Use of Ultrasound Elastography in Characterization of Solid Breast Lesions

Purpose: To study the role of strain ultrasound elastography in diagnosis of solid breast lesions, and evaluate its capability in differentiating benign from malignant lesions, in comparison to histopathological diagnosis taken as the reference standard. Patients and Methods: A total of eligible 28 female patients with solid breast masses, were subjected in our prospective study; sampled in a simple random manner. All patients underwent history taking, physical examination, conventional B-mode ultrasound examination which was evaluated according to the BIRADS (Breast Imaging Reporting and Data System) categories, and then subjected to ultrasound Elastography (Smart detect; S-detect and Elastoscan) in the same session which were evaluated according toTsukuba elasticity score and the Strain Ratio (SR) method. All patients with breast lesions were biopsied by US guided interventional procedures using true cut needle biopsy or Fine Needle Aspiration Cytology (FNAC) or undergo surgical biopsy. Data from elasticity scoring and the strain ratios were compared with the histopathological diagnoses. Results: It was found that conventional B-mode ultrasound examination and the Tsukuba color scoring system had the same sensitivity of 80%, specificity of 94.4% and accuracy of 89.3%. While, S-detect turned out to have sensitivity of 80%, specificity of 83.3% and accuracy of 82.1%. The addition of strain ratio parameter for evaluating the elastography images showed the highest sensitivity, specificity and accuracy (90%, 94.4% and 92.8% respectively) in differentiating benign from malignant breast lesions with the best SR cutoff point of 2. Conclusion: Ultrasound elastography of the breast masses is a non invasive and easy procedure with high diagnostic performance which can be easily integrated with the B-mode ultrasound examination in the same session and improves its specificity in differentiation between benign and malignant breast lesions, also it has proven benefit in minimizing the number of unnecessary biopsies.