Korean J Radiol.  2013 Aug;14(4):559-567. 10.3348/kjr.2013.14.4.559.

Sonoelastography in Distinguishing Benign from Malignant Complex Breast Mass and Making the Decision to Biopsy

• Kim MY
• Cho N
• Yi A
• Koo HR
• Yun BL
• Moon WK

• KMID: 1715759
• DOI: http://doi.org/10.3348/kjr.2013.14.4.559

Abstract

OBJECTIVE
To evaluate the additional effect of sonoelastography on the radiologist's ability for distinguishing benign from malignant complex breast masses and to decide whether to perform biopsy by B-mode US.
MATERIALS AND METHODS
One hundred eighteen complex breast masses (15 malignant lesions, 103 benign lesions) were included. Five blinded readers independently assessed the likelihood of the malignancy score from 1 to 5 for two data sets (B-mode ultrasound alone and B-mode ultrasound with sonoelastography). Elasticity scores were categorized as 0, 1, or 2 based on the degree and distribution of strain of the echogenic component within complex masses. The readers were asked to downgrade the likelihood of the malignancy score when an elasticity score of 0 was assigned and to upgrade the likelihood of the malignancy score when an elasticity score of 2 was assigned. The likelihood of the malignancy score was maintained as it was for the lesions with an elasticity score of 1. The Az values, sensitivities, and specificities were compared.
RESULTS
The Az value of B-mode ultrasound with sonoelastography (mean, 0.863) was greater than that of B-mode ultrasound alone (mean, 0.731; p = 0.001-0.007) for all authors. The specificity of B-mode ultrasound with sonoelastography (mean, 37.1%) was greater than that of B-mode ultrasound alone (mean, 3.8%; p < 0.001) for all readers. The addition of sonoelastography led to changes in decisions. A mean of 33.6% of benign masses were recommended for follow-up instead of biopsy.
CONCLUSION
For complex breast masses, sonoelastography allows increase in both the accuracy in distinguishing benign from malignant lesions and the specificity in deciding whether to perform biopsy.

Keyword

Breast; Neoplasm; Sonoelastography

MeSH Terms

Adult
Aged
Biopsy/*methods
Breast Diseases/pathology/*ultrasonography
Breast Neoplasms/diagnosis
Diagnosis, Differential
Elasticity Imaging Techniques/*methods
Female
Humans
Middle Aged
Pregnancy
Reproducibility of Results
Retrospective Studies
*Ultrasonography, Mammary
Young Adult

Figure

• 

  Fig. 1 Forty five-year-old woman with ductal carcinoma in situ. B-mode US image (A) shows microlobulated intracystic mass. Sonoelastographic image (B) shows entire solid component as blue, indicating hard lesion with elasticity score of 2. At B-mode US alone session, three of five readers classified lesion as likelihood of malignancy score of 2 (low suspicion for malignancy). Other two readers classified lesion as likelihood of malignancy score of 3 (intermediate suspicion for malignancy) and 4 (moderate suspicion for malignancy). At sonoelastography alone session, all readers classified lesion as elasticity score of 2 (no strain in entire echogenic component). At B-mode US and sonoelastography session, none of those readers changed their scores. US-guided vacuum-assisted biopsy and subsequent surgical excision revealed 2.9 cm in size papillary ductal carcinoma in situ. US = ultrasound

• 

  Fig. 2 Forty nine-year-old woman with fibrocystic changes. B-mode US image (A) shows oval, circumscribed, intracystic mass. Sonoelastographic image (B) shows entire solid component of complex mass as red or green, indicating soft lesion with elasticity score of 0. At B-mode US alone session, three of five readers classified lesion as likelihood of malignancy score of 2 (low suspicion for malignancy). Other two readers classified lesion as likelihood of malignancy score of 3 (intermediate suspicion for malignancy). For sonoelastographic image, all readers classified lesion as elasticity score of 0 (even strain for echogenic component). At B-mode US and sonoelastography session, all five readers downgraded lesion to likelihood of malignancy score of 1 (follow-up recommendation). US-guided core biopsy revealed fibrocystic changes. Lesion was stable during 2-year follow-up period. US = ultrasound

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