Eun-Ju Kang, Presenter: Nothing to Disclose

Jin Hwa Lee MD, Abstract Co-Author: Nothing to Disclose

Eun-Kyung Kim, Abstract Co-Author: Nothing to Disclose

Eun Sook Ko MD, Abstract Co-Author: Nothing to Disclose

Jin Han Cho, Abstract Co-Author: Nothing to Disclose

Byoung-Gwon Kim, Abstract Co-Author: Nothing to Disclose

Yeong Mi Park MD, Abstract Co-Author: Nothing to Disclose

Kyung Jin Nam MD, Abstract Co-Author: Nothing to Disclose

To prospectively evaluate the diagnostic performance of ultrasound (US) elastography for discriminating between benign and malignant breast lesions and to find out its role in diagnosing breast cancers, with pathologic results as the reference standard

Between December 2007 and December 2008, 284 women with 342 sonographically visible breast lesions who were scheduled to undergo biopsy were examined with US elastography (Siemens Antares Ultrasound unit). Elastographic findings were prospectively classified as benign or malignant; based on the area ratio, 1.00 as the threshold for differentiating benign from malignant masses. Conventional B-mode US findings were classified according to the BI-RADS category. All patients underwent US-guided core or fine needle aspiration biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were used to assess the diagnostic performance.

Of the 342 breast lesions, 85 (24.9%) were malignant and 257 (75.1%) were benign on pathology. B-mode US BI-RADS classification was category 3 in 74 (21.6%), category 4a in 179 (52.4%), category 4b in 36 (10.5%), category 4c in 15 (4.4%) and category 5 in 38 (11.1%). Elastogaphic findings were malignant in 102 (29.8%) and benign in 240 (70.2%). The sensitivity, specificity, NPV and PPV of B-mode US was 98.8%, 28.4%, 98.6% and 31.3% respectively. The sensitivity, specificity, NPV and PPV of US elastography was 77.4%, 83.3%, 89.2% and 67.4% respectively. US elastography was significantly better in specificity and PPV and worse in sensitivity and NPV than B-mode US (P<0.01).

US elastography can improve specificity and positive predictive value of B-mode US, but significantly sacrifice sensitivity and negative predictive value. Therefore, US elastography may not be helpful for distinguishing benign from malignant breast lesions and the decision of whether to perform breast biopsy.

US elastography may not be able to reduce the number of benign-result biopsies without missing a cancer.

Kang, E, Lee, J, Kim, E, Ko, E, Cho, J, Kim, B, Park, Y, Nam, K, The Role of US Elastography for Differentiating Benign from Malignant Breast Lesions: Can Benign-Result Biopsies Be Reduced?.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015159.html