terms of area under receiver operating characteristic curve (AUROC) were the highest (i.e., AUROC = 0.817), in comparison with other combined diagnostic methods. The associated sensitivity, specificity and accuracy were 78.69%, 84.09% and 80.95%, respectively. With method one, however, was similar with US-BI-RADS in specificity, 11 malignant breast lesions were regarded as a higher classification of BI-RADS and classified into malignant group, which were identified as benign on US-BI-RADS originally. CONCLUSIONS CEUS was useful to differentiate benign from malignant small breast lesions, and the combination of CEUS and BI-RADS-US can improve the early diagnosis of breast cancers.
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Affiliation(s)
- Yan-Ran Du
- Shanghai Putuo District Central Hospital, Shanghai, China
| | - Yang Wu
- Shanghai Putuo District Central Hospital, Shanghai, China
| | - Man Chen
- Department of Diagnostic Ultrasound, Tong Ren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-Gang Gu
- Shanghai Putuo District Central Hospital, Shanghai, China
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You QQ, Xu M, Yao MH, Xu G, Liu H, Pu H, Xiang LH, Wu R. Diagnostic value of acoustic radiation force impulse for BI-RADS category 4 breast lesions of different sizes. Clin Hemorheol Microcirc 2018; 70:143-154. [PMID: 29710678 DOI: 10.3233/ch-170299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Qi-Qin You
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Department of Medical Ultrasound, Qingpu Brance of Zhongshan Hospital, Fudan University School of Medicine, Shanghai, China
| | - Ming Xu
- Department of Medical Ultrasound, Huai’an First People’s Hospital, Nanjing Medical University School of Medicine, Huai’an, Jiangsu, China
| | - Ming-Hua Yao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Zhao Q, Wang XL, Sun JW, Jiang ZP, Tao L, Zhou XL. Comparison of strain and acoustic radiation force impulse elastography of breast lesions by qualitative evaluation. Clin Hemorheol Microcirc 2018; 70:39-50. [PMID: 29660916 DOI: 10.3233/ch-170364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Qing Zhao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nan Gang, Harbin, Heilongjiang, China
| | - Xiao-Lei Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nan Gang, Harbin, Heilongjiang, China
| | - Jia-Wei Sun
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nan Gang, Harbin, Heilongjiang, China
| | - Zhao-Peng Jiang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nan Gang, Harbin, Heilongjiang, China
| | - Lin Tao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nan Gang, Harbin, Heilongjiang, China
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nan Gang, Harbin, Heilongjiang, China
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Caliskan E, Ozturk M, Bayramoglu Z, Comert RG, Adaletli I. Evaluation of parotid glands in healthy children and adolescents using shear wave elastography and superb microvascular imaging. Radiol Med 2018; 123:710-718. [PMID: 29713928 DOI: 10.1007/s11547-018-0897-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/20/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We aim to determine parotid gland elasticity values from healthy children and adolescents using shear wave elastography (SWE). We also define the degree of vascularity using superb microvascular imaging (SMI), power Doppler (PD), and color Doppler (CD) and compare SMI with CD and PD. MATERIALS AND METHODS A total of 100 cases, comprising 50 girls and 50 boys, with ages ranging from 3 to 17 years were included in this prospective study. SWE, SMI, PD, and CD measurements were taken from both parotid glands, and the relationships with sex, age, and body mass index (BMI) were determined. The SMI was compared with the PD and CD. RESULTS The median elasticity values measured with SWE were 8.37 ± 2.09 kPa and 1.68 ± 0.26 m/s on the right and 8.33 ± 2.04 kPa and 1.69 ± 0.26 m/s on the left. There were significant positive correlations present for those aged below and above 10 years and for BMI with elasticity values. The median vascular spot numbers measured using SMI, PD, and CD were 5 ± 1.70, 3.5 ± 1.45, and 2 ± 1.1 on the right and 4 ± 1.7, 4 ± 1.43, and 2 ± 1.05 on the left, respectively. The median values obtained with SMI were significantly higher than the median values obtained with both PD and CD. CONCLUSION This study determined the reference SWE, SMI, PD, and CD values for normal parotid glands in healthy children and adolescents. Elasticity values were affected by age and BMI. There was no correlation between vascularity values and age, sex, or BMI. SMI provided more detailed information about vascularity compared with the other methods.
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Affiliation(s)
- Emine Caliskan
- Department of Pediatric Radiology, Istanbul Faculty of Medicine, Turgut Ozal Street, Fatih, 34063, Istanbul, Turkey.
| | - Mehmet Ozturk
- Department of Radiology, Faculty of Medicine, Selcuk University, Alaeddin Keykubat Yerleşkesi, kademi Mah. Yeni Istanbul Street. No:369, Konya, Turkey
| | - Zuhal Bayramoglu
- Department of Pediatric Radiology, Istanbul Faculty of Medicine, Turgut Ozal Street, Fatih, 34063, Istanbul, Turkey
| | - Rana Gunoz Comert
- Department of Radiology, Istanbul Faculty of Medicine, Turgut Ozal Street, Fatih, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Pediatric Radiology, Istanbul Faculty of Medicine, Turgut Ozal Street, Fatih, 34063, Istanbul, Turkey
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Li XL, Ren WW, Fu HJ, He YP, Wang Q, Sun LP, Guo LH, Liu BJ, Fang L, Xu HX. Shear wave speed imaging of breast lesions: Speed within the lesion, fat-to-lesion speed ratio, or gland-to-lesion speed ratio? Clin Hemorheol Microcirc 2017; 67:81-90. [PMID: 28482624 DOI: 10.3233/ch-170253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Jun Fu
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Lin Fang
- Department of Thyroid and Breast Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Zhang SP, Zeng Z, Liu H, Yao MH, Xu G, Wu R. Combination of conventional ultrasonography and virtual touch tissue imaging quantification for differential diagnosis of breast lesions smaller than 10 mm. Clin Hemorheol Microcirc 2017; 67:59-68. [PMID: 28598832 DOI: 10.3233/ch-170249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. METHODS A total of 98 breast lesions smaller than 10 mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. RESULTS Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75-9.34 m/s), significantly higher than that of benign lesions (2.68±1.02 m/s; range, 1.18-4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. CONCLUSION Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy.
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Affiliation(s)
- Shu-Pin Zhang
- Department of Medical Ultrasound, Baoshan Branch Shanghai First People's Hospital, Shanghai, China
| | - Zeng Zeng
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Ming-Hua Yao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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