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

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Abstract

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.

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Abbreviations

US:

Ultrasound

BI-RADS:

Breast Imaging-Reporting and Data System

EI:

Elastic imaging

VTI:

Virtual touch tissue imaging

VTIQ:

Virtual touch imaging quantification

SWV:

Shear wave velocity

AUC:

Area under the receiver operating characteristic curve

EI + VTI:

Combination of EI and VTI

EI + VTIQ:

Combination of EI and VTIQ

VTI + VTIQ:

Combination of VTI and VTIQ

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Author notes

  1. Xueyi Zheng, Yini Huang have contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, People’s Republic of China

    Xueyi Zheng, Yini Huang, Yun Wang, Yubo Liu, Fei Li, Jing Han, Jianwei Wang & Jianhua Zhou

  2. Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China

    Longhui Cao

Authors
  1. Xueyi Zheng
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  4. Yubo Liu
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Correspondence to Jianhua Zhou.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The experiments comply with the current laws of China.

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Verbal informed consent was obtained from all individual participants included in the study.

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Zheng, X., Huang, Y., Wang, Y. et al. Combination of different types of elastography in downgrading ultrasound Breast Imaging-Reporting and Data System category 4a breast lesions. Breast Cancer Res Treat 174, 423–432 (2019). https://doi.org/10.1007/s10549-018-05072-0

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  • DOI: https://doi.org/10.1007/s10549-018-05072-0

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