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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

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Budapest, 2017.

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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

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“Triple assessment”

3. Biopsy 2. Imaging 1. Clinical breast exam

Overdiagnosed!?

ELASTOGRAPHY

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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.

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Ueno staging-Tsukuba score (TES) Elastography-quantitative evaluation

A B

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Objective

To detect diagnostic performance of the combined use

f 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

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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

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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.

Method

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Final pathological diagnosis

Nonproliferative lesions Proliferative lesions without atypia Proliferative lesions with atypia Malignant lesions

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BI RADS classification benign malignant total 2 5 5 9.1% 0.0% 3.9% 3 7 7 12.7% 0.0% 5.5% 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%

BI RADS scores of benign and malignant breast lesions

Cut-off value benign vs. malignant 4

p<0.001

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Benign Malignant Total TES benigni/maligni TES 1, 2, 3 34 (92%) 3 37 TES 4, 5 21 70 (77%) 91 55 73 128

Pathological diagnosis Elasticity score TES 1 2 3 4 5 total benign 4 (7.3%) 7 (12.7%) 23 (41.8%) 13 (23.6%) 8 (14.5%) 55 malignant 1 (1.4%) 2 (2.7%) 14 (19.2%) 56 (76.7%) 73 total 128

p<0.001 Elasticity scores for benign and malignant lesions

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Elastography-TES

“cut-off” value benign/malignant– 4 Sensitiivity 95% and specificity 61.8% TES for benign lesions 3.25 TES for malignant lesions 4.71 p<0.001

AUC p CI 95% TES 0.866 < 0.001 0.797-0.934

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TES can predict certain type of benign lesions!

Xsr SD min Max median Nonproliferative lesions 3.25 1.09 1 5 3 Proliferative lesions without atypia 3.06 0.80 2 4 3 Proliferative lesions with atypia 4 4 4 4

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“cut-off” value - 4.27 Sensitivity 97,3%, Specificity 55.6%

Benign lesions 9 Malignant lesions 24 p<0.001

Elastography - SR

AUC p CI 95% SR 0.820 < 0.001 0.742-0.898

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ROC curve for TES and SR

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

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ROC curve for B-mode ultrasound and TES

AUC p CI 95% TES 0.866 < 0.001 0.797-0.934 US 0.905 0.853-0.958 TES and US 0.949 0.912-0.987

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TES 1 LIPOMA

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TES 2 Cysta mammae

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Fibroadenoma TES 3 SR 2.54

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

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TES 4 / SR 29.75 Malignant tumor

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TES 5 / SR 19.40 Malignant tumor

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“BGR” artefact Cysta mammae

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The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses, but combination

f 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…

CONCLUSION

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