Ultrasound elastography may prove valuable in avoiding unnecessary diagnostic procedures in benign breast lesions, research suggests.

 

 

Ultrasound elastography may prove valuable in avoiding unnecessary diagnostic procedures in benign breast lesions, research suggests.

 

 

Speakers at the European Congress on Radiology in Vienna on Friday indicated that elastography could improve the specificity of conventional ultrasound. They added that false positives might be reduced even further with the addition of a new technique, 'slip imaging,' designed to evaluate tissue mobility.

 

Consultant radiologist Dr Fritz KW Schaefer of the University Schleswig-Holstein in Kiel, Germany, presented a European multicentric study evaluating both ultrasound techniques in 429 breast lesions, 161 of which were malignant. The researchers obtained definitive diagnoses by FNA, core or surgical biopsies, follow-up or comparison with previous studies.

 

Using the 5-point Ueno classification where scores 1-3 were interpreted as benign and 4-5 malignant, elastography had a sensitivity of 72% and specificity of 89.5%. B-mode was interpreted with BI-RADS - scores 2-3 benign and 4-5 malignant - and had a sensitivity of 100% and specificity of 51.5%.

 

Elastography significantly increased the specificity of BI-RADS and was found to be highly reproducible between different centers and different readers.

 

Dr Schaefer said: "Elastography has a lower sensitivity and higher specificity than B-mode. It is a complementary method, especially for low-suspicion lesions."

 

He noted that while elastography may not be able to replace conventional B-mode ultrasound for the detection of breast cancer, it could improve diagnostic performance as an adjunctive assessment tool.

 

Consultant radiologist at Oxford Radcliffe Hospitals NHS Trust Dr RE English subsequently described data from a small observational study. The trial included 32 women with malignant breast tumors and 38 with benign lesions, who underwent ultrasound, elastography and slip imaging.

 

The diagnostic accuracy improved from 75.5% with ultrasound alone to 78.1% with elastography, and rose further to 80% when slip imaging was added. However, sensitivity fell from 81.3% to 77.1% with the addition of slip imaging.

 

Dr English warned that compromising sensitivity could be an issue. But she added: "Slip imaging improves the identification of benign lesions, and produces better overall diagnostic accuracy. The potential role of slip imaging needs to be identified."

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