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ELASTOGRAPHY presentation _ Dr Marwa Adel by wanghonghx

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									Real-time Ultrasound Elastography;
      Does it improve B-Mode Ultrasound
  Characterization of Solid Breast Lesions?


            Marwa Adel, MD
       Misr University for Science and Technology

                     Cairo Scan
   Elastography is a non-invasive medical
    imaging technique that detects tumors
    based on their


                  stiffness
                 (elasticity)
   An image in which different degrees
    of stiffness show as different
    shades of light and dark is called an

           Elastogram
Tissue elasticity imaging
   is performed with a conventional
    ultrasound probe
   does not require additional equipment.

   at the same time as the B mode image
    The interpretation criteria in elastography
                     consist of



    elasticity score           strain ratio
       Elasticity score
      Malignant Stiffer masses

deform less easily      dark
       Benign Softer masses

deform more easily       light
                Elasticity score



                Benign                                             Malignant


 1                    2                   3                    4                   5




Itoh A, Ueno E et al; Breast Disease; clinical application of US elastography for diagnosis, Radiology ,2006   
               Strain ratio
   Calculation of the SR value is based on
    comparing the average strain

      lesion            a similar area in the
                      adjacent breast tissue.
   Probability of malignancy INCREASES
    as the SR value INCREASES
         Aim of the study

to evaluate the sensitivity and specificity of the
 real-time sonoelastography as compared with B-
 mode US for distinguishing between
        benign and malignant solid breast masses
                taking in consideration



      Density                     BI-RADS
   Biopsy results were the reference standard
                  BI-RADS

   The Breast Imaging Reporting and Data
    System was developed through the
    American College of Radiology or ACR to
    help standardize feature analysis and final
    management of mammographic findings.
    BI-RADS Assessment Categories
   BIRADS 0   Need Additional Imaging Evaluation

   BIRADS 1   Negative

   BIRADS 2   Benign Finding

   BIRADS 3   Probably Benign Finding –
               Short Interval Follow-Up Suggested
   BIRADS 4   Suspicious Abnormality –
               Biopsy Should Be Considered
   BIRADS 5   Highly Suggestive of Malignancy –
               Appropriate Action Should Be Taken
   BIRADS 6   Known biopsy-proven malignancy,
                 Ultrasound Analysis
US criteria used to define a
benign solid breast mass
 oval shape
circumscribed margins
orientation parallel to the
chest wall
abrupt interface between
the mass and the
surrounding tissue
hypo- or isoechogenicity
increased or unchanged
posterior echoes
no change in the
surrounding tissue
                Ultrasound Analysis
US features that characterize
masses as malignant
included
irregular shape
microlobulated or spiculated
margins
width-to–AP dimension ratio of
1.4 or less.
thick echogenic halo
microcalcifications in or out of
the mass
ductal extension.
            Breast density




   Mammographies are evaluated for the
    glandular density according to the
    American College of Radiology (ACR)
    classification that identified four major
    groups for classifying breast density.
     ACR classification for breast
     density

   (1) Predominantly fat
   (2) Fat with some fibroglandular
    tissue
(3) Heterogeneously
dense
   (4) Extremely dense
           The lesions were set as



     (D1)                            (D2)
low density group            high density group
    (ACR 1 & 2)                  (ACR 3 & 4)
    MATERIALS AND METHODS

188 patients with 216 lesions; age ranging between 18
    and 72.
Underwent :
 Physical examination of both breasts, & relevant history
 B- mode Ultrasonography using a linear transducer
( frequency 6 to 13 MHz).
 Elastography
 In addition, the vascularization of the majority of lesions
    was determined using color Doppler
 NB: 147 women underwent mammographic
    examination.
           Results


       Histological diagnosis

                   216 lesions


123 benign (57%)                 93 malignant (43%)
                         Histological diagnosis
Pathologic diagnosis          No. of cases   Percent
Malignant lesions             93             43
-Ductal invasive carcinoma    71             32.9
-Lobular invasive carcinoma   13             6
-Mucinous carcinoma           1              0.5
-Tubular carcinoma            2              0.9
-DCIS                         6              2.8
Benign lesions                123            57
-Fibroadenoma                 101            46.8
- Fat necrosis                9              4.2
- Itraductal papilloma        4              1.9
-Fibrocytic changes           3              1.4
-Atypical hyperplasia         1              0.5
-Intramammary lymph node      2              0.9
-Hamartoma                    2              0.9
- Tubular adenoma             1              0.5
                                  Histopathology


                            HISTOPATHOLOGY


                   140


                   120      7

                   100
                                        4 3        US benign Elastography
                                                   Malignant
                   80
     Num be r of                                   US benign Elastography
      le s ions            101                     benign
                   60
                                                   US Malignant Elastography
                                        86         Malignant
                   40


                   20
                           15
                    0
                         Benign     Malignant



Bar graph demonstrating the distribution of ultrasound and
elastographic classifications for malignant and benign
lesions.
      Case
    Clinical summary:-
   A 26-year-old woman.
   Screening study
   Positive family history
      fibroadenoma

Findings:
Elastography score: 2 (benign).
SR: 0.83
        CASE
Clinical Summary:
   A 34-year-old woman with a right breast
    palpable lump
        Fibroadenoma.



elastography score 2
strain ratio value of 2.11
      CASE
Clinical Summary:
   A 45-year-old lady

   A right breast palpable lump.
ACR 3
BIRADS 3
              Biopsy
         mucinous carcinoma

SR of 4.42
               BIRADS 4 a
    Case
Clinical summary:
   A 61-year-old woman
   Left breast papable
    mass
BIRADS 5
                      Biopsy
                      invasive duct carcinom
Findings:
Ultrasound elastography score: 4
Strain ratio :6.05
      CASE
Clinical Summary:
   A 47-year-old lady having her
    Routine Screening Mammogram.
         Biopsy
         invasive duct carcinoma.
Findings:
     score 4             SR 5.72
      CASE
Clinical Summary:
   A 40 year old woman
   Bilateral mastalgia.
ACR 2
        Hamartoma
Eastographic score 2
        Case
Clinical Summary:
   A 31 year-old- lady doing US follow up for a
    palpable left retroareolar intraductal solid
    lesion
              intraductal papilloma


Elastography score 3 (benign)
                    B-mode   Elastography
Sensitivity           85%       80 %
Specificity           94%       97 %
+ve predictive value 92.5%      97 %
-ve predictive value 88%        82 %
          Elastography showed
less sensitivity       higher specificity
   than conventional sonography in the
   differentiation of benign from malignant
                 solid lesions
   Elastography was SUPERIOR to B-
    mode US in diagnosing solid lesions in
    the low density group (D1) (96.6% vs.
    92.4% specificity) and less in the
    dense glandular tissue (D2) (97.8% vs.
    95.9% specificity.
            CONCLUSION

  Real-time sonoelastography is a useful
technique for the characterization of benign
and malignant solid lesions as it increases the
diagnostic specificity comparable to B-Mode
Ultrasound, particularly in both ACR 1 and 2,
thus reducing the false-positive rate.

								
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