Real‐time elastography — an advanced method of ultrasound: first results in 108 patients with breast lesions

TLDR

The study assessed whether real‑time elastography can better differentiate benign from malignant breast lesions compared to conventional B‑mode ultrasound. Eighty‑eight patients underwent real‑time elastography, with elasticity measured via a 3‑D finite element model overlaid on B‑mode images, and a second observer independently evaluated the images to enhance objectivity, with results compared to histology and prior sonography. Elastography yielded a specificity of 91.5% (second observer) versus 78% for B‑mode, with a weighted kappa of 0.67, indicating improved specificity and added value for BI‑RADS IV lesions.

Abstract

To evaluate whether real-time elastography, a new, non-invasive method for the diagnosis of breast cancer, improves the differentiation and characterization of benign and malignant breast lesions.Real-time elastography was carried out in 108 potential breast tumor patients with cytologically or histologically confirmed focal breast lesions (59 benign, 49 malignant; median age, 53.9 years; range, 16-84 years). Tumor and healthy tissue were differentiated by measurement of elasticity based on the correlation between tissue properties and elasticity modulus. Evaluation was performed using the three-dimensional (3D) finite element method, in which the information is color-coded and superimposed on the B-mode ultrasound image. A second observer evaluated the elastography images, in order to improve the objectivity of the method. The results of B-mode scan and elastography were compared with those of histology and previous sonographic findings. Sensitivities and specificities were calculated, taking histology as the gold standard.B-mode ultrasound had a sensitivity of 91.8% and a specificity of 78%, compared with sensitivities of 77.6% and 79.6% and specificities of 91.5% and 84.7%, respectively, for the two observers evaluating elastography. Agreement between B-mode ultrasound and elastography was good, yielding a weighted kappa of 0.67.Our initial clinical results suggest that real-time elastography improves the specificity of breast lesion diagnosis and is a promising new approach for the diagnosis of breast cancer. Elastography provides additional information for differentiating malignant BI-RADS (breast imaging reporting and data system) category IV lesions.