Budapest, 2017.

Introduction

� The main purpose of all diagnostic methods is early breast cancer detection

� However, considering higher incidence of benign lesions comparing to malignant,

� there is a great importance of noninvasive detection of Benign Breast Diseases (BBD), since most of the benign lesions have not malignant potential

“Triple assessment”

3. Biopsy

2. Imaging

1. Clinical breast exam

Overdiagnosed!?

ELASTOGRAPHY

Elastography-definition

� Sonoelastography is noninvasive, complementary, diagnostic technique that directly reveals soft tissue elasticity.

� Elasticity assessment:

� qualitative (Tsukuba elasticity score-TES)

� semiquantitative evaluation (strain ratio between fat and lesion, SR).

*Sensitivity 86.5% - 96.9%Specificity 76% -89.8%

Accuracy 88.3%

*Faruk T. Clin Breast Cancer, 2015.

Ueno staging-Tsukuba score (TES)

Elastography-quantitative evaluation

A

B

Objective

� To detect diagnostic performance of the combined use of sonoelastographic scoring and strain ratio in differentiation of benign and malignant breast lesions

� and compare it with conventional sonography

� with the histopathology as the standard reference

Method

� A total of 128 breast lesions (73 malignant and 55 benign) in 125 women (mean age 54 years, range 21-84 yrs) were enrolled in one year prospective study that was conducted in Clinical Center “Bezanijska kosa” in Belgrade.

Minimum Maximum Medijana X SD

Age 21 84 57 54.79 14.71

�Conventional US and sonoelastography were performed.

�B-mode images were classified according to the Breast Imaging Recording and Data System.

�The hardness was determined with 5-point scoring method (Ueno classification) and SR of the lesions were calculated by dividing the strain value of the subcutaneous fat by that of the mass.

�Receiver operating characteristic (ROC) curves were performed and the cutoff point for differentiation of benign and malignant masses was detected.

Method

Final pathological diagnosis

Nonproliferative lesions

Proliferative lesions without atypia

Proliferative lesions with atypia

Malignant lesions

BI

RA

DS

clas

sifi

cati

on

benign malignant total

2 5 0 5

9.1% 0.0% 3.9%

3 7 0 7

12.7% 0.0% 5.5%

4 42 16 58

76.4% 21.9% 45.3%

5 1 57 58

1.8% 78.1% 45.3%

55 73 128

100,0% 100,0% 100,0%

BI RADS scores of benign and malignant breast lesions

Cut-off value benign vs. malignant4

p

Benign Malignant Total

TES

benigni/maligni

TES 1, 2, 3 34 (92%) 3 37

TES 4, 5 21 70 (77%) 91

55 73 128

Pathological diagnosis

Elasticity score TES

1 2 3 4 5 total

benign 4 (7.3%)

7 (12.7%)

23 (41.8%)

13 (23.6%)

8 (14.5%)

55

malignant 0 1 (1.4%)

2(2.7%)

14 (19.2%)

56 (76.7%)

73

total 128

p

Elastography-TES

“cut-off” value benign/malignant– 4Sensitiivity 95% and specificity 61.8%

TES for benign lesions 3.25TES for malignant lesions 4.71

p

TES can predict certain type of benign lesions!

Xsr SD min Max median

Nonproliferative

lesions

3.25 1.09 1 5 3

Proliferative lesions

without atypia

3.06 0.80 2 4 3

Proliferative lesions

with atypia

4 4 4 4

“cut-off” value - 4.27Sensitivity 97,3%, Specificity 55.6%

Benign lesions 9Malignant lesions 24p

ROC curve for TES and SR

AUC p CI 95%

TES 0.866 < 0.001 0.797-0.934

SR 0.820 0.742-0.898

TES and SR 0.874 0.807-0.941

ROC curve for B-mode ultrasound and TES

AUC p CI 95%

TES 0.866 < 0.001 0.797-0.934

US 0.905 0.853-0.958

TES and US 0.949 0.912-0.987

TES 1

LIPOMA

TES 2

Cysta mammae

Fibroadenoma

TES 3SR 2.54

TES 5/SR 8.53Ca mucinosum

TES 3/SR 5.11Ca mucinosum

TES 4 / SR 29.75

Malignant tumor

TES 5 / SR 19.40

Malignant tumor

“BGR” artefact

Cysta mammae

�The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses, but combination of sonography and TES had better diagnostic performance.

�Sonoelastography has demonstrated to be a promising, complementary, noninvasive technique to detect and evaluate breast lesions, and could potentially reduce the number of unnecessary biopsies.

�……But it needs optimizations in technique, “cut off” values, coding system, analyzing the effect of depth of the lesion and other parameters that can make influence to elastography exam, etc…

CONCLUSION