Ah Young Park MD, Abstract Co-Author: Nothing to Disclose

Ji Hyun Youk MD, Abstract Co-Author: Nothing to Disclose

Eun Ju Son MD, PhD, Abstract Co-Author: Nothing to Disclose

Hye Mi Gweon MD, Abstract Co-Author: Nothing to Disclose

Jeong-Ah Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Dahye Lee, Presenter: Nothing to Disclose

To determine whether lesion stiffness measured by shear-wave elastography (SWE) could be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses.

This retrospective study enrolled a total of 99 breast masses including 40 high-risk lesions and 59 DCIS which were diagnosed at US-guided CNB and excised surgically. SWE was performed for all breast masses to measure quantitative elasticity values. To identify the preoperative factors associated with the histologic underestimation, patient age, symptom, lesion size, B-mode US findings, and quantitative SWE parameters were compared between the upgrade group and the non-upgrade group and estimated the predictive power for underestimation of each variable using univariate and multivariate logistic regression.

The overall underestimation rate was 28.3% (28/99) and the underestimation rate of high-risk lesion (ADH, phyllodes tumor and other atypia) and DCIS was 25.0% (57.1%, 16.7%, and 20.0%) and 30.5%, respectively. Lesion size was larger (16.0 vs 10.0 mm, p=.016) and BI-RADS category was higher (p=.030) in the upgrade group than in non-upgraded group. The medians of all elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (p<.0001): mean (Emean), 133.1 vs 57.4 kPa; maximum, 151.1 vs 66.6 kPa, minimum, 103.1 vs 43.6 kPa; the lesion-to-fat ratio, 7.8 vs 4.6. In subgroup analysis, high-risk lesions which were upgraded to malignancy showed higher Emean than the non-upgrade lesions (ADH, p=.077; phyllodes tumors, p=.028; other atypia, p=.030) and as did DCIS upgraded to invasive cancer (p<.0001). In multivariate analysis, Emean was an independent predictor for underestimation of malignancy (odds ratio, 1.022; p<.0001).

Breast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided CNB.

For patients with high-risk lesions or DCIS after CNB which are sufficiently stiff on SWE, a one-step operation could be considered when surgical excision is performed.

Park, A, Youk, J, Son, E, Gweon, H, Kim, J, Lee, D, Lesion Stiffness Measured by Shear-wave Elastography: Preoperative Predictor of the Histologic Underestimation of US-guided Core Needle Breast Biopsy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007566.html