Combination of different types of elastography in downgrading ultrasound Breast Imaging-Reporting and Data System category 4a breast lesions

• Published in: Breast cancer research and treatment Vol. 174; no. 2; pp. 423 - 432
• Main Authors: Zheng, Xueyi, Huang, Yini, Wang, Yun, Liu, Yubo, Li, Fei, Han, Jing, Wang, Jianwei, Cao, Longhui, Zhou, Jianhua
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2019; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Benign; Breast; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Cancer research; Clinical Trial; Data Systems; Diagnostic errors; Elasticity Imaging Techniques - methods; Female; Humans; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging - methods; Oncology; Prospective Studies; Radiology Information Systems; Sensitivity and Specificity; Ultrasonic imaging; Ultrasonography, Mammary - methods; Ultrasound; Young Adult; Sensitivity; Specificity; Breast Neoplasms; Elasticity imaging techniques; Ultrasonography
• ISSN: 0167-6806; 1573-7217; 1573-7217
• DOI: 10.1007/s10549-018-05072-0

Objectives To determine whether a combination of different types of elastography could improve the accuracy of elastography-aided downgrading ultrasound (US) Breast Imaging-Reporting and Data System (BI-RADS) category 4a lesions. Materials and methods From January 2016 to May 2018, 458 consecutive women with 494 US BI-RADS category 4a breast lesions were enrolled in the prospective study. These lesions were subject to conventional US supplemented with strain elastography of elasticity imaging (EI), virtual touch tissue imaging (VTI), and shear wave elastography of virtual touch imaging quantification (VTIQ). Diagnostic performances were calculated for BI-RADS, EI, VTI, and VTIQ as well as the combination of EI, VTI, and VTIQ (combination of EI and VTI [EI + VTI], combination of EI and VTIQ [EI + VTIQ], and combination of VTI and VTIQ [VTI + VTIQ]). Results Pathologically, 445 lesions (90.1%) were benign, and 49 (9.9%) were malignant. The specificities of EI, VTI, and VTIQ were significantly higher than those of BI-RADS (69.9%, 83.8%, 75.5% vs. 0, respectively, P  < 0.001), while their sensitivities were significantly lower than those of BI-RADS (83.7%, 73.5%, 65.3% vs. 100%, respectively, P  < 0.05). Among the combinations, EI + VTI and EI + VTIQ showed similar sensitivity to BI-RADS (98% vs 100%, P  = 1.000; 93.9% vs 100%, P  = 0.25), while the specificity of EI + VTI was significantly higher than that of EI + VTIQ and BI-RADS ( P  < 0.001). When using EI + VTI to downgrade lesions, 58.7% of these lesions were downgraded, among those 99.7% were benign. Conclusions Combinations of EI and VTI to downgrade BI-RADS category 4a lesions may reduce the misdiagnosis of breast cancers and the number of unnecessary biopsies.