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Significant Differentiation of Focal Breast Lesions: Raw-Data-Based Calculation of Strain Ratio
Abstracts Mon, Aug 29, 2011 Hall F1 SS 23 10:30-12:00 Breast 1 - Elastography, ABVS and CEUS SS 23.01 Significant Differentiation of Focal Breast Lesions: Raw-DataBased Calculation of Strain Ratio T. Fischer,1 U. Peiser,2 F. Stephanie,2 T. Slowinski,3 P. Wedemeyer,1 F. Diekmann,1 M. Grigoryev,1 A. Thomas4 1 Department of Radiology and Ultrasound Research Laboratory, Charite – Universit€ atsmedizin Berlin, Berlin/DE, 2Department of Obstetrics and Gynecology, Hermann-Joseph-Hospital, Erkelenz/DE, 3 Department of Nephrology, Charite – Universit€atsmedizin Berlin, Berlin/DE, 4Department of Obstetrics and Gynaecology and Ultrasound Research Laboratory, Charite – Universit€atsmedizin Berlin, Berlin/DE Purpose: We compared elastography, B-mode ultrasound and mammography to determine whether raw data calculation of strain ratios (SRs) can further improve the differentiation of focal breast lesions. Material & Methods: 201 women with histologically proven focal breast lesions (85 benign, 116 malignant) were included at two German breast centers. Patients underwent standardized ultrasound procedure using high-end ultrasound system with a 9-MHz broadband linear transducer. Two experienced readers analyzed B-mode scans and mammograms using the BI-RADS criteria; elastograms were analyzed using the Tsukuba score. SRs were calculated from a tumor-adjusted ROI and a comparable ROI placed in the lateral fatty tissue. Sensitivity, specificity, and cutoff values were calculated for SRs (ROC analysis). Results: Median age was 53 years. Sensitivity and specificity were 85% and /60% for B-mode scanning, 85% and /68% for elastography, 78% and /62% for mammography, and 95% and /74% for SRs. SR cutoff value of 2.27 (AUC 0.907) allowed significant differentiation (p,0.001) of malignant and benign lesions. The quantitative SR calculation was superior to subjective interpretation of B-mode scans and sonoelastograms with a positive predictive value of 83% versus 78 % and 74%, and equal to mammograms. Conclusion: Calculation of strain ratios contributes to the standardization of sonoelastography with high sensitivity and allows significant differentiation of benign and malignant breast lesions with a higher specificity compared with B-mode, subjective evaluation of elastography and mammography.
SS 23.02 Elastic Moduli of Breast Carcinoma Comparing US Elastography Findings T. Umemoto,1 E. Ueno,1 Y. Fujihara,2 T. Matsumura,2 M. Yamakawa,3 T. Shiina,3 E. Tohno,4 T. Mitake,2 H. Bando,5 I. Morishima,1 H. Hara5 1 Department of Senology, Tsukuba Medical Center Hospital, Tsukuba/JP, 2Ultrasound Systems Division, Hitachi Medical Corporation, Kashiwa/JP, 3University of Kyoto, Kyoto/JP, 4Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba/JP, 5University of Tsukuba, Tsukuba/JP Purpose: To evaluate the elastic moduli of the breast tissue and to contrast them with elasticity images for accurate interpretation of real-time US elastography.
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Material & Methods: This study was approved by Human Subjects Institutional Review Board in Tsukuba Medical Center Hospital and University of Tsukuba. Written informed consent was obtained from all of the patients. Conventional US and Real-time Tissue Elastography were performed preoperatively in patients who had breast cancer. The slice of 5mm thickness including the lesion and the surrounding breast tissue was obtained from patient’s specimen immediately after resection. Within 2 hours after surgical resection, elastic modulus of each region was measured using materials testing machine (Instron 3342) under the constant pre-compression and the controlled temperature. Results: The elastic moduli obtained from the measurement were in increasing order of fat tissue, normal mammary gland, non-invasive and invasive breast cancer. The nonlinearity of the stress dependency was admitted in each region. Conclusion: In this study, we confirmed the values of elastic moduli of the breast carcinoma tissue were varied according to the histological structure of each lesion while those of fat and normal mammary gland tissue were almost constant. The nonlinearity of the stress dependency was also different in each region. These differences were demonstrated well on elasticity images.
SS 23.03 Shear Wave Elastography Patterns of Common Benign and Malignant Breast Lesions with Histopathologic Correlation E. B. Mendelson,1 V. V. D. Wear,2 L. Arnold,1 I. Karst1 1 Radiology, Feinberg School of Medicine, Northwestern University, Chicago/IL/US, 2Radiology, Illinois Masonic Hospital, Chicago/IL/US Purpose: To ascertain characteristic shear wave elastographic (SWE) patterns associated with breast malignancies, fibrosis, fibroadenomas (FA), and fibroepithelial lesions (FEL). Material & Methods: 168 biopsy-proved cases collected between 11/ 08 and 12/09 for an international IRB-approved multicenter trial using a prototype US system (Supersonic Imagine, Aix-en-Provence, FR). US-guided core biopsies were performed for BI-RADSÒ B-mode assessments 4 & 5, and 3 on request. SWE color patterns within the mass and surrounding area assessed for tissue stiffness using a color spectrum from red (hard) to blue (soft). SWE patterns were sorted into groups by color heterogeneity and size and shape comparison with B-mode lesion appearance. Results: SWE patterns for 58 cancers, 23 fibroses, 31 FA’s, and 6 FEL’s were identified. Color heterogeneity including stiffer colors (red, orange) and, in some, black areas impenetrable to shear waves, was the dominant SWE pattern in malignancies (46/58, 95.8%; sens 79.3%, spec 70%). A similar pattern, considered false positive, found in 10/23 (43.4%) stromal fibroses, 5/31 (16.1%) FA’s, and 3/6 (50%) FEL’s. Monochromatic blue overlay seen in 21/31 (67.7%) FA’s and 2/6 (30%) FEL’s. "Soft cancers" (5/58, 8.6%) had similar SWE patterns, considered false negative. Conclusion: Heterogeneous SWE color patterns that include red and orange, on a color spectrum labeling tissue stiffness as red and softness as blue was most commonly associated with malignancies, with a sensitivity of 79.3% and a specificity of 70% in our series.
SS 23.04 Shear-Wave Elastographic Values of Benign and Malignant Breast Lesions and Surrounding Tissue G. Ivanac, A. Hrkac Pustahija, R. Huzjan Korunic, B. Brkljacic Department of Radiology, University Hospital Dubrava, Zagreb/HR
SS 23.02 Elastic Moduli of Breast Carcinoma Comparing US Elastography Findings T. Umemoto,1 E. Ueno,1 Y. Fujihara,2 T. Matsumura,2 M. Yamakawa,3 T. Shiina,3 E. Tohno,4 T. Mitake,2 H. Bando,5 I. Morishima,1 H. Hara5 1 Department of Senology, Tsukuba Medical Center Hospital, Tsukuba/JP, 2Ultrasound Systems Division, Hitachi Medical Corporation, Kashiwa/JP, 3University of Kyoto, Kyoto/JP, 4Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba/JP, 5University of Tsukuba, Tsukuba/JP Purpose: To evaluate the elastic moduli of the breast tissue and to contrast them with elasticity images for accurate interpretation of real-time US elastography.
S45
Material & Methods: This study was approved by Human Subjects Institutional Review Board in Tsukuba Medical Center Hospital and University of Tsukuba. Written informed consent was obtained from all of the patients. Conventional US and Real-time Tissue Elastography were performed preoperatively in patients who had breast cancer. The slice of 5mm thickness including the lesion and the surrounding breast tissue was obtained from patient’s specimen immediately after resection. Within 2 hours after surgical resection, elastic modulus of each region was measured using materials testing machine (Instron 3342) under the constant pre-compression and the controlled temperature. Results: The elastic moduli obtained from the measurement were in increasing order of fat tissue, normal mammary gland, non-invasive and invasive breast cancer. The nonlinearity of the stress dependency was admitted in each region. Conclusion: In this study, we confirmed the values of elastic moduli of the breast carcinoma tissue were varied according to the histological structure of each lesion while those of fat and normal mammary gland tissue were almost constant. The nonlinearity of the stress dependency was also different in each region. These differences were demonstrated well on elasticity images.
SS 23.03 Shear Wave Elastography Patterns of Common Benign and Malignant Breast Lesions with Histopathologic Correlation E. B. Mendelson,1 V. V. D. Wear,2 L. Arnold,1 I. Karst1 1 Radiology, Feinberg School of Medicine, Northwestern University, Chicago/IL/US, 2Radiology, Illinois Masonic Hospital, Chicago/IL/US Purpose: To ascertain characteristic shear wave elastographic (SWE) patterns associated with breast malignancies, fibrosis, fibroadenomas (FA), and fibroepithelial lesions (FEL). Material & Methods: 168 biopsy-proved cases collected between 11/ 08 and 12/09 for an international IRB-approved multicenter trial using a prototype US system (Supersonic Imagine, Aix-en-Provence, FR). US-guided core biopsies were performed for BI-RADSÒ B-mode assessments 4 & 5, and 3 on request. SWE color patterns within the mass and surrounding area assessed for tissue stiffness using a color spectrum from red (hard) to blue (soft). SWE patterns were sorted into groups by color heterogeneity and size and shape comparison with B-mode lesion appearance. Results: SWE patterns for 58 cancers, 23 fibroses, 31 FA’s, and 6 FEL’s were identified. Color heterogeneity including stiffer colors (red, orange) and, in some, black areas impenetrable to shear waves, was the dominant SWE pattern in malignancies (46/58, 95.8%; sens 79.3%, spec 70%). A similar pattern, considered false positive, found in 10/23 (43.4%) stromal fibroses, 5/31 (16.1%) FA’s, and 3/6 (50%) FEL’s. Monochromatic blue overlay seen in 21/31 (67.7%) FA’s and 2/6 (30%) FEL’s. "Soft cancers" (5/58, 8.6%) had similar SWE patterns, considered false negative. Conclusion: Heterogeneous SWE color patterns that include red and orange, on a color spectrum labeling tissue stiffness as red and softness as blue was most commonly associated with malignancies, with a sensitivity of 79.3% and a specificity of 70% in our series.
SS 23.04 Shear-Wave Elastographic Values of Benign and Malignant Breast Lesions and Surrounding Tissue G. Ivanac, A. Hrkac Pustahija, R. Huzjan Korunic, B. Brkljacic Department of Radiology, University Hospital Dubrava, Zagreb/HR