yun Xiao

Ultrasonic Elastography in Breast Cancer Diagnosis: Strain Ratio vs 5-point Scale

RATIONALE AND OBJECTIVES The aim of this study was to develop a more reliable ultrasonic elastographic diagnostic method than a five-point scoring system by analyzing the difference in stiffness between benign and malignant breast lesions. MATERIALS AND METHODS From January 2008 to April 2009, 559 solid lesions (415 benign, 144 malignant) in 437 consecutive patients (age range, 12-77 years) were examined using ultrasound elastography (UE). Final diagnosis was made on the basis of histopathologic findings. The strain ratios of the lesions were calculated. The area under the curve and cutoff point, both of which were obtained using receiver-operating characteristic curve analysis, were used to assess diagnostic performance. Diagnostic performance was further compared to that generated using a five-point scoring system with the z test. The sensitivity, specificity, and accuracy of these two evaluation systems were compared using McNemars test. RESULTS The strain ratios of benign lesions (mean, 1.83 ± 1.22) and malignant lesions (mean, 8.38 ± 7.65) were significantly different (P < .00001). When a cutoff point of 3.05 was introduced, UE had 92.4% sensitivity, 91.1% specificity, and 91.4% accuracy. The area under the curve for strain ratio-based elastographic analysis was 0.944, and the area under the curve for the five-point scoring system was 0.885. The diagnostic performance of strain ratio-based elastographic analysis was better than that of the five-point scoring system with UE (P < .05). CONCLUSIONS Strain ratio-based elastographic analysis can provide a new, more reliable diagnostic tool in comparison to a five-point scoring system for UE.

Semi-quantitating Stiffness of Breast Solid Lesions in Ultrasonic Elastography

RATIONALE AND OBJECTIVES To explore whether strain ratio measurement could semi-quantitatively evaluate the stiffness of breast lesions. MATERIALS AND METHODS From January 2008 to May 2008, 148 patients with 254 solid lesions (183 benign, 71 malignant) in the breast were included in the study. Ultrasound sonography found the lesions and ultrasonic elastography obtained the strain images. By using the strain ratio measurement method together with the ultrasound machine, the strain index of the lesion was calculated. Different depths of breast tissue were selected as the reference. The strain indexes of malignant and benign solid lesions were calculated with the same level of breast tissue as the reference. RESULTS The strain indexes of breast lesions were different compared to the same depth of breast tissue and the superior level of fat tissue (P = 0.000). The strain indexes of breast lesions were different compared to different depths of breast glandular tissues (P = 0.003). At the same level of the breast lesions, 212 lesions were glandular tissue, 11 were fat tissue, and 40 were both. In the lesion plane, six lesions had almost no glandular tissue and 20 had almost no superior fat tissue. Compared to the same depth of breast tissue, the strain indexes of benign lesions (range, 0.62-11.07) and malignant lesions (range, 3.12-39.28) were different (P = 0.000). CONCLUSION Using the strain ratio measurement, stiffness of breast lesions could be semi-quantitated with the same depth of breast tissue as the reference. This method may provide another diagnostic method in addition to the 5-point scoring system used with ultrasonic elastography in the future.

Ultrasound Elastography of Breast Lesions in Chinese Women: A Multicenter Study in China

PURPOSE Through analysis, the elastograms characteristics of breast lesions of Chinese women, a suitable diagnostic standard of quasistatic ultrasound elastography (UE) for Chinese women was proposed. METHODS From June 2010 to March 2012, 1036 consecutive female patients (mean age, 44 years old) with breast lesions were recruited into a multicenter retrospective study, which involved 8 centers across China. Each institutional ethic review board approved the study, and all the patients gave written informed consent. All breast lesions underwent ultrasound and UE examination. Two radiologists analyzed the elastograms and separated the elastograms into 10 types. A final diagnosis was made on the basis of histologic findings. The characteristics of the elastograms were analyzed. Receiver operating characteristic curves were plotted for evaluating the diagnostic performance. Sensitivity, specificity, and accuracy were calculated. Differences in sensitivity, specificity, and accuracy were tested by using the McNemar test. RESULTS There were 1150 lesions (593 benign, 557 malignant). There was a highly significant correlation between the elastogram color distribution and the percentage of malignant lesions, with a value of 0.92 (2P < .0001). Through analysis the different malignant percentages in different elastogram types, UE diagnostic standard was proposed, which was correlated with the blue percentage in the elastogram. The specificity, sensitivity, and accuracy of UE were 86.4%, 80.8%, and 83.5%, respectively. The specificity and accuracy of UE were higher than with ultrasound. The area under the curve was 0.86. CONCLUSION UE could give valuable assessment in the diagnosis of breast lesions. The proposed UE diagnostic standard was suitable for Chinese women.

Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast-enhanced ultrasonographic microvascular imaging.

OBJECTIVE To evaluate the diagnostic performance of superb microvascular imaging (SMI) in breast lesions, comparing with contrast-enhanced ultrasonographic microvascular imaging (MVI). METHODS From April to November 2015, 132 patients (with 132 breast lesions) were enrolled in the retrospective study. All lesions were evaluated with colour Doppler flow imaging (CDFI), colour SMI (cSMI), monochrome SMI (mSMI) and contrast-enhanced ultrasonographic MVI. Receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of SMI and MVI for discrimination between benign and malignant breast lesions. RESULTS Histological analysis showed 58 malignant and 74 benign lesions. mSMI was more sensitive in detecting blood flow signals in breast lesions than CDFI (p < 0.001) and cSMI (p < 0.001). Differences of vessels inside breast lesions and morphologic features of vessels between benign and malignant lesions were statistically significant on mSMI (p < 0.001). Using root hair-like and crab claw-like patterns as the criteria for malignant lesions, the sensitivity, specificity and accuracy for differentiation based on the microvascular architecture patterns were 77.6, 90.5 and 84.8% for mSMI and 89.6, 87.8 and 88.6% for MVI. Areas under curve of mSMI and MVI were not significantly different (p = 0.129). CONCLUSION mSMI can increase blood flow detection and depict the microvascular architecture of breast lesions. The diagnostic performance of mSMI was not significantly different from MVI. SMI has potential in the differential diagnosis of breast lesions. ADVANCES IN KNOWLEDGE mSMI is a non-invasive technique for vascularity evaluation of breast tumours and it is beneficial for breast tumour differentiation.

Breast Contrast-Enhanced Ultrasound: Is a Scoring System Feasible? ----A Preliminary Study in China

Objectives Although many studies about breast contrast-enhanced ultrasound had been conducted, clear diagnostic criteria for evaluating enhancement patterns are still lacking. This study aims to identify significant indicators for breast contrast-enhanced ultrasound and to establish an initial scoring system. Materials and Methods Totally 839 patients were included in the study. This study was divided into two parts. 364 patients were included in part 1 while 475 in part 2. Conventional ultrasound and contrast-enhanced ultrasound were used to examine each lesion. Only the cases in part 2 were also examined by elastography. In part 1, Logistic regression analysis was performed to predict significant variables. A 5-point scoring system was developed based on the results. In part 2, the scoring system was used to evaluate all the breast lesions. To evaluate the diagnostic efficacy of the new scoring system, it was compared with the system established for elastography and conventional ultrasound (BI-RADS). Results Three independent variables, namely, lesion scope, margin, and shape were selected in the final step of the logistic regression analysis in part 1. In part 2, the area under the ROC (receiver operating characteristic) curve for the contrast-enhanced scoring system was 0.912. The difference in the diagnostic capabilities of the contrast-enhanced scoring system and elastography was not statistically significant (P = 0.17). The difference in the diagnostic capabilities of the contrast-enhanced scoring system and BI-RADS was statistically significant (P<0.001). Conclusions The contrast-enhanced patterns of benign and malignant breast tumors are different. The application of a 5-point scoring system for contrast-enhanced ultrasound is clinically promising.

Non-Mass Breast Lesions on Ultrasound: Feature Exploration and Multimode Ultrasonic Diagnosis

The aim of this study was to analyze the features of non-mass breast lesions (NMLs) on B-mode ultrasound (US), color Doppler US, strain elastography (SE) and contrast-enhanced ultrasound (CEUS) and to develop a multimode ultrasonic method for NML differentiation. Seventy-one NMLs were included in this retrospective study. Binary logistic regression was used to identify the independent risk factors. Pathology results were used as the standard criterion. Microcalcification on US, high stiffness on SE and hyper-enhanced intensity on CEUS were identified as features correlated with malignancy. A multimode method to evaluate NMLs based on the logistic regression was developed. The sensitivity and specificity for US, US + Doppler, US + SE, US + CEUS and the multimode method were 100% and 29%, 92.5% and 41.9%, 97.5% and 58.1%, 90.0% and 58.1% and 95.0% and 77.4%, respectively. The accuracy of these methods was 69.0%, 70.4%, 80.2%, 76.1% and 87.3%, respectively. The multimode ultrasonic method is simple and exhibited high diagnostic performance, which might be helpful for predicting the potential malignancy of NMLs.