Smitha Putturaya MD, FRCR, Presenter: Nothing to Disclose

Victoria Stewart, Abstract Co-Author: Nothing to Disclose

Neelofer Y Zaman, Abstract Co-Author: Nothing to Disclose

Ruth Williamson MBBS, Abstract Co-Author: Nothing to Disclose

K. Satchithananda, Abstract Co-Author: Nothing to Disclose

William Svensson MD, Abstract Co-Author: Equipment support, Siemens AG Speaker, Siemens AG Speaker, Koninklijke Philips Electronics NV Speaker, SuperSonic Imagine Research support, SuperSonic Imagine

To report seven years experience of real time elasticity imaging in symptomatic breast ultrasound.

Patients attending breast ultrasound with palpable abnormalities had routine ultrasound  plus ultrasound strain imaging on a Siemens Elegra (research - first three years) and on a Siemens Antares (audit – last four years). The combined imaging result was assessed and correlated with subsequent histology or follow up.

1058 cases have been analysed to date (research 334, audit 724). 257 cancers, 45 intermediate grade lesions and 758 benign pathologies.  Elasticity imaging alone using an elasticity-b mode ratio > 0.75 as an indicator for cancers and intermediate lesions had sensitivity 96 %, specificity of 52 %. Elasticity combined with B-mode and colour Doppler gave sensitivity 99% (for invasive cancers, dropping to 98% if intermediate lesions are included), specificity 47% (72% including cases with no B-mode abnormality). In 45 % of cases, strain imaging increased diagnostic confidence. In 2 % of cases, strain imaging affected management.  90% of cancers are stiff and appear larger on strain imaging with better demonstration of tumour extent. 40% of benign lesions appear significantly smaller and cysts have classical patterns on strain imaging. No stiffness is seen in normal parenchyma, fat islands and gynaecomastia. False negatives included 2 ADH and 2 DCIS, one radial scar, one invasive ductal carcinoma, and one grade 2 invasive lobular carcinoma with LCIS. 7 phylloides, 6 mucinous cancers, 11 intraductal papilloma, and 8 pure DCIS were true positives.  

We have found elasticity imaging to be a useful adjunct to routine breast ultrasound. Increasing skill and experience provides greater accuracy in diagnosis. Correlation with b-mode, colour Doppler, subsequent histology and follow –up is crucial. Cysts with echogenic contents and isoechoic fibro adenomas were identified more easily, ensuring appropriate management. Eyeballing of the lesion size is as reliable as measurement in most cases.

There is potential to safely decrease biopsies for benign lesions and map tumours more accurately if strain imaging is used as an adjunct to routine breast ultrasound.  

Putturaya, S, Stewart, V, Zaman, N, Williamson, R, Satchithananda, K, Svensson, W, Analysis of the Clinical Utility of Real Time Elasticity Imaging as a Part of Routine Symptomatic Breast Ultrasound.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015154.html