TY - JOUR
T1 - Shear-wave elastography improves the specificity of breast US
T2 - The BE1 multinational study of 939 masses
AU - Berg, Wendie A.
AU - Cosgrove, David O.
AU - Doré, Caroline J.
AU - Schäfer, Fritz K.W.
AU - Svensson, William E.
AU - Hooley, Regina J.
AU - Ohlinger, Ralf
AU - Mendelson, Ellen B.
AU - Balu-Maestro, Catherine
AU - Locatelli, Martina
AU - Tourasse, Christophe
AU - Cavanaugh, Barbara C.
AU - Juhan, Valérie
AU - Stavros, A. Thomas
AU - Tardivon, Anne
AU - Gay, Joel
AU - Henry, Jean Pierre
AU - Cohen-Bacrie, Claude
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/2
Y1 - 2012/2
N2 - Purpose: To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses. Materials and Methods: From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-tofat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined. Results: Median participant age was 50 years; 289 of 939(30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303(2.6%) BI-RADS category 3 masses, 18 of 193(9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57(74%) category 4c lesions, and 180 of 187(96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specifi city improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962(P =.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC. Conclusion: Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.
AB - Purpose: To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses. Materials and Methods: From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-tofat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined. Results: Median participant age was 50 years; 289 of 939(30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303(2.6%) BI-RADS category 3 masses, 18 of 193(9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57(74%) category 4c lesions, and 180 of 187(96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specifi city improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962(P =.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC. Conclusion: Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.
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U2 - 10.1148/radiol.11110640
DO - 10.1148/radiol.11110640
M3 - Article
C2 - 22282182
AN - SCOPUS:84857410377
VL - 262
SP - 435
EP - 449
JO - Radiology
JF - Radiology
SN - 0033-8419
IS - 2
ER -