J Breast Cancer.  2014 Mar;17(1):76-82.

Diagnostic Value of Elastography Using Acoustic Radiation Force Impulse Imaging and Strain Ratio for Breast Tumors

• Kim YS
• Park JG
• Kim BS
• Lee CH
• Ryu DW

Abstract

PURPOSE
The aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone.
METHODS
ARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch(TM) tissue imaging (VTI) and Virtual Touch(TM) tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations.
RESULTS
Among the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7+/-1.0 vs. 1.6+/-0.8, p<0.01), SWV (4.23+/-1.09 m/sec vs. 2.22+/-0.88 m/sec, p<0.01), and SR (5.69+/-1.63 vs. 2.69+/-1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each).
CONCLUSION
ARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.

Keyword

Breast neoplasms; Elasticity imaging techniques; Ultrasonography

MeSH Terms

Acoustics*
Adipose Tissue
Breast Neoplasms*
Breast*
Complement System Proteins
Diagnosis
Elasticity
Elasticity Imaging Techniques*
Humans
Information Systems
Sensitivity and Specificity
Ultrasonography
Complement System Proteins

Figure

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  Figure 1 Calculation of shear wave velocity (Vs) of breast lesion. Marginal areas of mass and the surrounding tissues are included in the region of interest. The numeric value of the shear wave velocity is displayed on the monitor.

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  Figure 2 Measurement of strain ratio of breast lesion. Strain ratio is measured by comparing the average strain between breast lesion and surrounding adipose tissue. The numeric value of the strain ratio is displayed on the monitor. ROI=region of interest.

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  Figure 3 Elasticity scores of breast lesions according to Itoh classification. (A) Score 1, even strain for the lesion. (B) Score 2, strain in most of the lesion with some areas of no strain. (C) Score 3, no strain in the central part of the lesion. (D) Score 4, no strain throughout the lesion. (E) Score 5, no strain throughout the lesion and the surrounding area. Black circle indicates outline of hypoechoic lesion on B-mode ultrasound.

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