AIM: To determine the role of ultrasound elastography of breast mass lesions. Methods: A prospective research was conducted at the radiology department of Continental Hospitals in Nanakaramguda, Hyderabad. 50 women with breast edema verified by ultrasonography were part in this research. Results: Out of the 50 individuals in the research, 26 (52%) exhibited benign characteristics, whereas 24 (48%) had malignant characteristics. Out of the 50 patients in the research, 22 (44%) exhibited benign characteristics and 28 (56%) exhibited malignant characteristics as per elastography results. In a study of 50 patients, ultrasonography revealed malignancy signs in 24 patients (48%). Subsequent elastography conducted on these 24 patients indicated malignant features in 23 of them (95.8%). Out of 26 patients in the study, 52% exhibited benign characteristics on ultrasound. Among these 26 patients, 21 (80.7%) showed benign features on elastography. When comparing ultrasound and elastography findings in these 50 patients, the sensitivity for detecting malignant lesions was 82% and the specificity was 95%, resulting in an overall accuracy rate of 88%. Conclusion: We found that using elastography in conjunction with conventional B-mode ultrasonography enhances the diagnostic accuracy in differentiating between benign and malignant breast lesions, leading to a significant reduction in needless biopsies for benign lesions. |
Elastography-based imaging methods have garnered significant interest in recent years for non-invasive evaluation of tissue mechanical characteristics. These methods use altered soft tissue elasticity in different diseases to provide qualitative and quantitative data for diagnostic application. Mammography and ultrasound are often used together to analyze breast lumps and evaluate the likelihood of cancer.1,2 Ultrasound elastography is used as an additional method to enhance the characterisation of lesions. Elastography evaluates the rigidity of a lesion by charting the deformation in tissue components under external pressure. Currently, there are two technological options accessible for clinical use: Strain Elastography and Shear Wave Elastography. Mammography and Ultrasonography are the most sensitive diagnostic procedures for detecting breast cancer. Both systems have drawbacks. Dense breasts may lead to inaccurate findings in mammography. Ultrasonography is effective in identifying abnormalities, but its ability to accurately distinguish between different types of lesions is limited, with many solid lesions being noncancerous.
To get a sufficient specificity, several aspects of the lesions need to be assessed based on the BIRADS Criteria established by the American College of Radiology. The BIRADS Criteria produced a considerable number of false positive outcomes. These constraints result in a rise in biopsies with a cancer detection rate ranging from 10% to 30%. Several biopsies are conducted on benign lesions, causing distress to patients and being quite costly. USG Elastography was designed to address these limitations and provide a more precise assessment of breast lesions. USG Elastography is a non-invasive technique that evaluates tissue deformation by analyzing elasticity. The concept is founded on the idea that there are notable variations in the mechanical characteristics of the tissue that may be identified by applying an external mechanical stress. Elastography has shown good specificity in assessing lesions located in different organs. However, this method is still novel, especially given the many options available in practical practice. Elasticity is the ability of a body or material to deform under external force and return to its former shape or size when the force is withdrawn.
Various tissues are anticipated to exhibit varied responses based on their unique elastic modulus. Tissue deformation decreases as the stiffness of the material and response time increase. Adipose tissue is more deformable than other tissues, but fibrous tissue takes longer to recover to its previous condition compared to adipose and muscular tissues.2-53
Prospective research was conducted at the radiology department of Continental Hospitals, Nanakaramguda, Hyderabad. 50 women with breast edema verified by ultrasonography were included in the trial.
Inclusion criteria:
Patients having a breast mass detected on ultrasonography at the Department of Radio Diagnosis, Continental Hospitals in Hyderabad were part of this research.
Exclusion criteria:
Patients who have already been diagnosed.
Methodology
Conventional B-mode ultrasonography and ultrasonic elastography were conducted for all patients simultaneously utilizing a 3-12 MHz linear array transducer attached to a real-time ultrasound system (Samsung Madison RS80A). Following the patient's informed permission, they were positioned supine with their arms put behind their head on a pillow. All patients had a thorough examination of both breasts using conventional B-mode ultrasound, with a focus on capturing pictures of the target lesions. A radial-ductal examination was performed by positioning the transducer perpendicular to the skin and radially on the breast, with one end covering the areola and the other end pointing outward from the areola. Then, the transducer was spun around the areola. Upon identifying a duct, the transducer's rotation was halted, and it was moved sideways to thoroughly examine the duct, its branches, and the lobules. Next, the transducer was adjusted to access the following ducto-lobular complex.
This process was continued until all ductal structures were assessed. Another rotational sweep was conducted on the top outside periphery of each breast. Following identification of a target lesion on a B-mode ultrasound picture, ultrasound elastography was conducted for the lesion. The characteristics of the diagnosed breast masses in the US were categorized using the ACR BIRADS US vocabulary, which analyzes six morphological variables: form, orientation, margin, lesion border, internal echo pattern, and posterior acoustic properties.6Lesions categorized as BI-RADS 1 and 2 were classified as benign, BI-RADS 3 as uncertain, and BI-RADS 4 and 5 as malignant.7
The features indicating malignancy were supposition, unparallel orientation (taller than broader), angular borders, shadowing, branching pattern, hypoechogenecity, calcifications, duct extension, and microlobulations.8 Characteristics indicating benign breast masses include smooth, well-defined, and slightly brighter masses with a thin echogenic capsule. They typically have an oval shape, are parallel in orientation, have three or fewer gentle lobulations, and lack any signs of malignancy. The elasticity pictures were generated using a color map and overlaid on the B-mode images. They were exhibited on the left side of a dual-display image, while the equivalent B-mode image was shown on the right side to provide continuous real-time viewing. The area of interest (ROI) was defined inside a manually highlighted box. Each region of interest (ROI) included the breast mass and surrounding tissue up to a depth of 0.5 centimetres, including the subcutaneous layers and pectoralis muscle, but excluding the costal cartilages. Each lesion was evaluated using 256-level color mapping in red-green-blue.
Elastography: Green represents the average stiffness of the tissue, blue represents hard tissue, and red represents soft tissue as reported by Itoh et al.9The color scale's elasticity, as developed by ITOH et al.9, was as follows: We awarded each picture an elasticity score on a five-point scale based on the overall pattern. A score of 0 was given to lesions with a distinct red-green-blue characteristic typical of simple cystic lesions. A score of 1 indicated uniform strain across the hypoechoic lesion, with the whole lesion appearing uniformly tinted in green. A score of 2 showed strain in most parts of the hypoechoic lesion, with some regions lacking strain, resulting in a mosaic pattern of green and blue. A score of 3 showed tension around the edge of the hypoechoic lesion, but the center of the lesion remained unaffected (i.e., the outside section of the lesion appeared green, while the inner part appeared blue). A score of 4 showed absence of strain in the complete hypoechoic lesion, which means the entire lesion was blue, excluding its surrounding region. A score of 5, according to the criteria of ITOH et al., showed the absence of strain in both the complete hypoechoic lesion and its surrounding region, as they appeared blue. Elastography scores were compared with BIRADS categories, where a BIRADS II lesion corresponded with elastography scores of 1 and 2, while the other categories had a one-to-one correlation.
Among the 50 patients in the research, the majority fall within the age range of 41-50 (28%), followed by those in the age ranges of 31-40 and 51-60 (22% each), with 18% being over 60 and 10% below 30.
Out of 50 individuals in the research, 27 patients presented on the left side (54.0%) and 23 patients presented on the right side (46.0%).
Out of the 50 individuals examined in the research, 26 (52%) exhibited benign characteristics, whereas 24 (48%) had malignant characteristics.
The research found that 22 individuals (44%) exhibited benign characteristics, whereas 28 patients (56%) had malignant characteristics based on elastography.
Out of the 50 patients studied using ultrasonography, 24 patients (48%) exhibited characteristics of malignancy. Subsequent elastography conducted on these 24 patients revealed that 23 of them (95.8%) had malignant traits. Out of 26 patients, 52% showed benign features on ultrasound. Among these 26 patients, 80.7% showed benign features on elastography. When comparing ultrasound and elastography findings in these 50 patients, the sensitivity for detecting malignant lesions was 82% and the specificity was 95%, resulting in an accuracy rate of 88%.
Ultrasonographic elastography is a non-invasive medical imaging method that distinguishes masses by their firmness.10 Analysis of breast nodules seen on B-mode ultrasound mostly depends on morphological characteristics. Additional methods like as Doppler and harmonic imaging may enhance the accuracy of ultrasonography (USG). There has been a growing interest in the last ten years in measuring the elasticity of biological tissues to enhance information obtained from traditional anatomical imaging.
This prospective research was conducted on 50 patients sent to the department of radiology due to a palpable breast tumour, some of which were accompanied by discomfort.
The research included females over 17 years old. Most patients in the study were in the 41-50 age range (28%), with 22% between 31-40 and 51-60 years old. 18% of the patients were over 60 years old, with a mean age of 45 years and a standard deviation of 14.23.
Among 50 patients, 27 individuals (54%) had a left side breast lesion, whereas 23 (46%) had a right-side breast lesion. Among 50 patients, 26 (52%) exhibited benign characteristics and 24 (48%) exhibited malignant characteristics on ultrasonography. Out of 50 patients, elastography revealed that 23 patients (46%) exhibited benign features, whereas 27 patients (54%) exhibited malignant characteristics.
Out of the 50 patients studied using ultrasonography, 24 patients (48%) exhibited signs of malignancy. Subsequent elastography conducted on these 24 patients revealed that 23 of them (95.8%) had malignant characteristics. Other writers conducted a similar investigation.11Out of 26 patients in the study, 52% exhibited benign characteristics. Among these 26 patients, elastography revealed benign features in 21 patients, accounting for 80.7%. When comparing the ultrasound findings and elastography results of these 50 patients, the sensitivity for detecting malignant lesions was 82% and the specificity was 95%, resulting in an accuracy rate of 88%. Other writers conducted a similar investigation.12,13This work was limited by heterogeneity in acquiring the strain index from sonoelastography pictures, both within and between observers. When comparing ultrasound, elastography, and strain ratio techniques, ultrasound and elastography have similar sensitivity, but ultrasound has slightly higher specificity. When strain ratio is added to the study, sensitivity increases to 86% and specificity to 82%.
We found that using elastography in combination with conventional B-mode ultrasonography may enhance its diagnostic accuracy in differentiating between benign and malignant breast lesions, leading to a significant reduction in needless biopsies for benign lesions.