Diagnostic Value of Elastography, Strain Ratio, and Elasticity to B-Mode Ratio and Color Doppler Ultrasonography in Breast Lesions

Abstract

Mahnaz Ranjkesh,1,2 Farid Hajibonabi,2– 4 Fatemeh Seifar,5 Mohammad Kazem Tarzamni,1,2 Behzad Moradi,1,2 Zhila Khamnian6 1Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran; 2Radiology Department, Tabriz University of Medical Sciences, Tabriz, Iran; 3Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; 4Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; 5Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 6Social Determinant of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Zhila Khamnian Email [email protected]: The aim of this study was to investigate the sensitivity, specificity, and diagnostic accuracy of sonoelastography (SE), strain ratio (SR), elasticity to B-mode (E/B) ratio, and color Doppler ultrasonography (US) in suspected breast lesions.Materials and Methods: This prospective study was conducted on women referred to Alzahra university hospital of Tabriz for annual screening of breast cancer between May 2017 and December 2018. B-mode US, SE, and color Doppler imaging were conducted in females with suspected mammography reports. The lesions in B-mode were classified according to the Breast Imaging Reporting and Data System (B-RADS). The results of SE imaging were graded based on five-grade SE score. SR and E/B ratio of each lesion were also analyzed in SE images. Color Doppler findings were categorized from 0 (no visible vessel) to 2 (> two vessels) based on the vascularity of the tumor. Pathology results were used as the gold standard to measure the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and diagnostic accuracy of each modality.Results: One-hundred and ten breast lesions of 104 women aged 42.05± 10.33 years were included in the study. Seventy-seven of the lesions were benign and 3 were malignant. Sensitivity and specificity of 97.0% and 77.9% for B-mode US, 93.9% and 87.0% for SE score, 81.8% and 66.2% for color Doppler US, 72.7% and 77.6% for E/B ratio (cutoff: 1.05), and 77.3% and 79.6% for SR (cutoff: 1.90) were obtained, respectively. Addition of SE score to B-mode US increased the sensitivity to 93.9%, specificity to 93.5%, and AUC from 0.95 to 0.97. Cumulative color Doppler US with B-mode US did not enhance the diagnostic accuracy of B-mode US.Conclusion: SE was more effective than color Doppler US for distinguishing malignant from benign breast lesion. Among the three different SE features, five-grade SE score was superior to E/B ratio and SR.Keywords: breast cancer, elastography, color Doppler sonography, strain ratio, B-mode ultrasonography

Keywords

• breast cancer
• elastography
• color doppler sonography
• strain ratio
• b-mode ultrasonography