Breast Elastography: How to Perform and Integrate Into a "Best-Practice" Patient Treatment Algorithm
breast cancer; breast; elastography; shear wave elastography; strain elastography; breast tumors; sonoelastography
Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively steep learning curve, and variability in methods between vendors. This article describes our protocol for performing breast elastography using both strain elastography and shear wave elastography, which produces high sensitivity and specificity. Additionally, we will describe the most commonly known false-positive and false-negative lesions as well as how to detect them.
Barr Richard G
Journal Of Ultrasound In Medicine: Official Journal Of The American Institute Of Ultrasound In Medicine
2019
2019-10-16
Journal Article
<a href="http://doi.org/10.1002/jum.15137" target="_blank" rel="noreferrer noopener">10.1002/jum.15137</a>
PMID: 31617225
Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis
breast; breast cancer; breast tumors; elastography; sonoelastography
There are 3 methods of interpreting breast strain elastography: the elastographic-to-B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy.
Barr Richard G; De Silvestri Annalisa; Scotti Valeria; Manzoni Federica; Rebuffi Chiara; Capittini Cristina; Tinelli Carmine
Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
2019
2019-06
<a href="http://doi.org/10.1002/jum.14849" target="_blank" rel="noreferrer noopener">10.1002/jum.14849</a>
Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis.
breast; breast cancer; breast tumors; elastography; sonoelastography
There are 3 methods of interpreting breast strain elastography: the elastographic-to-B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy.
Barr Richard G; De Silvestri Annalisa; Scotti Valeria; Manzoni Federica; Rebuffi Chiara; Capittini Cristina; Tinelli Carmine
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2018
2018-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/jum.14849" target="_blank" rel="noreferrer noopener">10.1002/jum.14849</a>
Evaluation of Breast Lesions Using Sonographic Elasticity Imaging A Multicenter Trial
ultrasound; breast; elastography; Acoustics; sonoelastography; Radiology; Nuclear Medicine & Medical Imaging; tissues; benign; biopsy; breast lesion characterization
Objectives-The purpose of this study was to determine the sensitivity and specificity of real-time compression elasticity imaging in characterizing breast lesions as benign or malignant. Methods-A cohort of 578 women scheduled for sonographically guided biopsy of breast lesions were recruited from 6 sites under an Institutional Review Board-approved protocol. All participants received an elastogram, which displayed both the B-mode and elasticity images in real time. The longest dimensions of the lesion on the B-mode and elasticity imaging were measured. An elasticity imaging/B-mode ratio of at least 1.0 was considered positive for malignant lesions. The reference standard was based on biopsy. Results-A total of 635 lesions were imaged and biopsied. There were 222 (35%) malignant or borderline lesions and 413 (65%) benign lesions. The benign lesions were either cystic (145 [35%]) or solid (268 [65%]). Of the 222 malignant lesions, 219 had an elasticity imaging/B-mode ratio of at least 1.0. Of the 413 benign lesions, 361 had an elasticity imaging/B-mode ratio less than 1.0. These results corresponded to overall sensitivity of 98.6% and overall specificity of 87.4%. Individual site sensitivities ranged from 96.7% to 100% whereas specificities ranged from 66.7% to 95.4%. Conclusions-Elasticity imaging has high sensitivity in characterizing malignant lesions of the breast. Variability in specificity between sites and sonographers is possibly due to individual technique differences in performing elastography and measuring lesions. Further work in standardizing the technique is required.
Barr R G; Destounis S; Lackey L B; Svensson W E; Balleyguier C; Smith C
Journal of Ultrasound in Medicine
2012
2012-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.7863/jum.2012.31.2.281" target="_blank" rel="noreferrer noopener">10.7863/jum.2012.31.2.281</a>
Strain Elastography For Prediction Of Breast Cancer Tumor Grades
Acoustics; agreement; breast; breast cancer; breast ultrasound; ductal carcinoma; elasticity; elastography; experience; grade; histologic grade; lesions; Nuclear Medicine & Medical Imaging; prognostic factors; Radiology; sonoelastography; sonography; strain; tumor; Ultrasound
Objectives-The purpose of this study was to determine whether the elasticity imaging/B-mode ratio on strain elastography can predict breast cancer tumor grades. Methods-A retrospective review of patients with breast lesions who underwent strain elastography and had a diagnosis of breast cancer by image-guided or surgical biopsy was performed. The axis of the maximum elastographic dimension was compared to the B-mode dimension to form an elasticity imaging/B-mode ratio. Lesions were categorized according to their pathologic type, including atypical ductal hyperplasia (ADH), mucinous or colloid cancer, ductal carcinoma in situ (DCIS), grade I invasive ductal carcinoma (MC), grade II IDC, grade III DC, invasive lobular carcinoma (ILC), and lymphoma. The mean elasticity imaging/B-mode ratio of each tumor type was calculated. The elasticity imaging/B-mode ratio of the tumor was compared to the tumor type by Kruskal-Wallis and Tukey-Kramer tests (lymphoma and ADH excluded because of small numbers). Results-Tumor grades included lymphoma (n = 3),.ADH (n = 2), mucinous cancer (n = 11), DCIS (n = 19), DC (grades I III; n = 200), and ILC (n = 31). The mean elasticity imaging/B-mode ratio varied with increasing tumor grade. Tumor grades could not have been selected at random from one population (P < .0001, chi(2) test). Invasive lobular carcinoma and grade III DC were statistically different from mucinous or colloid cancer, DCIS, and grade land II IDC. Conclusions-The elasticity imaging/B-mode ratio on strain elastography is related to the tumor grade.
Grajo J R; Barr R G
Journal of Ultrasound in Medicine
2014
2014-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.7863/ultra.33.1.129" target="_blank" rel="noreferrer noopener">10.7863/ultra.33.1.129</a>
Us Elastography Of Breast And Prostate Lesions
cancer detection; diagnosis; elasticity; images; Nuclear Medicine & Medical Imaging; pathological correlation; Radiology; real-time elastography; sonoelastography; systematic biopsy; tissues; ultrasound
Ginat D T; Destounis S V; Barr R G; Castaneda B; Strang J G; Rubens D J
Radiographics
2009
2009-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1148/rg.297095058" target="_blank" rel="noreferrer noopener">10.1148/rg.297095058</a>