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Budapest, 2017 . Introduction The main purpose of all diagnostic methods is early breast cancer detection However, considering higher incidence of benign lesions comparing to malignant, there is a great importance of noninvasive

  1. Budapest, 2017 .

  2. Introduction � The main purpose of all diagnostic methods is early breast cancer detection � However, considering higher incidence of benign lesions comparing to malignant, � there is a great importance of noninvasive detection of Benign Breast Diseases (BBD), since most of the benign lesions have not malignant potential

  3. 1. Clinical breast 2. exam Imaging ELASTOGRAPHY 3. Biopsy “Triple assessment” Overdiagnosed!?

  4. Elastography-definition � Sonoelastography is noninvasive, complementary, diagnostic technique that directly reveals soft tissue elasticity. � Elasticity assessment: � qualitative (Tsukuba elasticity score-TES) � semiquantitative evaluation (strain ratio between fat and lesion, SR). *Sensitivity 86.5% - 96.9% Specificity 76% -89.8% Accuracy 88.3% *Faruk T. Clin Breast Cancer, 2015.

  5. Ueno staging-Tsukuba score (TES) A Elastography-quantitative B evaluation

  6. Objective � To detect diagnostic performance of the combined use of sonoelastographic scoring and strain ratio in differentiation of benign and malignant breast lesions � and compare it with conventional sonography � with the histopathology as the standard reference

  7. Method � A total of 128 breast lesions (73 malignant and 55 benign) in 125 women (mean age 54 years, range 21-84 yrs) were enrolled in one year prospective study that was conducted in Clinical Center “Bezanijska kosa” in Belgrade. Minimum Maximum Medijana X SD Age 21 84 57 54.79 14.71

  8. Method � Conventional US and sonoelastography were performed. � B-mode images were classified according to the Breast Imaging Recording and Data System. � The hardness was determined with 5-point scoring method (Ueno classification) and SR of the lesions were calculated by dividing the strain value of the subcutaneous fat by that of the mass . � Receiver operating characteristic (ROC) curves were performed and the cutoff point for differentiation of benign and malignant masses was detected.

  9. Final pathological diagnosis Nonproliferative lesions Proliferative lesions without atypia Proliferative lesions with atypia Malignant lesions

  10. BI RADS scores of benign and malignant breast lesions Cut-off value benign vs. malignant 4 benign malignant total 2 5 0 5 9.1% 0.0% 3.9% BI RADS classification 3 7 0 7 12.7% 0.0% 5.5% p<0.001 4 42 16 58 76.4% 21.9% 45.3% 5 1 57 58 1.8% 78.1% 45.3% 55 73 128 100,0% 100,0% 100,0%

  11. Elasticity scores for benign and malignant lesions Benign Malignant Total 34 (92%) TES TES 1, 2, 3 3 37 benigni/maligni 70 (77%) TES 4, 5 21 91 55 73 128 p<0.001 Pathological Elasticity score TES diagnosis 1 2 3 4 5 total benign 4 7 23 13 8 55 (7.3%) (12.7%) (41.8%) (23.6%) (14.5%) malignant 0 1 2 14 56 73 (1.4%) (2.7%) (19.2%) (76.7%) total 128

  12. Elastography-TES TES for benign lesions 3.25 TES for malignant lesions 4.71 p<0.001 “ cut-off ” value benign/malignant– 4 Sensitiivity 95% and specificity 61.8% AUC p CI 95% TES 0.866 < 0.001 0.797-0.934

  13. TES can predict certain type of benign lesions! Xsr SD min Max median Nonproliferative 3.25 1.09 1 5 3 lesions Proliferative lesions 3.06 0.80 2 4 3 without atypia Proliferative lesions 4 4 4 4 with atypia

  14. Elastography - SR Benign lesions 9 Malignant lesions 24 p<0.001 “ cut-off ” value - 4.27 Sensitivity 97,3%, Specificity 55.6% AUC p CI 95% SR 0.820 < 0.001 0.742-0.898

  15. ROC curve for TES and SR AUC p CI 95% 0.866 TES < 0.001 0.797-0.934 SR 0.820 0.742-0.898 0.874 TES and SR 0.807-0.941

  16. ROC curve for B-mode ultrasound and TES AUC p CI 95% 0.866 TES < 0.001 0.797-0.934 US 0.905 0.853-0.958 0.949 TES and US 0.912-0.987

  17. TES 1 LIPOMA

  18. TES 2 Cysta mammae

  19. TES 3 SR 2.54 Fibroadenoma

  20. TES 5/SR 8.53 Ca mucinosum TES 3/SR 5.11 Ca mucinosum

  21. TES 4 / SR 29.75 Malignant tumor

  22. TES 5 / SR 19.40 Malignant tumor

  23. “BGR” artefact Cysta mammae

  24. CONCLUSION � The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses, but combination of sonography and TES had better diagnostic performance. � Sonoelastography has demonstrated to be a promising, complementary, noninvasive technique to detect and evaluate breast lesions, and could potentially reduce the number of unnecessary biopsies. � ……But it needs optimizations in technique, “cut off” values, coding system, analyzing the effect of depth of the lesion and other parameters that can make influence to elastography exam, etc…

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