Richard Gary Barr MD, PhD, Presenter: Consultant, Siemens AG Consultant, Koninklijke Philips Electronics NV Research grant, Siemens AG Research grant, SuperSonics Imagine Speakers Bureau, Koninklijke Philips Electronics NV Research grant, Bracco Group

To evaluate the accuracy of the “bull’s eye” artifact of elasticity imaging (EI) in determining the benignity of cystic breast lesions. To determine the utility of such artifact in reducing the biopsy rate of the benign lesions.

This study was performed under local institutional review board supervision and was in compliance with The Health Insurance Portability and Accountability Act of 1996 (HIPAA). A retrospective review of 383 breast lesions from 309 consecutive patients undergoing diagnostic breast ultrasonography (US) with EI (Siemens Antares or Siemens S2000, Mountain View, Ca) was conducted. The B-mode characteristics of those lesions determined whether biopsy was conducted. Pathology reports of the biopsied lesions were reviewed. Lesions demonstrating the “bull’s eye” artifact on EI were determined. The accuracy of the artifact in determining the benignity of cystic breast lesions was determined

Of the 383 lesions, 243 lesions were recommended for biopsy based on the B-mode characteristics (biopsy rate 63.4%). Of those 243 lesions, 62 lesions demonstrated the “bull’s eye” artifact on EI and all were confirmed benign cysts on pathology. Of the 181 lesions without the artifact, 116 were benign non-cystic lesions and 65 were malignant non-cystic lesions. Hence within the biopsied lesions, the “bull’s eye” artifact had perfect sensitivity, specificity and positive predictive value in determining pathologically proven benign cysts. If the artifact can be used as a criteria to exclude lesions from biopsy, then the biopsy rate will be 181/383 (47.3%), significantly lower than the 63.4% biopsy rate without using this criteria (P< 0.001).

The “bull’s eye” artifact seen on EI on Siemens’ ultrasound equipment is a promising tool in the evaluation and characterization of benign breast cysts, and has the potential to significantly reduce the amount of unnecessary breast biopsy.

Cystic breast lesions are common and a reason for negative biopsies or short-term follow up. A reliable technique to confirm they are benign and reduce the number of follow-up exams and biopsies.

Barr, R, The Utility of the “Bull’s Eye” Artifact on Breast Elasticity Imaging in Reducing Breast Lesion Biopsy Rate.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004466.html