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The assessment of sensitivity of ultrasound elastographyin correlation with mammographic and histopathologicalresults in 42 patients with neoplastic breast lesions.

Poster No.: C-2411Congress: ECR 2013Type: Scientific ExhibitAuthors: D. Sieron, D. Knap; Katowice/PLKeywords: Breast, Ultrasound physics, Ultrasound, Elastography, Equipment,

Tissue characterisation, Cancer, Image verificationDOI: 10.1594/ecr2013/C-2411

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Purpose

Currently in Poland 12 000 women suffer from breast cancer; that number means thelevel of standardized coefficient amounting to 40,7/100 000. For women aged from 50 to69 years the screening MMG breast examinations is the first contact diagnostic method;it often is the first and in many cases, the last form of breast diagnostics carried out infemale patients within the above-mentioned age group.

Lesions that are radiologically suspicious in MMG examination are assessed in BI-RADSscale and are subjected to more detailed diagnostics using USG and fine- or thick-needlebiopsy in order to provide a further diagnostics enhancement and histopathologicalverification.

Female patients with cancerous lesions undergo surgical procedures, chemotherapyand radiation therapy. In this study, we present our own experience and review ofliterature concerning implementation of USG examination with the option of elastographicassessment of lesions.

Methods and Materials

The research group consisted of 42 female patients from Silesia Province in whom duringthe MMG and USG examinations, a suspicious lesion was found.

The selected patients were subjected to a MMG examination in MLO and CC projections,as well as to an USG examination. Lesions that were detected in patients during imagingwere verified in a 2D, DOPPLER and elastographic examinations.

Elastographic examination is based on a physical phenomenon described by ThomasYoung, who developed the theory of the transverse elasticity modulus. Elastographyis relatively new imaging technique; therefore, its implementation is restricted to theselected organs. At present, elastography is used mainly to assess lesions in breast,prostate, thyroid, lymph nodes or liver.

The examinations were carried out using EUB-7500 HV HITACHI device equipped withHitachi Real-Time Tissue Elastography application mapping in colors the assessment ofchanges in tissue elasticity.

The red-yellow color means predominant soft tissue (Fig.1.), yellow-green means mixedhard/soft tissue (Fig.2.), and predominant blue means the hard area (Fig. 3).

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During the examination consisting in a 1-3 mm deep mechanical pressure on the tissue inelastography option, we examined the strain of the examined tissue in terms of elasticity,the strain of the tumor and that of the healthy tissue. The examined area was presentedin visual color scale.

Each of the suspicious lesions were subjected to a biopsy and histopathologically verified.

Images for this section:

Fig. 1: The red-yellow color on US elastogram means predominant of soft tissue.

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Fig. 2: The yellow-green color on on US elastogram means mixed hard/soft tissue.

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Fig. 3: The predominant blue color on US elastogram means the hard tissue.

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Results

Within the group of 42 female patients, we found changes that had radiological featuresof malignant lesions and that in elastographic examination showed rich, hard lumps inconnective tissue. In histotathological examination, those lesions proved to be malignantones. In 19 patients, the lesions proved to be benign.

After carrying out histopathological and elastographic examinations, the results of bothexaminations were compiled in one table 1 and bar chart, (Fig. 4,).

From the attached material it follows, that within the group of 42 female patients,malignant lesions were found in 23 of them. The vast majority (23 out of 42 patients) ofmalignant lesion cases were related to hard elasticity aberrations. On the other hand,the occurrence of mixed aberrations or their absence was accompanied mostly by thepresence of benign lesions (19 out of 42 patients).The ultrasonographic assessment within the range of BI-RADS scale corresponded to theassessment in MMG examination were compiled in table 2 and graphic representation(Fig.5.).

Images for this section:

Table 1: Elastographic assessment in correlation with histopathological result

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Fig. 4: Bar chart showing the percentage relationship between the elastographicassessment and the histopathological result.

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Table 2: The percentage representation of the BI-RADS scale results in MMGexamination versus USG examination using the option of elastographic assessment.

Fig. 5: Graphic representation of the BI-RADS scale assessment in MMG examinationversus USG examination using the option of elastographic assessment.

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Conclusion

In assessment of the elasticity level, the elastographic examination is an excellentcomplement to the basic USG examination, allowing for carrying out an enhanced opticalassessment of the tissue structure that meets the radiological features of a malignantlesion in USG and MMG examinations.

References

1.Konofagou EE. Quo vadis elasticity imaging? Ultrasonics 2004;42(1-9):331-336.2.Garra BS. Imaging and estimation of tissue elasticity by ultrasound.Ultrasound Q. 2007Dec;23(4):255-68.3.Garra BS. Elastography: current status, future prospects, and making it work for you.Ultrasound Q. 2011 Sep;27(3):177-86.4. Ginat DT, Destounis SV Barr RG Castaneda B Strang JG Rubens DJ US elastographyof breast and prostate lesions. Radiographics. 2009 Nov;29(7):2007-16.5. Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor ofmalignancy.Radiology. 1999 Jun;211(3):845-50.6. Masroor I. Prediction of benignity or malignancy of a lesion using BI-RADS.J CollPhysicians Surg Pak. 2005 Nov;15(11):686-87. Raza S, Goldkamp AL, Chikarmane SA, Birdwell RL. US of breast masses categorizedas BI-RADS 3, 4, and 5: pictorial review of factors influencing clinical management.Radiographics. 2010 Sep;30(5):1199-213.

Personal Information

Dominik Siero#1

1.Breast Diagnostic Center in Miko#w, Poland

Daniel Knap2

2.Department of Radiology and Interventional Radiology, Medical University of Silesia,Katowice, Poland

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