Comparision of mammography, ultrasonography and ultrasound elastography in the differentiation of breast lesions

[M. R. Radović]

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Radiologija - Radiology

UVOD: U otkrivanju i razlikovanju lezija u dojkama se primenjuje klinički pregled, radiološka dijagnostika, uglavnom mamografija i ultrasonografija i patohistološka dijagnostika. Ograničenja palpacije, mamografije i ultrazvuka i potreba da se ne previdi rani karcinom dojke, doveli su do povećanja broja biopsija, koje se najčešće izvode zbog benignih lezija. Stoga je razvijena elastografija, kao nova, komplementarna, neinvazivna tehnika, koja direktno otkriva elastične karakteristike tkiva dojke, koja se razlikuju po tvrdoći, pa invazivni karcinom ima najnižu elastičnost, a potom neinvazivni karcinom, fibrozno tkivo dojke, normalno glandularno tkivo, potom masno tkivo dojke i to ovim redom. Elastografska evaluacija se vrši kvalitativno (Tsukuba elastični skor, TES) i semikvantitativno (odnosom kompresibilnosti masti i lezije, FLR, SR). CILJ RADA: Cilj istraživanja je bio da se proceni da li elastografijom, kao novom metodom, mogu da se postignu bolji rezultati u detekciji i razlikovanju benignih i malignih lezija, u odnosu na konvencionalni ultrazvuk i mamografiju i da li kombinacija elastografije i ultrazvuka ili elastografije, ultrazvuka i mamografije može da poveća pouzdanost dijagnostike lezija u dojci. Takođe je cilj bio i da se utvrdi da li postoje neke kliničke osobine bolesnica koji mogu da utiču na ove dijagnostičke testove. MATERIJAL I METODE: Istraživanje je obavljeno u KBC „Bežanijska kosa“, u Beogradu kao jednogodišnja prospektivna studija preseka. Studija je obuhvatila ukupno 128 lezija kod 122 bolesnice (prosečne starosti 54 godine, raspona 21-84 godine) koje su dijagnostikovane kao benigne ili maligne, mamografijom i ultrazvukom i dalje analizirane elastografijom. Dijagnostički algoritam je uključivao i klinički pregled, kao prvi test. Mamografija i ultrazvuk su analizirani i kodirani po BI RADS klasifikaciji. Elastografija je određena Tsukuba elastičnim skorom (TES), sistemom od 5 kategorija i vrednošću odnosa kompresibilnosti masnog tkiva i lezije (SR, FLR). Dijagnostički rezultati su poređeni sa histopatološkim nalazom, kao standardom. Izračunati su senzitivnost, specifičnost, tačnost, pozitivna i negativna prediktivna vrednost i stepen lažno-pozitivnih i lažno-negativnih nalaza sa svaki modalitet. Primenili smo ROC analizu u proceni uloge elastografije i drugih modaliteta i njihovih kombinacija u dijagnosti lezija u dojkama...

INTRODUCTION: Detection and differentiation of brest lesions is performed by clinical examination, imaging methods, preferably mammography and sonography, and patohistological diagnostic. Limitations of palpation, mammography and sonography and the great need not to miss a malignant lesion in the early stage of disease lead to increased rate of aggressive biopsy, that are mostly performed for benign diseases. Therefore, elastography developed, as new, complementary, noninvasive method, which directly reveals soft tissue elasticity. Various breast tissues have different elastic stiffness, as invasive carcinoma having the lowest elasticity, followed by noninvasive carcinoma, fibrous tissue in the breast, normal glandular breast tissue, and breast fat tissue in that order. Elasticity assessment consists of qualitative (Tsukuba elasticity score, TES assessment) and semiquantitative evaluation (strain ratio between fat and lesion, FLR, SR). AIM: The goal of this study was to evaluate whether the method of elastography could improve the detection and differentiation of benign and malignant breast lesions compared with conventional sonography and mammography and whether the combination of elastography and sonography or elastography, sonography and mammography could improve the accuracy of diagnosis of breast lesions. Also, the goal was to determine potential influence of clinical characteristics to diagnostic methods. MATERIAL AND METHODS: The investigation was performed from February 2015. to April 2016, in Clinical Center „Bezanijska kosa“ in Belgrade as one year prospective study. Study included 128 lesion from 122 consecutive patients (men age, 54 years, range 21-84 years), that were diagnosed as benign or malignant by mammography and sonography and further analyzed with elastography. Diagnostic algorithm also included clinical breast examination, as first test. Mammography and sonography were analyzed and classified according to the BI RADS. Sonoelastography was determined by Tsukuba elasticity score (TES), with 5-point scoring method and calculation of strain ratio, fat to lesion ratio (SR, FLR). The diagnostic results were compared with histopathologic findings, as standard reference. The senzitivity, specificity, accuracy, positive and negative predictive values, and false-positive and –negative rates were calculated for each modality. We performed ROC analysis for assessment of the role of elastography and other modalities and their combination in diagnosis of breast lesions...

tumori dojke, mamografija, ultrazvuk dojki, sonoelastografija

breast masses, mammography, breast sonography, sonoelastography

618.19-006-07(043.3)

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